Investors — PCC

Investor Overview — Confidential

Every day, Medicare beneficiaries sit in a doctor's office or a pharmacy enrolled in the wrong plan — and the clinical data to identify that is already in the room, connected to nothing.

Patient Coverage Connect turns a provider's clinical data into a compliant, pre-qualified Medicare referral — delivered to a licensed advisor who already knows the patient's plan, medications, and the specific coverage question. PCC Direct works today from any browser, with any EHR or none at all. PCC Integrated automates detection across the full patient panel. The data was always there. Now it's captured.

"My providers send me their problem cases. All I do is solve their problems — and I accidentally make money all day."

— Scott Woods, Founder

PCC Integrated — Phase 2 vision: the advisor embedded in the patient portal

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‹ Insurance Summary Close

Coverage Overview

Humana Gold Plus H1036 / Medicare Advantage HMO

✓ Information from Humana. Prices may vary.

SubscriberRobert T. Hollis

Member IDH10360041882

⚠️

Formulary change. Eliquis moved to Tier 4. Now $180/fill vs. $8. Annual cost increase ~$2,064. No therapeutic equivalent.

💊Prescription Drug Coverage (Part D)

Levothyroxine 200mcg

Thyroid · 30-day supply

$8/fill

Tier 1

Apixaban (Eliquis) 5mg

Blood thinner · AFib

$180/fill

Tier 4 ↑

Allopurinol 300mg

Gout · 30-day supply

$8/fill

Tier 1

ℹ️

You may qualify for Extra Help with prescription costs. Ask your advisor.

Your Medicare Advisor

Jenny Woods

Rural Health Advisors

👨‍⚕️ Your Care Team Coverage

The Vision
The advisor's photo and a coverage review button embedded directly inside the patient's portal — MyChart, athenaOne, Oracle Health, and others. The agent relationship becomes part of the clinical record.

The Platform

Automatic. Before the appointment.
Before the crisis.

Patient Coverage Connect does not rely on clinical staff to recognize coverage problems. The platform identifies them automatically from the clinical record — a formulary change that took effect months ago, a diagnosis that qualifies for a better plan, an income indicator that triggers subsidy eligibility. Staff can act on what the system surfaces at the point of care. Or the system can surface the problem before the patient even arrives.

The system finds the gap — automatically

Clinical records already contain everything needed to know a patient is in the wrong plan. Patient Coverage Connect reads those records and surfaces coverage gaps automatically — before the appointment, before the formulary change hits the patient's wallet, before open enrollment closes without them acting.

The referral is built in seconds

When a referral is submitted — by staff or automatically — the clinical record is parsed instantly. Medications, diagnoses, current plan, income indicators where available in the record. The referral packet is built without manual data entry. Patient gives permission, documented with a timestamp.

The advisor arrives knowing

The Medicare advisor receives a complete clinical brief before making contact. No cold calling. No discovery. No wasted appointments. The advisor already knows the patient's medications, diagnoses, current plan, and exactly why they were referred.

Embedded in the patient portal

The advisor's photo and a coverage review button surface directly inside the patient's portal — MyChart, athenaOne, Oracle Health, and others. The patient can initiate a review from the waiting room. The agent relationship becomes part of the clinical record.

What makes this different

🏥

Clinically sourced

Referrals originate inside clinical workflows — physician offices and pharmacies. The highest-trust setting in healthcare.

⚡

First to know — automatically

The platform surfaces coverage gaps from clinical data before the patient receives a termination notice, before the formulary change hits, before open enrollment closes. Staff activation is one path. Automated detection is the other.

📋

Pre-qualified and fully briefed

The advisor receives medications, diagnoses, current plan, and the specific coverage question — before making contact. No other lead channel in Medicare distribution does this.

✓

Carrier-agnostic

Works across all Medicare plan types. Not tied to any carrier. The lead source that was always there — now captured.

The Problem

Providers are plagued by coverage problems they cannot solve.

Every clinical setting is confronted daily with coverage failures that slow care, harm outcomes, and burden staff. Providers try to connect patients to resources — Extra Help, better plans, subsidy programs — but the system is fragmented and unstreamlined. Most coverage problems leave the office unresolved. Until now.

💊

Patients rationing medications because their plan moved their drug to a higher tier

A formulary change the patient never understood is affecting their adherence — and the provider's outcomes scores. The clinical record shows exactly which patients face this. The system finds it automatically.

HEDIS: Medication Adherence — Statins, Diabetes, Hypertension

🏥

Specialists and facilities outside the plan network

The referral the physician just wrote may not be coverable. The patient won't find out until they receive a bill. Diagnosis codes in the clinical record identify who faces this — before the appointment.

