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>> Jeanan Yasiri: This is Entrepreneurship in Society. It is a course that's offered
through the University
of Wisconsin-Madison School of Human Ecology.
As we begin today, I'd like to I'm Jeanan Yasiri.
extend thanks to our partners in producing this course: the UW Office of Corporate Relations,
the UW College of Engineering for their technical support, and
financial support which is provided through the Ewing
Marion Kauffman Foundation
entrepreneurship. I'd also like to thank our media They are committed to advancing academic education in
partners in this course, Wisconsin Public Television and
their University Place crew for taping today's lecture. I'm quite pleased to introduce
that will be joining us. two special guests today
president of My Coverage Plan Inc., along with his colleague and executive director of ABC for Health and founder and
Erin McBride who is managing attorney for ABC for Health.
They will be talking with us
about both of those organizations and the social entrepreneurship ventures that
both organizations are running
in tandem. Bobby is a graduate of the UW Law School and as dedicated his
career to serving low income and
coverage and services. health disparity populations in obtaining and maintaining a connection to healthcare
benefits through advocacy and In 1994,counseling. ABC for In 2010, he founded My Coverage Plan Inc., an innovative
new technology firm to provide
consumers and providers an opportunity to connect and
coverage needs. Erin McBride is managing maximize all of their healthcare
advocacy as well as litigation attorney for ABC for Health and she engages in direct legal
on behalf of their clients. She is a frequent presenter on a number of very complex issues
as they relate to healthcare
benefits, including BadgerCare Plus. She earned her law degree from
the University of Iowa. This is an organization, ABC for
Health, Bobby and Erin that have become nationally known for
helping to turn traditional debt
collection programs into innovative health benefits
reduce bad debt and ultimately counseling programs that do
coverage. heI've asked Bobby and Erin toy coverage options but obtain and maintain their healthcare
how they interact as we start our conversations regarding comesocial entrepreneurship.ABC and about My Coverage Plan, and
Let's start[APPLAUSE]y Peterson.
Bobby Peterson: Thank you,
Jeanan. It's a pleasure to be here today to talk to you a little bit
about some of the entrepreneurial things we are doing at both ABC for Health
Anytime you talk about starting a business, be it a nonprofit or and My Coverage Plan, Inc.
to think about the beginning, the birth of an idea and the a for-profit business, you have to go back in time a little bit
time here to think about when these ideas started percolating in my mind, what I was working And we're going to go back in
Health and the way we developed that program of services, and then starting up on, the introduction of ABC for
which is technology company that My Coverage Plan Inc.,
actually grew out of a nonprofit organization. The potential of that company,
that the future of the company
and some of the directions we see it going in. So the birth of the idea
started, for me, back in law
school. I was a student here from 1984 to 1987.
Started law school without a
great idea of where I wanted to practice, what I wanted to practice, how was I going to
apply my legal knowledge and
skills. By the end of my first year, I applied for a clinical program
through an organization at that time called the Center for
Public Representation. They were offering a fellowship
that was in northern Wisconsin, northwest Wisconsin, and the
program was to help assess the needs of the rural uninsured.
Now, it doesn't sound much like a law school project, it sounds like maybe sociology, or
social sciences, but it was something I was interested in and I always felt people had social work or one of the
and services. So I signed up for the a right to healthcare coverages
project with another student. Our job was to walk the streets inof small towns, Turtle Lake,n Wisconsin, began working on this
Barron, talking to people who ran small businesses. We talked to people who ran Ahospitals and clinics, and wee,
also talked to people that had
been sued for medical debt. And that should give you a clue, that's probably some of the
conversations that I had that gave me the idea. The idea was, at that time, after we completed the research
and we identified a number
of people that had been sued for medical debt for programs or for coverage that they didn't
know existed. So they didn't know they could
They didn't know about programs for their children with challedisabilities.urance They didn't realize the timing
issues for applying for benefits. And at that time during my
more and more about, well, internship, I began thinking
couldn't we help these people get coverage, get services and then providers would get paid.
In a way I thought, you know, it was a win-win situation. Well, I started job hunting and my idea as I talked to law firms
at that time was the win-win
proposition. I'd go to firms that practiced
well, I have a thought that if health law and I would say,
your firm worked with hospitals, helped their patients secure
companies paid what they were supposed to, held government coverage, made sure insurance
applications and programs, programs accountable, made sure that the timing was right on
there's a lot of money at play in the healthcare system. It's one-fifth of our economy.
When that starts to go south and
the programs aren't aligned correctly, a lot of money is left on the table.
Well, my pitch didn't work
because I got blank looks like what are you talking about. Mr. Peterson, we do mergers and
acquisitions of large healthcare
providers. Are you interested in that? I said no thank you.
Not what I'm interested in. So I did what most, well not
most, some headstrong people like me would do,
and I just said forget it.
