(L-R) M-Tiba CEO, Pieter Prickaerts; Actnable AI CEO, Dharmendra Jain; Penda Health CEO, Stephanie Koczela; Kenbright Managing Director, Ezekiel Macharia; and Jubilee Health Insurance CEO, Njeri Jomo, at The Digital Pulse 2025, hosted by M-Tiba on February 13, 2025 at Radisson Blu, Nairobi.
Health insurance and technology leaders are optimistic that Artificial Intelligence (AI) and real-time data will enhance healthcare quality, reduce costs, and expand insurance access in Kenya.
According to the professionals, AI is set to improve decision-making, streamline
operations, and make health insurance more accessible for Kenyans.
At The Digital Pulse CEO Roundtable 2025, hosted by M-TIBA, industry leaders from health insurance, reinsurance, technology, and healthcare explored practical AI-driven strategies to transform healthcare and insurance.
This year’s theme, "Connected Intelligence: The Future of Data, Tech, and AI in Health Insurance," focused on how AI and real-time data can simplify health insurance.
The discussions led to actionable ideas for managing costs and risks, shifting from reactive to proactive care, and strengthening partnerships across the healthcare ecosystem.
“AI is the buzzword of the day. At this year’s event we focused on turning innovation into real tangible benefits for health insurance,” said Pieter Prickaerts, CEO of CarePay International and M-TIBA.
“Already, AI is proving most valuable in administrative tasks like approvals and claims processing, but more benefits of data and AI are expected in the near future.”
Early AI applications in health insurance—such as automated pre-authorizations and claims processing—have significantly improved efficiency.
M-TIBA’s data-driven platform has shortened payment cycles up to 95 per cent, while healthcare costs have dropped by up to 15 per cent, allowing members to stretch their coverage further. Members can also track claims in real-time, improving transparency and flexibility in decision-making.
Njeri Jomo, CEO of Jubilee Health Insurance, highlighted how AI is optimising pricing, enabling premiums as low as Sh500 per month.
“AI has streamlined our administrative processes, allowing 80% of claims to be processed faster while maintaining accuracy, efficiency, and predictability,” she said.
AI is also enhancing
real-time monitoring for healthcare providers, preventing duplicate treatments,
detecting anomalies, and flagging high utilisation in real time. This fosters
better collaboration between providers and insurers, leading to improved patient
outcomes and cost savings.
Looking ahead, experts predict AI will play an even greater role in diagnostics, treatment recommendations, and drug development. However, human oversight will remain essential to ensure AI-driven decisions align with ethical and medical standards.
“AI is transforming healthcare much like electricity revolutionized industries,” said Dharmendra Jain, CEO of Actnable AI.
“To unlock its potential today, we must take
immediate, actionable steps, such as mapping the member’s health insurance
journey to identify areas where AI can enhance the patient and member
experience.”
Ezekiel Macharia, Managing Director of Kenbright, emphasized the need for a practical approach: "AI is strong in areas like reading, summarising and education, but when it comes to complex mathematics and data calculations, even the latest models are still struggling. In health insurance, we should focus on where AI truly excels, implementing it for tasks that can streamline administrative processes and improve efficiency."
“The industry must not expect AI to solve everything overnight. Instead, we should start with proven, high-impact use cases,” he added.
As AI advances, it is expected by experts to assist in diagnosis, treatment planning, and even surgery.By reducing time spent on ad By reducing time spent on administrative tasks, healthcare professionals can focus on patient care and support more individuals.
The opportunity for collaboration in AI-driven innovation is vast. Industry leaders agree that leveraging connected intelligence can drive the development of simple, affordable solutions, expanding insurance coverage for underserved Kenyan populations.