STAR: Plan All-Cause Readmissions (3× weight, 2025)

📅

Patients approaching Medicare eligibility with no one to guide them

T-65 patients make expensive, irreversible decisions without guidance. They don't know where to turn or who to trust. The provider knows. Now there's a systematic answer.

STAR: Care for Older Adults

💰

Patients paying full drug costs when assistance programs could cover them

Pharmaceutical patient assistance programs and disease foundations can dramatically reduce or eliminate drug costs for qualifying patients. Providers try — but navigating dozens of programs is fragmented and time-consuming.

HEDIS: Medication Adherence — income-eligible population

📋

Chronic condition patients in the wrong plan type

A patient with diabetes or COPD may qualify for a Chronic Special Needs Plan with far better coverage. The diagnosis codes are in the record. Without this platform, they stay there.

HEDIS: Comprehensive Diabetes Care, Controlling Blood Pressure

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Plans terminating or leaving the service area

The patient learns this from you — because the letter they received meant nothing to them. They don't know where to turn or who to trust. Now there's a systematic answer.

STAR: Member Experience / CAHPS

How It Works

From clinical record to informed advisor
in seconds.

The platform works automatically from clinical data that already exists. When a gap is surfaced — automatically or by staff — the patient gives permission, documented with a timestamp. The advisor receives a complete clinical brief before making contact.

🔍

Gap identified

Platform surfaces coverage problem from clinical record — automatically, or when staff submits a referral

📋

Record parsed

Clinical record parsed instantly — medications, diagnoses, current plan, income indicators where available — no manual data entry

⚡

Advisor briefed

Medicare advisor receives a complete clinical brief before making contact — the highest-value lead ever delivered in Medicare distribution

✓

Patient helped

The advisor arrives knowing. The patient gets the right plan. The provider's coverage problem is resolved.

Market Opportunity

The lead source that was always there.
Now captured.

Why provider referrals are the best leads in Medicare — and always have been

Internet leads are bought, sold, and recycled. A clinical referral is warm, specific, trusted, and accompanied by a clinical brief no other channel can provide.

The patient has already identified a need in a setting they trust, with permission documented. The advisor arrives knowing the patient's medications, diagnoses, current plan, and the specific coverage question that triggered the referral.

Highest conversion rates of any Medicare lead type
Clinical brief eliminates discovery — advisor goes straight to solutions
Permission documented with timestamp
Advisor relationship begins with trust, not a cold call
Every clinic generates referrals continuously — self-replenishing
Carrier-agnostic — MA, PDP, supplement, and social programs that seed future Medicare leads

The channel that was always there

Provider referrals have always been the highest-quality Medicare lead source. They have also always been entirely analog — a sticky note, a phone number on a prescription pad, a conversation that went nowhere.

Patient Coverage Connect systematizes this channel for the first time. The infrastructure didn't exist. Now it does.

The timing is not incidental

The disruption driving demand is accelerating. In 2026, health systems and MA plans parting ways forced more than 3.7 million enrollees to choose between new insurance and new doctors — and a peer-reviewed analysis projects forced disenrollment reaching 10% of MA enrollees this year, up from roughly 1% before 2025. Every one of those patients is a coverage decision that has to be made, in a setting they trust, on a clock. State insurance commissioners have formally asked CMS for a group Special Enrollment Period covering these displaced members. The problem PCC solves is not static — it is growing, quickly, and being recognized at the regulatory level.

The validation is already happening

In July 2025, Epic launched a carrier-specific integration allowing coverage information to surface inside patient portals for one major Medicare Advantage plan. This confirms the largest EHR vendor in the country sees the same opportunity. Patient Coverage Connect is carrier-agnostic, works across all plan types, and requires no EHR integration to operate today.

Social care platforms — the partnership that accelerates everything

Companies like findhelp and Unite Us have already built production EHR integrations across Epic, Oracle Health, eClinicalWorks, and athenahealth — and their platforms already touch Medicare patients at the moments when coverage questions arise. They route social care referrals. The licensed Medicare agent channel is entirely outside their current scope. PCC fills that gap. Partnership discussions are active. An investor with relationships at either company — or in EHR app development — lends organizational credibility to conversations already underway.

Business Model

Premium leads. Per referral.
The accidental revenue model.

The Medicare lead market is built around "leads cost X." Patient Coverage Connect enters at the premium end of that market. Clinical sourcing, pre-qualification, and conversion rates no other channel can match justify the highest per-lead pricing in the market.

Lead Fee — Every First Contact

Every referral through PCC carries a flat lead fee — paid by the agent, never by the provider. The agent receives the patient's medications, diagnoses, current plan, and the specific coverage question before making contact. No other lead channel in Medicare distribution delivers this. Premium exclusive internet leads run up to $100 with no clinical context and a patient who may not remember requesting information. A PCC lead costs $40 and arrives with everything the agent needs.