I'm going to buy a one-way ticket to Europe. Decided to travel, to forget
about the law, and I spent
about people and living off the land, but ultimately a backpack and a tent and learning a tremendous amount
kind of hit a dead end, and I had to come back to Wisconsin. the dream of traveling around the world and writing novels
So my dad paid for my ticket back, which is a little bit of
humble pie for sure.
law jobs and came back to Madison and visited the Center working in a plant store. Thought about interviewing for
very excited when I got back and for Public Representation and talked to my old boss who was
said, Bobby, we applied for a grant based upon your research as a student and we're going to
be hiring a staff attorney to help people with health benefits
So I interviewed for the issues. I was like, sign me up.
position and I ultimately got hired as the staff attorney in 1988 after a year of being away
from law school and traveling and working in plant stores and a variety of manual labor jobs, began my job as staff attorney
at the Center for Public
people need help, providers need Representation. But the idea was still there. How can we turn situations where
to get paid, into a situation that has a better result for both?
So the birth of a family health benefits counseling idea became something that we really worked on.
It started off pretty crudely because there were no experts out there and still there are very few people really who have
a command of health benefits
across the spectrum from private insurance to public programs, medical debt issues,
charity care. It's not something that you learn in school.
And there's no way of really You really learn it on the job.
measuring and testing. In class you get your exam and
In this, someone lost $10,000, did you get an A, B, C or D.
they didn't get paid. Well, you flunked. Someone didn't sign up on their
application on the day they should have.
They were three days late, a $100,000 bill didn't get paid.
Those are the things that happen
the consumer sometimes. aSo we started working on thist pissue and our initial research the resulting debt that goes to
on health benefits counseling generated $10 in third party showed that every dollar spent
that if you help people and you're spending a dollar in salary and everything to help people work on benefits, connect
to benefits and get coverage, that dollar that you're investing in the salary and time
And we thought that was pretty of an individual brings in $10.
remarkable. We wrote it in some of our grant proposals, and we began writing
more grant proposals to further develop the concept.
own organization. So I moved from the Center for By 1994, I had developed enough skill and experience to start my
private nonprofit organization, and Jeanan described a little Pubit about what we do.nd There are some of the logos that
we've had over the years. At the very beginning we looked more like a daycare center than a public interest law firm.
But we've changed a little bit
since then, and we've definitely gotten a little bit more
and our strategies. We provide statewide services across all corners of Wisconsin. sophisticated in our approach
for healthcare providers so obviously what we know is very We've developed training models
So we've developed ways of important for providers and their staff to know.
teaching providers the tricks of the trade, the tips that they need to secure third party
reimbursements. We've developed management
better, and some of these I'll information systems and strategies to track information
talk a little bit more about as we get to the development of the My Coverage Plan company.
We know that ABC for Health has an important role to play.
caught in the maze. If you, family members, friends Hor relatives, everyone usually the sophistication, families are
who just got caught up in the maze of healthcare. They ended up with big bills. They ended up with unpaid bills.
They ended up with collection notices.
They ended up with compromised credit scores and trouble
because it's hard to figure it
out. And the system is not designed
When you have private insurance, in a way to be easy.
public insurance, school health programs, charity care programs, it just does take a lot.
All of these programs are governed by laws, rules and regulations.
law firm, and me as a lawyer, it's a nice fit. So that's why ABC for Health, a
And early on when I was making my pitch to law firms, it does
make sense for law firms to play
a more active role because they're the experts in making sure that the rules are followed
and that people are getting what
they're supposed to be getting in some situations like this. So the lawyers at ABC for Health
and benefits counselors work in tandem to help people through the system to make sure that
need, representing families at they get the services that they
to make sure they're complying hearings, sometimes in court, writing letters, demand letters sometimes to insurance companies
with a contract, make sure they're complying with
and now federal regulations related to healthcare reform government and state regulations
that are currently active to make sure people are getting
what they're supposed to be getting out of the system.
Brynne McBride. Erin will be up here a little In 2007, thatbit.hen we hired Erin McBride and her sister
presence. You probably don't recognize We established a new community
this picture but this is the old Mifflin Street co-op back in
about 1910 when it was a grocery
store. Here it is in the late '60s, the
paradise that it is. first sign of the hippie
awning blew off in the big wind storm, so we're getting a new awning in the next week or so. Maybe last week because our
close to looking today. And there's our famous mural on the side of the building. The old Mifflin Street co-op is
now a public interest law firm
coverage. And we still have a very strong mission rooted in the community. connect to healthcare and
between the management of the old Mifflin co-op to ABC for Health. And we had a really nice segue
they were all very happy and And it was a nice hand off and
proud to be transitioning it over to ABC for Health, and we're proud to carry on that
legacy. We had to renovate the office.
There's me signing the paperwork to buy the office.
Here's what it looked like
empty. There's where we're starting to build it out.
That's kind of the mess in the
back. You can see in the very back corner it says "food for the
revolution" and some of that
graffiti we left back in the back room.
There's a doorway that cut It's still on the wall.
through it a little bit. There's the multitasking
And one of our staff working in the bathroom. And there it is today. executive director.
into a public interest law firm and right now we're working on a So we transformed the old co-op
variety of projects. Erin McBride is going to tell
you a little bit more about how we translated the idea of helping patients and working
more of a business model with ABC for Health. Erin. >> Erin McBride: Thanks, Bobby.
Hi, everyone. One of the ventures that we wanted to talk about, one of the
was this partnership that we examples of ABC in the community
because it kind of carries on the theme that Bobby was talking Hospital. And we're excited about this
about. It's a win-win situation.
