Streamlining access to coverage and care for Canadians
The problem
Physicians and their teams often bear the brunt of filling out prior authorization forms for their patients, required by public and private insurers to determine the need for new and innovative treatments. This burden is set to grow over the coming years, as medications requiring prior authorization expand into common chronic conditions like diabetes and asthma.
The solution
This initiative aims to launch the first electronic prior authorization standards in Canada, facilitating its integration with electronic medical records and ensuring these systems can communicate with each other. Ultimately, it aims to reduce physician administrative burden and improve patient outcomes through faster access to medication and therapy. It will first launch nationwide with a focus on rheumatology, with a longer-term goal of scaling to all conditions and private insurers.
"We are grateful for this grant and the recognition the administrative burden prior authorization forms place on physicians. This innovative technology will usher in a new standard for prior authorization in Canada and significantly reduce that burden, allowing doctors to dedicate more time to their patients."
The innovators
GreenShield is an integrated health services organization and the first in Canada to operate as payer-provider— offering insurance, administering benefits, and paying claims as a 'payer' while offering health services such as mental health, pharmacy, chronic disease management, and telemedicine services as a 'provider.' Integrating both sides of the payer-provider equation enables GreenShield to simplify access to care, remove administrative barriers, and improve health outcomes for its customers.
OkRx is a Canadian tech company that connects healthcare communities through centralized cloud-based technology solutions that improve access and coverage to medications.
Dr. Sonja Gill is a specialist of internal medicine and adult rheumatology who completed her undergraduate training at McGill University, internal medicine in upstate New York, and her rheumatology training at the University of Toronto. She now has a busy rheumatology practice in Oakville, Ontario and is an investigator in several clinical trials.