Everyone wants an M-TIBA app, and this is currently in the final stages of testing, prior to launch in 2021. This is according to Moses Kuria, who is at the helm of CarePay Kenya.

M-TIBA is a health financing platform that is enabling mobile-first healthcare services for millions of Kenyans and helping providers and insurance companies digitize management processes.

The platform was developed 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.  Safaricom launched its use since 2015 through their M-PESA Foundation and the PharmAccess Foundation.

Covid-19 pandemic an added push

M-TIBA was already gaining traction when the pandemic struck at the beginning of 2020. This provided 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 Kuria.

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 Kuria.

New enhancements on demand

“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 real-time.”
They started using the platform to manage the staff medical scheme in July after seeing how the experience was with their patients.

“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 Kuria.

Successes with M-PESA Foundation

M-TIBA has reached to 4.7 million people since its launch in 2015 by Safaricom, through the M-PESA Foundation. M-TIBA has at least 3128 health providers on the platform and has also handled 1048 million plus transactions 684k treatment claims.

However, Kuria says  their current successes do not mean they get to sit on their laurels. There is still more work to be done. He is optimistic M-TIBA can transform healthcare the way M-PESA transformed financial inclusion.

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