But the question is, who really wins when you put lawyers in a
lawyers in a hospital other than hospital? And it's hard to think of
malpractice or something going horribly wrong. I don't think you would picture
lawyers in a hospital as being
preempting problems. And you certainly wouldn't
neonatal intensive care, holding picture an attorney sitting in
a baby, talking to a mom, but that should be the image of ABC in the hospital.
In fact, that's what we do. So what we've done since 2005 is
gone into the hospital, actually go into patient rooms, and so we
have attorneys, we have health
benefits advocates, we have health benefits counselors, we have students, we have
volunteers, and they're all trained as health benefits
of health insurance so they know counselors. They're all trained in the rules
how to help people get, how to help people use and help people keep their insurance
or their coverage.
And so it's a nice way to kind of get into where people need help the most.
Catch them where they are.
And so we go into the hospital, we talk to a mom about getting coverage for her baby.
Or maybe she has a baby in
neonatal intensive care and so the baby has special needs or is going to have some
pretty high bills.
we're really trying to do is We talk about preempting debt for age 0-1, 1-3, 3-6, 6-9. We can map it out because what
The hospital wins because now we connect patients to services. And accidentally, everybody wins.
have health insurance to pay the bill. The patient wins because health
insurance is paying their bill, they're not paying out of pocket. ABC wins because on some level
we're getting a small reimbursement for our time, but we're, on a bigger scale, fulfilling the mission of ABC in
connecting children to
healthcare. And I think insured people and other people at the hospital and
community members benefit because if people go to the hospital and they're not
bill? It gets shifted onto insured insured, who actually pays the
individuals. There's this cost shifting that
goes on.
There's a reason Tylenol is $17 a piece in the hospital. There's a reason
a Band-Aid is $15.
It's because all of the expenses get shifted onto people who can pay.
So what we try to do is identify
who doesn't have coverage. So our work in 2005 started with
We started with nonqualified the very small group of people.
And we tried to identify what were some emergency resources we speaking who were pregnant. So we started small.
could hook people up to. And then pregnant women, now we
have a baby, so then we started doing coverage for children.
And now we do anyone who's uninsured but we also do people
who are underinsured. Maybe their insurance is not
paying for everything. Maybe they got ridered out of a
certain condition.
Maybe their bill only provides certain services. But it's a nice expansion to a
lot of people who either don't
don't know. They may have had coverage but underinsured, and there's there's a segment of people who
they fell off. They missed a review or their
insurance company canceled them and they didn't know. They didn't get a notice. And now you can see where having
some legal backup would be
really important. What went wrong? How can we make sure that things
get fixed?
So to have this whole spectrum is really a beneficial source for the hospital.
They now have someone who can help figure out the coverage
because doctors aren't trained in this and billing staff aren't
trained in this.
They're trained on how to bill insurance and how to collect on the bill.
They're not trained on how to navigate these different avenues
can be a little step removed and and navigate these resources. So it's nice to have someone who
find out what's actually going on. If patients don't pay their
bills, they either get sent to
collections or in some cases the hospital will help them waive the bill.
They'll get charity care. So we like to say what we do
at something like St. Mary's Hospital and now at Meriter
Hospital, we do smart charity care. We save the kindness of the hospital and the hospital's
obligation to help people who are low income. We save that for people who absolutely have no option.
And then we help everybody who
does have an option. We figure out what that option
And so it's nice to see that it actually has a benefit to hospital or they wouldn't be is.
And what's the benefit? Well, since we started at St. Mary's, it's $23 million doing this.
hospital just by making sure that we've collected for the
coverage was either acquired or paid for the claims like it
So we keep really close track just to make sure that people are held accountable. Insurance is held accountable,
the patient is held accountable and the hospital is.
And so I guess everybody wins. So it's a nice system.
And what I like is that there's a very tangible way of measuring--
A very tangible way of measuring And there's the co-op--
what's going on. One, we see the outcomes. We see that the patient is not
turned away from the hospital.
We see that the patient can go back and can go back and can go to this specialist and can go to
that specialist because we're making sure we get insurance
that they need and that covers their medical condition.
So the outcome to the patient is
so that's why we have some of tthe charts here. But the outcome to the hospital is extremely measurable too, and
How much are we actually securing for the hospital?
And it's breathtaking when you
think why doesn't every hospital do this.
There's the possibility that And so there is an option.
hospitals could put folks in their hospital to help connect
Or patients to private patients to services.
insurance. Or to help troubleshoot some
You remember insurance policies are a contract and so a doctor private insurance denials.
an attorney probably is. probably isn't equipped to negotiate a contract,
So connecting patients to attorneys to help negotiate this results in some big, big spend
down. So right now we're at about,
gaining for St. Mary's hospital. we're averaging now about $6 million a year is what we're
And that's just counting the first time we see the patient.
bills. We're not counting any other
talks about MCP, keep in mind what if every hospital did this. hospital and I think it's something that as, as Bobby
Is there a way to get people like ABC in every single
hospital just to see what would that mean in terms of patient coverage but what would it mean in terms of finances for the
hospital too. So I'll hand it back over to
Peterson: You can see on the chart the year Bobthat Erin started is 2007.th the MCP idea.
shooting up. That's when things started
So congratulations to Erin and Brynne for all their help in
really well at St. Mary's and it's a model program. St. Mary's is great gettingto work with. running
They have a tremendous mission
and they fully understand their mission to the community and service, and this is an
opportunity to us to help them
provide help to even more people because we're finding resources for those that have other
options.