Lead marketplace integrations with Connecture, AgencyBloc, Sunfire, LeadStar, and others bring PCC leads directly into agent CRMs across hundreds of FMOs nationwide. Agents also register directly on the PCC marketplace.

$40 Per qualified referral — clinical context, documented consent, patient expecting contact

Ongoing Relationship — $0

Every agent who receives a PCC lead gets a compliance package delivered to their CRM: the clinical brief, a completed Scope of Sales Appointment, 1:1 consent documentation, and a TrustedForm certificate. The agent arrives at the appointment with everything they need — and everything CMS requires already documented.

The patient-facing confirmation screen doubles as the Scope of Appointment. The patient confirms their advisor, selects product types, and signs — before the call. No paperwork at the meeting.

SOA Completed before the advisor makes contact — compliance built into the workflow

The Accidental Revenue Model

Clinical workflows generating Medicare coverage referrals will continue whether or not Patient Coverage Connect exists. The platform captures value from activity that was already happening — and going nowhere. Social program referrals that begin as Extra Help navigation become Medicare coverage leads as patient circumstances change.

Every clinical encounter with a Medicare patient is a potential revenue event. The system runs continuously.

20+ Coverage gap types detected from a single patient clinical record

Regulatory Tailwinds

Correct plan placement is a quality measure intervention.

Every referral that results in correct plan placement directly affects the HEDIS measures that determine Medicare Advantage STAR ratings — and the hundreds of millions in quality bonuses those ratings control. CMS estimated that improved medication adherence in 2020–2021 generated more than $11.6 billion in healthcare cost avoidance for statins alone.

HEDIS — Medication Adherence

Statins · Noninsulin Diabetes Medications · RAS Antagonists

These three medication classes are the core HEDIS adherence measures for Medicare Advantage plans. Patients in wrong Part D plans who cannot afford their medications fail these measures. Correct plan placement directly restores adherence. Note: CMS temporarily reduced the weight of these measures from 3× to 1× for 2026 while implementing social determinants risk adjustment; they return to full weight in 2029.

STAR — Plan All-Cause Readmissions (3× weight, 2025)

Coverage Gaps Drive Avoidable Readmissions

Patients who delay care due to coverage problems get sicker and get readmitted. CMS increased the readmission measure weight from 1× to 3× for 2025 STAR ratings. Every referral that resolves a coverage gap before the patient deteriorates is a direct readmission prevention intervention.

HEDIS — Comprehensive Diabetes Care

Chronic Condition Patients in the Right Plan

Patients with diabetes who are not in plans designed for their condition miss care management support, medication coverage, and specialist access. Diagnosis codes in the clinical record identify these patients automatically. A Chronic Special Needs Plan referral changes their coverage profile — and their plan's STAR performance.

STAR — Care for Older Adults · Member Experience

Functional Outcomes and Patient Satisfaction

Coverage gaps that go unresolved accelerate functional decline and erode member experience — both tracked STAR measures. Connecting patients to correct plans, appropriate subsidies, and advisors who arrive knowing their situation improves both clinical outcomes and the member satisfaction scores that drive STAR ratings.

Current Status

Where we are right now.

Platform live — open for business

PCC Direct is built and operational. Provider registration, consent capture, referral submission, gap detection, agent marketplace, appointment scheduling, and patient-facing SOA confirmation are all live. No EHR required to operate. HIPAA-compliant infrastructure with BAA at provider registration.

Provider registration open

Clinics register online, execute a BAA, and begin referrals with PCC Direct — no EHR integration project required. The platform is ready for health-system and independent-practice partners.

Provisional patents filed

Two provisional applications protecting four core platform elements: the coverage gap detection engine, the clinical referral workflow, the agent matching mechanism, and the patient portal self-service review. Filed June 2026.

Lead delivery operational

Leads import directly into IntegrityCONNECT, Lead Advantage Pro, and HealthSherpa via standard formats. Lead marketplace integrations with Connecture, AgencyBloc, Sunfire, and LeadStar in active pursuit. PCC's own agent marketplace is live for direct agent registration.

Social care platform partnership — discussions active

findhelp and Unite Us have production EHR integrations across all major platforms and existing health system relationships. A partnership brings PCC's Medicare coverage channel into their provider workflows and eliminates the independent EHR integration timeline. Discussions underway.

Raising $500K angel round

Funds national marketing activation, conference circuit, lead marketplace partnerships, and PCC Integrated development. PCC Direct is generating revenue now. The round accelerates growth — it is not the starting gun. Base case reaches operating profitability in Year 2 without additional capital.

Automatic. Before the appointment.Before the crisis.