Less than one in five Kenyans enjoy some form of medical cover. This is mainly attributed to the increasing cost of care and the lack of trust between insurance providers, providers and consumers. Every year, about 1.5 million Kenyans are pushed below the poverty line due to catastrophic Healthcare costs . Insurance providers have been unsuccessful in scaling affordable medical insurance covers due to the high administration costs, increasing levels of fraud and the escalating cost of Healthcare. The situation in the other markets where CarePay currently is active in (Nigeria and Tanzania) is similar, if not worse. The highly manual claims submission processes make it impossible to take prompt actions due to lack of real-time data. It is estimated that as much as 50 per cent of insurance claims paid out are actually-falsified iii. Delays in payment, on the fee for service model, have further incentivized Healthcare providers towards over-utilization and increasing service costs. Insurers in return, in a bid to manage escalating costs, have increased premiums to allow them to deploy biometric and utilization monitoring technology to manage the highly complex benefit restrictions.
Through CarePay’s M-TIBA platform, funds from Donors, Public and Private insurers are directed to consumers Mobile Health wallet making them much more involved and aware of the cost and quality of care they receive. The funds can be restricted to conditional spending at selected healthcare providers. With every transaction, CarePay can offer a digital payment for real-time medical and financial data, making healthcare more transparent for patients, healthcare providers and Payers. The real time data available to insurers should help improve their pricing strategy and their ability to pay providers promptly. In addition, using machine learning and artificial intelligence, the platform aims to automate claims management, prevent fraud, and shift the focus away from fee for service models towards rewarding providers for outcomes and quality care. Competition exists in specific segments, but no player is offering a holistic solution across the entire customer journey. The use of the mobile phone to manage benefits also fosters a closer relationship with every consumer creating opportunities for behavioral change and increasing the focus on preventative care
|Projected Cumulative Lives Impacted||20|
|New Implemented Countries||Ghana|
|Recruit||10 management 5 board members|
|New Feature||Disease tracking apps and other Data propositions|
The Carepay leadership is very dynamic and Diverse. We have has