So let's talk about MCP. Well, first, ABC for Health, if you look at the logo, there's a
green block, a red block, and a blue black, and that was done by
with a new logo because we have some organizations that are part design. Back in about 2004 we came up
of ABC for Health. We have ABC for Rural Health and
Mike Rust is our chief operating
officer up in Balsam Lake. HealthWatch Wisconsin is still a
separate organization that, as project but is emerging as a
we should have a forum to do we learn about all these issues in the trenches, as we're providing casework to people,
that. MCP, which I'm excited to talk policy work and HealthWatch Wisconsin is the vehicle for
to you about, is our new technology company.
And you can see from the logo,
we've incorporated colors from ABC for Health and we've nested our company in the cloud.
And we've got the rainbow which signifies the pot of gold, and
that will choose to use it there is a pot of gold at the end of that rainbow for people
because we believe it will have a significant financial impact on healthcare providers that
choose to use this system.
Now, how did this idea come from the original idea that I had
If you think about back as a law student?
entrepreneurship, people that are entrepreneurs are always kind of thinking and scheming
and dreaming, and I guess I fall
the next level. into What's the next step? it's alwWhat's the next system? my What's the next way we can beo
more efficient and effective? Back in about 2005 I was in a meeting with colleagues and we
youth with special healthcare needs, and they were talking were working on children and
about developing service coordination plans and how they
would coordinate services for children and I'm sitting in this
That's where the real money is meeting thinking but you got to coordinate the coverage.
and that's where people fall off the table, and a light bulb just
a healthcare coverage plan. And My Coverage Plan really grew went on and I thought developing
out of that. It was the idea that there was a
big growth in electronic medical
records and your medical records were a big part of the news and everybody was thinking about how
do we digitize our medical
records, and I thought, well, but if we could think about ways to track people's healthcare
coverage, develop a healthcare
coverage record and automate that system in a way that providers could use it.
Then we wouldn't have to send ABC for Health staff
to St. Mary's, to Meriter, to 20, 30, 40, 50, 60,
hundreds of other hospitals.
way of that would be helpful to them and also helpful to a new that they could use to help their patients in a systematic
company. So we began applying for grants.
And if you're thinking about
becoming an entrepreneur and you've got lots of great ideas, just get ready to get smacked in
the face at least a dozen times because we did. I wrote grant proposals to the
HRSA, AHRQ, NSF, dozens of National Institutes of Health,
agencies and people kind of gave me the same blank look that that
for the firm to do mergers and lawyer that was recruiting me
acquisitions did when I was trying to pitch my idea. Didn't understand what a
healthcare coverage plan was. Didn't understand what
migrate a for-profit company and ABC for Health was doing. Didn't understand how we could
develop a software as a service product out of this. So it took us a long time.
We got a lot of very strange
responses back from reviewers. We were probably on the verge of
One of our board members said this is it, you've really got to stop. quitting.
for you. This isn't a good direction
It's just taking too much out of you.
grant application and around Well, we wrote that one last
December of 2009 we got word that we had made the cut and
And by 2010 we were funded. And it was a very significant grant through the NIH. that we were being reviewed.
to $1.6 million to develop It was up to five years and up
the company and to develop the technology. So we really hit a home run but
it was not an overnight success by any means. Remember, the original idea was 20 years earlier or 25 years
earlier.
So what is MCP? BYou think about technology and to start building the new company.
to reservations in a hotel, finding a rental car, there's a thlot of tools that are usedy but from booking airline tickets
assist you in your decision making process. Decision support. Do I want four rooms or do I
want a four-door or a two-door
car? Do I want four-wheel drive? There's a lot of ways for you to
go through the system and for your decisions to be supported
in that process. Healthcare really has very
little to offer in that regard. My Coverage Plan Inc. is a database, web application
process to take you through a series of questions and, as you answer those questions, the coverage that might be right for
you is better identified. It's a tool that we've been using since probably for the
was the classic garage built last 10 years a tool like this
grants. aWe've really tuned it up since used for just recording information and reporting to
then and created a tool that will help take people through
systems, again, with the
ultimate goal of helping patients get coverage and for the providers to get reimbursed.
Here's what it looks like in a
prototype phase. So this would be your screen
We're thinking of My Coverage Plan really as a suite of tools. shot as you enter the system.
opportunities of what do you It's not just going to be one process but a suite of
need. You'll see the one button is a benefit screening tool.
Okay, you can see on the screen the new benefits screening. That would take people through
The knowledge and training the whole interview process.
separate funding on this, but really because the information This is really the latest development, and we've sought
is so complex. People have said to me, Bobby,
this really is rocket science when you have to understood private health insurance rules, the social security rules,
Medicaid rules, medical debt
Well, if you've been doing it for 25 years like I have, I have requirements. A lot to know.
a pretty good ability to work my way through those rules because
I've spent my whole career
immersing myself in this. But if you're just starting out, a knowledge and training portal
will help you dial into those specific areas that you need a
sheet or get to the source tutorial on, extra help on, maybe a quick video or a fact
documents of what the rules and regulations are. So the knowledge and training
portal helps get you to the information but also a part of
We're not going to make everybody into an expert this is what knowledge level do you need.
