Brief and Context:
This project was completed over the 2020 fall semester at OCADu as part the Business and Design Thinking course, given by Helen Kerr from KerrSmith Design. This course was completed during my time at OCADu as a Strategic Foresight and Innovation Candidate (MDes).
The aim of the project was to identify vulnerable populations that are being affected by the Covid-19 pandemic and creating a product and business model that can help them mediate these difficulties. My teammates and I decided to focus on the refugee and asylum seeking populations in Ontario.
The work was divided in a way that all four of the team members weighed in equally in the decision making and thinking process throughout the project. I was mostly involved with the research, problem finding and development of the product. I included the business model developed the by the team as reference.
In 2019, around 64,000 people claimed refugee status in Canada. As of October 2020, the number went down to 21’000 due to the pandemic we are facing. With the upcoming 2021-2023 Immigration Levels Plan, Canada aims to welcome a total of 145,000 refugees and refugee claimants over the next three years.
We analyzed the difficulties that asylum seekers and refugees face in Ontario, especially given the context of COVID-19. And amongst income, housing, and education, we focused on asylum seekers' access to healthcare.
Health Insurance Plans:
There are 3 different types of healthcare coverage in Ontario.
The most commonly known is probably OHIP, which covers Canadians, people with a work permit or a resident permit.
Refugees and refugee claimants receive coverage under the Interim Federal Health Program.
And because there are some gaps in coverage for rejected claimants for example, Ontario also set up the temporary health program.
When it comes to IFHP, there are many problems faced by both sides: healthcare providers and refugees.
They range from not being able to communicate well with each other to inconsistencies in coverage and billing issues, unfortunately leading to refugees having to pay out of pocket, despite being covered, and with no way of getting the money back.
The model above is a simplified diagram of the healthcare system that includes key actors or stakeholders - in this case: refugees, who are seeking health care, and hospital administrators, who provide health care, based on the IFHP coverage. The process works in theory, but in practice: Refugees have to deal with variety of problems the main one being inability to get medical attention, and the healthcare provider/administrator who is supposed to process IFHP certificate using Medavie Blue Cross System.
The complexity of Medavie software leads to constant problems and errors during the billing process, and in return, lowers the motivation of medical staff when dealing with IFHP. We discovered examples of cases whn refugees were denied services due to lack of knowledge on behalf of the administrators to process the claim.
But even when refugees get accepted by the hospital, they often get charged for the services that are supposed to be free. Language barriers in the local healthcare system lead refugees to either pay a significant amount of money for the healthcare services that they are not supposed to pay, or even avoid visiting doctors, which created a massive burden for the public health and increases the risk of covid spread among vulnerable populations.
Ontario Healthcare providers deny refugees medical services due to billing complexities
Personas and User Journeys
To better illustrate and understand the problems and the different perspectives at hand, we created user personas and documented their journeys. We included the personas of a healthcare administrator and a refugee/asylum seeker.
Sam, 41- Healthcare Administrator
When Sam bills a OHIP patient, he simply has to enter the health card number in the system. The platform automatically does a health card validation and Sam then simply has to fill it the additional information to submit the claim. This is a process that takes at most, 30 seconds.
With IFHP it is another story. And Sam often turns people away because he does not have the time or the motivation to do this different process. For IFHP, the refugee has to bring a paper document. Either a IFHP certificate or a refugee protection claimant document. Then Sam is the one that has to verify the refugee’s eligibility. He has to either call or send an electronic submission to Medavie Blue Cross and only when the refugee’s eligibility is confirmed can he start processing the claim. It is a process that in the best-case scenario, takes at least 20 minutes.
Hana, 28 - Asylum Seeker
The IFHP billing process can go wrong at every step.
Maybe the administrator of the clinic does not know that he has to contact Medavie Blue Cross.
Or maybe Hana arrives outside the working hours where the Blue Cross can be reached by phone.
Maybe the Blue Cross can’t confirm her eligibility, because the Border Officers forgot to enter her information in the system, despite the fact that they gave her all the IFHP certificate. Or maybe, the clinic is not a Blue Cross approved provider.
In many cases, the refugees have to pay out of pocket, despite being covered and often, with no possibility of reimbursement.
This is where MedCxT comes in
Our solution is two fold:
First we would be introducing a brochure that would be available along with the IFHP document. This brochure details what their rights and benefits under the IFHP and is available in the the official UN languages so that this information is accessible by as many individuals as possible.
Secondly, the introduction of the MedCxT widget within all of the different billing softwares used by healthcare administrators: this includes the native Blue Cross billing program and any third-party billing software such as mdbilling.ca and doctorbill.ca. For the purpose of the project, we focused on wireframing the widget within the mdbilling.ca portal.
This add on essentially allows administrators to toggle between OHIP and IFHP billing seamlessly and automates the data gathering process for the administrators. It also simplifies submitting the claim by making the process similar to that of an OHIP claim.
If eligible, then simply by inputting either the IFHP ID number or the SIN number of the patient the rest of the fields would all be automatically filled out and all the administrator has to do is fill out the claim as per usual.
The process without this solution would take usually up to 20 minutes best case scenario and up to several hours if things were to go wrong - which they often do.
But in this case it can take less than one minute.
MedCxT Illustrated: A Swimlane Scenario
In the case where Med CXT is not implemented:
Hana does not have a good understanding of her rights and so cannot properly communicate with the administrator Sam what her needs are. Sam does not have a good understanding of IFHP. Also, the receiving payments for refugees under IFHP is notorious for being laggy and slow. Sam does not even bother to fill out Hana’s profile. Hana then asked to pay out of pocket for her doctors emergency visit
In the second scenario Hana explains that she is covered under IFHP:
Sam has a good understanding of IFHP and the MEDCXT widget . This makes the whole process simpler and more efficient for both parties. Hana can just go to the doctor and get her check up making sure her baby is still healthy without having to pay up to 350 CAD out of pocket.
*Swimlane developed and illustrated by Justine De Ridder
*A breakdown of the cost:
App development costs range $ 8000 - $75,000 depending on complexity and if it is developed locally or outsourced to another country. We assume that MedCxt widget is at the low end because of its simplicity.
$30k *2 for = $ 60,000 for both Mac and Windows
We also assume an average acquisition cost for app adoption is $ 4.27 per user. We budgeted roughly around $8 to get the online course ready for training hospital workers and another $10k for Collateral development including brochures, posters etc.
Business model developed by the entire team and brought together by Diane Lai and Maxim Rakov
Future Possibilities for Innovation
It is also important to note that our solution will be opening doors for future innovation. A first step could for example be to implement a digital proof of coverage, in the form of a QR code sticker on a refugee’s passport for example. This could lead to the development of an actual IFHP health card. Similarly, we can image a more streamlined process across federal and provincial government, where refugees automatically get re-enrolled in IFHP if it is close to expiring, or automatically transferred to OHIP when their status changes.
To sum it up
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