COVID-19 may have disrupted our lives, but Moses Kuria and team are working round the clock to ensure it doesn’t stop Kenyans from accessing healthcare and the healthcare industry to become more efficient.

Moses sits at the helm of CarePay Kenya, the organization that runs M-TIBA, a mobile-based health financing platform that serves individuals, insurers, healthcare providers, and the Government.

M-TIBA was developed by CarePay with investment from the M-PESA Foundation, and IFHA (Investment Funds for Health in Africa). The main idea behind the platform was to enable Kenyans, particularly low-income earners, to access and afford quality healthcare.

Before COVID-19, the platform had gained steady traction with early adopters in the insurance sector, including NHIF, AAR and Britam. They were attracted by M-TIBA’s ability to help them reach new customers, reduce the cost of scheme management and reduce fraud.

When the pandemic struck, there was an added incentive for the whole healthcare sector to go cashless and quickly roll out mobile and digital services. Some of the things the team at CarePay thought would make a business case in two or three years had to be done immediately.

“Before COVID-19, we had very few telehealth players running on our mobile platform. During the pandemic, we saw a lot of players coming on board. Healthcare providers and insurance companies who had not digitized before the pandemic were really exposed,” says Moses, who is pictured below.

As Kenya went into lockdown in March 2020 hospitals and clinics saw a dramatic reduction in the number of face to face patient visits. As they responded with mobile and digital services, M-TIBA was there as a proven payment, data and claims platform.

There are now over 3,000 providers on M-TIBA, ranging from the large private high-end hospitals like Nairobi, MP Shah, Gertrudes and Aga Khan, mid-level hospitals like Nairobi Women’s to small community health clinics.

A look at the 2020 transaction volumes on M-TIBA points to far-reaching changes in the sector. A dramatic fall in transactions in March has been followed by steady increases. By July 2020, digital transaction volumes had reached their highest ever level and the platform will have processed more than KSh2.6 billion in healthcare-related payments in 2020.

One reason for the increase in transaction volumes has been the insurance companies moving more policies onto M-TIBA.

“When we look at the trends in terms of how insurance companies adopt technology, they take time, because people will say, ‘Well, let’s try do it step by step and then over time we will move,’” says Moses.

“What we are now seeing is all of them saying: ‘We now want e-claims’ and that has led to part of the enhancements that we have done to the platform,” says Moses.

CarePay quickly enhanced the e-claims module, which enabled faster processing of claims without paperwork. The team also rolled out One Time Password (OTP), removing the need to authenticate identity using fingerprints. They also built algorithms, driven by Artificial Intelligence that enable them to flag suspicious claims.

For insurance companies, this means increasingly using the platform to manage their key processes – identifying patients digitally, receiving claims, verifying them, and paying.
For providers it means improving claims processing times (down to as little as 48 hours) and boosting clinics and hospitals, whose incomes have been negatively affected. CarePay has now handled over 721,000 digital treatment claims on the platform since its launch.

For facilities, like the Nairobi Women’s Hospital and Melchizedek Hospital in Nairobi, speed, accuracy and the enhanced authentication methods are essential in fighting fraud.

At Nairobi Women’s, M-TIBA is used to manage the staff’s medical scheme, as well as the billing platform. “We used to have challenges with tracking and misuse,” says Hosea Buliba, a manager in the Human Resource Department. “We are now able to track usage and add staff in realtime.”
They started using the platform to manage the staff medical scheme in July after seeing how the experience was with their patients.

Norah Kinya at the Credit Control office dreads having to tell patients to wait as a system processes their needs and she has so far been happy with the M-TIBA. “It doesn’t keep clients waiting. In our industry, if you keep clients waiting, it brings a lot of issues,” she says.

For John Gitau, who is in Credit Control at Melchizedek, a 40-bed hospital on Naivasha Road in Nairobi and whose catchment area is Dagoretti and Kawangware, the faster processing of claims and going paperless has made a difference. Users also appreciate the transparency on usage per visit.

“Apart from the rest who are trying to go in that direction, it’s the only platform that allows a client to know the exact amount they have spent on a visit. That way they can track the amounts they have – like you do in a bank account,” he says.

Melchizedek currently uses M-TIBA as a billing platform (for AAR and Minet), and as a payment platform for M-PESA.
The 20-year-old hospital has also benefitted from two programmes linked to M-TIBA: Ngao ya Afya and the Medical Credit Fund.

Ngao ya Afya is a programme that enables users who save for their healthcare funding using M-TIBA access discounted consultations, tests and medicine for diabetes and hypertension. They also get tools to help them manage the conditions and communication with doctors.

Through the Medical Credit Fund, a loan facility for small and medium medical enterprises by PharmAccess, Melchizedek has accessed funding to invest in medical equipment that has enabled them to expand the range of services they offer.

Facilities are assessed for their qualification to get finance based on their digital cash flows as on M-TIBA, which means that the more digital they go, the more they can get.
Moses says the efficiencies brought about by the move to digitize services has evident benefits for insurers as well.

“We’re seeing that M-TIBA is helping insurers reduce the cost of scheme management by between 15 and 20 per cent. It means that insurance companies can now concentrate their energies on developing new customer-centric digital products for the mass market,” says Moses.

On the ground at CarePay, the increased demand in 2020 meant getting all the engineers on board working faster to put more features or modules on the platform. The company’s 50 software engineers comprise nearly half the entire workforce of 115, and they are continuously working at improving the platform.

In September, M-TIBA’s work was applauded by Fortune, who hailed its expansion since its reach to 4.7 million people since its launch in 2015 by Safaricom, through the M-PESA Foundation.

“We felt quite honoured,” says Moses. “That recognition really urges our whole team forward. It keeps us fired up to know that we indeed are making a difference, and we are on the right track.”

There is certainly lots more to be done.
Hosea, the Human Resource manager at Nairobi Women’s Hospital, has been talking to CarePay about his suggestions for enabling and tracking different claim approvers, as well as ways to further ease reconciliations.

From her desk at Credit Control at Nairobi Women’s Hospital, Norah sees an opportunity to make changes in the prescription module.

Everyone wants an M-TIBA app, and this is currently in the final stages of testing, prior to launch in 2021.
For Moses, those are good problems to have.

“When we started, a lot of people were very skeptical. Now we see what’s possible on the platform, when we work together. Health insurance was seen as challenging to do at scale and at a low cost. Managing multiple providers, brokers and agents was seen as too complex. We are proving that we can manage thousands of providers and multiple insurers on the platform. With better data and analytics, our partners can develop simpler products for millions of Kenyans,” he says.

He is optimistic M-TIBA can transform healthcare the way M-PESA transformed financial inclusion.

“Despite the disruption caused by COVID-19, there is a silver lining. The healthcare sector has proved its adaptability and there is increasing impetus for transformation. Changes in products, physical facilities and departmental structures were implemented overnight. Pre-pandemic, these would have been thought as impossible or as taking many years to plan and implement,” concludes Moses.

This story is part of Safaricom@20 celebrations. For 20 years, Safaricom has developed new technologies and innovations to support and enable Kenyans to communicate, connect and to go beyond.