Maybe you're working at a healthcare organization and you do some of the initial patient experience.
What's the knowledge that you need? So part of our knowledge and interviews.
your knowledge and to help you training portal is to assess
build skills based upon that assessment. So what do you need to know
about private insurance?
What do you need to know about Medicaid and BadgerCare?
the charity care policies and rules? What do you need to know about
That will allow us then to identify specific training that
meets the skills that are required as a part of your job
the basic information that you and doesn't maybe take you to the expert level but gets you
need to know to help families at an initial level or to pass it
level of expertise. We also are incorporating a very on to people that have a higher
significant resources database which will help identify a
variety of other community-based
resources that may not be health resources but other community resources that some of the
patients may need and require.
is our benefit screening tool So, for My Coverage Plan.on a The benefit screening process The main tstarts out.d right now
Here we have Kitty Kitterson. We have to enter her birthday.
We'll indicate that she is a US citizen and that she is not Is she a qdisabled.immigrant? We'll get basic information.
It will start assembling the
client record as with enter this information into the tools. We have a section down on the
corner which is alerts down here. You'll see later that at certain
know that there are key dates that we have to be aware of, and points during the process we'll
the system will alert us to make sure that we're intervening with
the client appropriately in a timely manner so that we get an application in when we need to
recertification, that's a tool or a reapplication, a
available. that we've integrated into this to make sure we're maximizing all the benefits that are
It's easy, how much to you make? We have to indicate household income. And that's tricky.
But when you get into sometimes, and for students, you know, how much do you make during the
school? How much do you make in the summer? It depends.
Did I get that construction job for the summer or am I just stacking hay in the barn for the
can't find anything else? Am I flipping burgers or did I farmer down the road because I
get a good job down at the factory that's paying me $15 an
hour? It depends. And so your income can fluctuate
For families and for a from month to month.
healthcare program that's huge. If your income is high one month and low the next month we're
going to say get in in the next month and let's see if we can get you coverage at least for a short period of time.
You get laid off. Your income goes down.
Well, that's the time you need help with healthcare coverage so
we're going to be looking at
as the federal poverty limit your income, what the timing is for that income, and we'll be able to calculate what's known
from it. And that's the tool that most government programs use to gauge
your eligibility. And it's going to be based on your income and your family size.
Family income is also important.
This is changing too. It's something that we have to keep an eye on because it's mom,
dad, and whatever kids are in the family. Also, you see the little baby here, it does count the fetus as
part of the family size.
The programs that we work with here in Wisconsin if you have twins, that means it's mom, dad,
and twins, that's a family size of four when you're applying for
BadgerCare Plus. So it's very important for us to
know that information, the
client income, as well as the family income. So when we look at this
situation and the computer
behind the scenes, the logic that's behind it and the
will tell us it's a household of algorithms that we've built in
three. Annual household incomes
a federal poverty limit, which of $46,404 and that equals
we call FPL, percentage of 250%. So we kind of know the lay of the land then.
Here's the family size. Here's what their income is.
Here's what their FPL calculates out to.
Then we'll be able to look at some of the programs. The computer will search through
programs that fit those parameters for that family. And here we see BadgerCare Plus Benchmark Plan might be an
option for that family. We'll be looking at application dates, dates that they may have medical bills.
There are certain rules that
relate to when you apply. You have to apply during the month when you have had services
in order to get them paid.
So if you're eligible during that month, the end of the month
very busy time. Last day of the month we're scrambling around to make sure at ABC for Health is always a
or have contacted us during that any clients that we've talked to
time period we're really working to make sure we get them their
registration application in, so that we can help them with their applications in, or at least a
client record that gives us more programs and coverages. We have some information on our
about their finances and summarizes everything.
Barbara Stanwick as our client And you can see here we have
and it tells us a little more. And this is some of the information that is synthesized
into the health coverage plan record. For us, this is really important
become really important because in the same way that you want to and for other providers this can
an accident on spring break down have electronic medical records portable between, if you're in
in Florida, and your medical records are all up here in
for them to ship those down, it doesn't happen anymore. Now, for most providers that are Madison, Milwaukee, or Chicago,
records, those flow in the moving to electronic medical
information highway and they can get down to that hospital very
They can identify what your medical needs are, what your quickly.
medical diagnoses are, any problems that you might have,
any reactions to medications
that you've had in the past. But in the same way, your coverage information would be
very helpful for that to be there as well along with your electronic medical record.
coverage is, what insurance company you have or what People need to know what your
for, what were you eligible for in the past. government program you might be eligible for or are eligible
All of those are big pieces of information that can be used to
assess how is the hospital going
to get paid, how are we going to keep you from getting billed for
potentially, or what can we do a lot of extra services,
been thinking of ABC for Health to and My Coverage Plan Inc.now as services and technology that Oreally is built on the publics
health model of prevention. The more we know, the earlier,
that we know it, we can help you avoid and prevent medical debt
situations and issues related to
not getting services because you don't have coverage.
types of programs and make sure that we develop the coverage So we can work a lot on these
plan in a way that keeps the providers informed about your
coverage opportunities and you
as well. You can see here, as I pointed
know, right in the middle of the to a couple of the alerts, we
So if there's an advocate scworking with this family, wen this date BadgerCare Plus renewal has to occur.
know that they will get an alert saying that the family has to be
renewed by this date so a month prior to that they'll get a notice to contact the family and
care of. say let's get that renewal taken
Another note in here, Birth to Three ends. It's a program for kids with
developmental disabilities from birth up to age three.
So when they turn three, the program ends and they should be
transitioning to certain early
We want families to be able to childhood programs. Again, it's nice to know that ahead of time.
they're going to the therapist be ready for these coverage transitions so that they're not caught off-guard and suddenly
and saying your birth to three coverage is over, here's your bill for $500.
That catches people off-guard and people are focusing their energies on their families and
financing and reimbursement stuff, it is complicated and it does take a back seat. on their children, and the
strategies to help them focus their attention on their So if we can develop tools and
families and their kids, I think we're doing
quite a good service. So we've been on quite a ride.
This is the scenario of My Coverage Plan in the first year.
In March, we started the
company, of 2010. It is a for-profit subsidiary of ABC for Health.
We work with the National Institutes of Health on getting all the paperwork squared away
our lawyers, accountants, to and getting it structured with
We worked with a variety of venders through the summer and company in the correct way. We started building new tools.
different build strategies for the technology because, for
those of you that have worked on
technology or databases, there's a lot of different ways to build
And we've worked and this.
experimented with a number of different strategies on how to do it, and we're settling in on
a couple ideas right now, but part of our first year was
tool. And we're continuing that rthrough June of this yeare dbecause the initial phase onee
grant concludes in June of 2012.
We've designed our logo. We've built up a pretty good
tools. reservoir of business plan
We have a foresight analysis that was conducted with the NIH in January of 2011 which really
gave us confidence in our idea. So these were outside venders that came in, interviewed me, looked at our technology,
compared it to other
This one really could go technologies that are out there in the field and basically said this one has a lot of potential.
somewhere. Here's what you probably need to
intellectual property, making sure that you've got the niche do making sure you secure your
I think the strength that we in the market correctly between different venders.
bring to this and other people who we've worked with in the
this is a company that has past have noted this is, is that
started in a little different way than most. Most of the start-ups that you
hear about are a lot of times people that have been in the
private sector for a while and then they start a new business.
There's not a lot of
entrepreneurship that emerges from the nonprofit sector. And I don't think it has to be
that way. I think there are a lot of very creative, talented people in the
think about those opportunities. nonprofit world, they just don't
I don't think they've been given the opportunity to translate
doing that effective in communities, in the social their ideas of what they're
service sector and translating it into business ideas and
models. And we feel very fortunate at ABC for Health that we have this
way to go yet. opportunity, and we do have a
company, but I think we're on a My Costrong path.Inc. is a long which from becoming a successful, commercially viable
We've been involved in several national SBIR meetings.
SBIR is the funding, Small
Business Innovative Research program.
It's always under threat so we're always waiting for the It's federal funding.
plug to be pulled. But in some ways it's foolish to
think about pulling the plug on a program that is developing
business and future jobs. And the SBIR program is one of technologies and jobs and opportunities for future
So it has pretty strong bipartisan support at Capitol the strongestHill.creators that the But you never know.has.
They do crazy things up there so
hopeful that it will continue we jfor the next few years. the We've done some other analysis hanging in there, but we're
Analysis. That was a free analysis that was done with ABC for Health, I'm sorry, with My Coverage Plan
Inc, and they also gave us some very promising information about
the company. The growth potential on one side
of it was listed as high as $8 billion because of the concentration of resources in this country spent on
healthcare. We don't think we're going to get to that point, but it shows you the potential of what we're
doing and how much of an impact we can have on healthcare coverage and financing if you do
Remember, now, just on a smaller it correctly.
scale at St. Mary's, we're dealing with one hospital that's
And we're still really not fully over $6 million a year.
engaged there yet. We're still exploring new ways
hospital, to reach people earlier on and execute even better in terms of helping to extend further into the
If you take that across many patients.
hospitals, community based organizations, federally
clinics, there's tremendous opportunity and potential tools that we're developing. qualified health centers,
end users. We can think about different
community that want to have their home version of their healthcare coverage plan. So a version that consumers
could use to track family healthcare coverage for themselves and their families.
issue until it becomes a big For some people it's not a big
issue. You think we're healthy, we're
Someone gets in an accident, okay.
autism in the family, those can really create a lot of tremors child develops special health care needs, there's a child with
the right path to take is overwhelming. And tools like My Coverage Plan worldcan be very helpful.e out
I said that in June of this year
we'll be going to our phase two, and that's got to be approved yet, but we've submitted all the
paperwork and our application to
take My Coverage Plan to the next level of a phase two process and that will be our
commercialization phase.
and strategies to actually So we're actually going to be moving from sort of the laboratory and testing processes
deploying it with some other customers.
lined up to actually show them So we've got potential customers
how to use the tool and to provide services to their patients and obviously
ABC for Health is going to be one of My Coverage Plan Inc.'s
customers and our services at St. Mary's Hospital.
We're looking at new tools, and again, as I told you, I'm always
thinking about new ways of doing things, new ways of developing
strategies, helping people, and I think, in some ways I'm hoping
that My Coverage Plan is going to grow into a company that can
really fully support the mission
of ABC for Health, and one thing as the executive director for ABC for Health you have to do a
lot of is write grants, and it
would sure be nice if My Coverage Plan replaced a lot of those grants with a funding
stream that could support the nonprofit mission of ABC for
something that we've been working on, we've been working Health into the future. That's the hope and it's
we go to the commercialization hard on, and we hope that through the course of 2012 when
phase, we see some results and some successful outcomes. Here's information on both
organizations.
My Coverage Plan has its own separate suite now in the Mifflin Street co-op.
So we're up on the second floor in the old business office of the co-op, and that's where my
I spend close to 60% of my time on the new company, and I still work with ABC for Health the office is.
So I'm split a little bit, but other 40% of the time.
I'm working more and more on My Coverage Plan issues and developing that organization and
business and working to see that
it becomes successful, and hopefully, that idea I had way
emerges into something that will back when I was a student
questions and some interaction. lasPeople have thoughts andhe future. We've got some time for some
might want to ask. questions, Jeanan asked me to save some time for anything you
>> Thanks for that, Bobby, and the students know to put their
I'm going to offer, just because hands up as they have questions.
this is a slightly different concept from that which we've been discussing this semester,
don't be afraid to ask questions
hardly intuitive. It's not something that you just concept to you as well. Health benefits counseling is
background in it. So if there are aspects of some of what ABC is doing or what My Coverage Plan hopes to intend
that you don't understand, feel free to ask that as well. I'm going to start off by asking, so My Coverage Plan,
who will you sell it to?
>> Well, initially, it's going to be looking at providers. So hospitals are our primary
organizations that we'd want to sell the tool to. It's going to be cloud based
hospitals could log into our so it would be something that
system, develop confidential and secure information. We will be fully HIPAA
compliant, HL7 compliant so that
hospitals can use this system and it will be interoperable with their electronic medical
records to help assess what coverage opportunities are
health benefits counseling isn't available for their patients. Jeanan asked the question like
really intuitive and I can understand where that comes from
10 people, there's two that could really use some health because maybe out of a room of
benefits counseling services because they're having
encounters with the healthcare
system. If you're healthy and you're not going to the doctor and you're
not going to the hospital a lot,
you may not need a lot of health benefits counseling.
I said, to avoid the problem You probably should have it, as
later, but if you have someone in your household that has a
medical bills that keep showing up and you're not sure why, if disability, if you have some
you think should be, if you get laid off and you're wondering how am I going to be able to covered by your insurance that
should I be thinking about a afford my health insurance or
program like BadgerCare Plus that's there as part of the safety net to help, that's when
you're going to need health benefits counseling to sit down and assess your benefits, your
the rules are applied correctly for you. coverage, and how to make sure
go to the insurance company or Because what we found is that many times you, on your own, you
the government bureaucracy that's there to help you, you get the wrong information.
It changes quickly and you can
get the wrong information, and then you're one of those
back when in Polk County that got sued for a $7,000 medical bill. faAnd I'd be saying, well, itay
didn't have to happen.
I wish we could have talked to you earlier because I could have
for your child. We could have used a deductible because there's crowd out issues told you about BadgerCare Plus
We could have helped you get here.
these bills paid. But now it's too late. So health benefits counseling,
it's a service that integrates
aspects of law, social work, community organizing, people
counselors at ABC for Health that have been health benefits
have run the course from people that had degrees in geography, dancers, priests, reverends,
really, you've got to have the
answers that you're getting from tenacity and the intellectual curiosity to think about how do you get to yes from the no
the bureaucracy and the system because you dig hard enough and you work hard enough at it,
usually you can find it.
>> Question over here. >> Yes. >> Hi, my name is Hannah.
I was just curious, for you personally on a day-to-day
schedule normally look like? basis, are you mostly working with clients or what does your
>> That's a great question. I think it varies. But today is Wednesday so we had
our client case meeting.
Every Wednesday, every case that comes into the firm, new clients
or issues are all entered into that have called with questions
conference room and we summarize our old garage built database system. We project them in our
what the issue is. And so today was a big client day.
We talked about client cases and
I was very active involved in discussing all the new clients I didn't talk to any of those clients specifically myself, but
that come into the firm. On a day-to-day basis, there can
be a week that goes by where I
don't talk to one client. Erin can't say the same thing, but I can and a lot of the staff
that are at the front end of it are very, very active in talking
up to 2,500 requests to clients every day. We get over 2,000 requests and
for assistance each year at ABC for Health.
meeting so I'm hearing about I usually sit in on every case
them as they come in and I'm offering my insights and my thoughts.
And actually when we think about
you got to build the algorithms that sit behind, the if/then variables behind the computer, a
lot of those come from the case meeting because we're thinking
about what are our strategies, and we have our code writer
sitting in our case meeting with
us and converting a lot of the issues that we synthesize into
we can build it into our tool. the strategy into code so that
So that was a good question. Thanks. >> Hi, my name is Sarah.
I was wondering, so in an entrepreneurial service kind of industry that you're working
every day but not only just people but people in need, do you have a hard time separating withyour work life from yourple
personal life?
Do you find yourself sometimes getting too close to certain
Is that just kind of hard to cases?
separate? >> That's another very insightful question, and I think
it's something that we all have trouble from time to time.
some separation from your personal life and your work life And through experience and time you do learn to try and create
you have clients that die. because it can consume you. And it's not easy at times when
You have little kids that you're representing that don't get the services that you thought they
should. You have families that are going
through the heartbreak of kids that have serious, serious
illnesses.
We know that in our role as advocates we're doing as much as we possibly can to take that
burden off of the family and
absorb it ourselves. But we have to be careful that
process because we're not going to be able to help all the other we're not taken down in the
you have to be thinking about those issues and you have to clients that need our help. So you have to be thoughtful,
yourself a little bit because the emotional weight can be very give yourself some space to get away and kind of cleanse
heavy sometimes. >> Question back here.
Hi, I'm Amanda. I was wondering if you had one
case that's just stayed with you?
Well, there's a case that we've been working on since 2003, and it's a little boy who had autism and couldn't get
speech therapy. Went through the whole health benefits counseling process at
We started asking the insurance company, in this case this mom ABC for Health.
worked for American Family and they were insured by Cigna, and
we were really curious about why
the services weren't provided. There were some letters that we received from Cigna saying that
these speech therapy services weren't allowed, that they
weren't covered services, that they were based on tools that
Cigna had called clinical resource tools and benefit
staff attorney who's now on our board wrote a letter saying we'd resources tool. Well, back in 2003, another
provide them to us within 30 like to get copies of those tools, and you're required to
days or you're subject to fines of up to $110 a day. And we wrote letters.
He ended up moving back to Ohio at that time. I took over the case. I wrote four or five more
letters.
Our interns, because we have a lot of student interns that work
interns and both undergrad at ABC for Health and legal
interns that work with us. We wrote letters, we made phone calls.
It took us a year to finally get
one of the documents that we wanted. Finally, we had a hearing and
they granted benefits because they said we were right but they
didn't tell us why we were right.
We got the benefits for the little boy by 2005. We had the hearing, they didn't pay the bills until 2006.
We filed suit in federal court
information back. beIt was beyond the 30 days.e period in which they were supposed to be sending
In fact, it took 27 months before we finally got the
documents.
And remember, $110 a day penalty is the rule.
We took it to the Seventh Circuit Court in Chicago. We won. The insurance company appealed
to the Supreme Court. They lost.
We had a trial last summer, or the summer of 2010, We went back to the trial court here in Madison.
found to have breached the before Judge Crabb. And the insurance company was
fiduciary duty. But the penalties were way too low from what we felt they
should have been and the
attorney's fees were not what they should have been for a case that has taken this long.
So we appealed again to the Seventh Circuit.
So this is a case that started in 2003, we're still working on
it today, and it's up in the
Seventh Circuit again. The little boy is getting big now.
He's 12 years old.
He was two or three when we started. How old is he?
Nine or 10 maybe, or 11?
And the family is going through a very rough time. This is one of the clients that
we're very close to, and it's a single mom, boy with autism, and
trying to get what they should, trying to get what they deserve they'rout of the system. in a very difficult environment
The mom has had struggles finding a job. He's had struggles with school.
strongly to this day and it will And it's been very tough and so that one sticks with me very
for a long time I think. >> Hi, I'm Brett. You mentioned student interns
earlier, I was just wondering what kind of role undergrads
like us could play in this whole thing?
We have a lot of interns and
usually, the thing is this is not the kind of internship where you come and bring your homework
and do your homework at your
desk. This is one where we really work you pretty hard.
So you know that going in.
But you have a responsibility and you're part of the team. You're going to be working on
helping file organization,
getting materials together for meetings and trainings, making
And not everybody does it. client calls in some situations.
You have to have the right skill and aptitude and earn the trust of Erin, myself and others at
ABC for Health. But there's opportunities to do some limited client work, follow-up calls, research.
And then, like everybody else,
today is garbage day, so I'll be hauling probably trash cans out to the curb when I get back.
We all pitch in and try and do
as much as we can. But it's a variety of tasks.
wouldn't be here today without And the students are, we
the powerful student interns we've had over the last 17
They've been great and they do years.
tremendous work and service. >> I'm going to close with just kind of an overarching question
on the federal level. Is there a way to characterize
how the federal healthcare reform initiative will impact
what you're doing either with ABC or My Coverage Plan?
I like to focus on the >> I think both of them provide both threats and opportunities.
opportunities because more people will have coverage but it's more confusing.
People are going to need tools
like My Coverage Plan to help sort out information through the healthcare exchanges.
There's different levels of coverage through the exchanges. There's different criteria for
There's certain expansions in Medicaid and other cutbacks in Medicaid.
stewier, and a program like My Coverage Plan and services like ABC for Health that they provide are not going away
because of healthcare reform. >> Important to note. I know that all the students
Peterson and Erin McBride. join me in thanking Bobby
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