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Health insurance and technology leaders in Kenya see Artificial Intelligence (AI) and real-time data as pivotal tools for improving healthcare quality, reducing costs, and expanding insurance access. AI is expected to enhance decision-making, streamline operations, and make health coverage more accessible to millions.

At The Digital Pulse CEO Roundtable 2025, hosted by M-TIBA, industry leaders from health insurance, reinsurance, technology, and healthcare convened to explore AI-driven strategies aimed at transforming healthcare and insurance.

This year’s theme, “Connected Intelligence: The Future of Data, Tech, and AI in Health Insurance,” centered on how AI and real-time data can simplify health insurance processes. The discussions yielded actionable strategies for managing costs and risks, shifting from reactive to proactive care, and fostering stronger collaborations 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 by up to 95%, while healthcare costs have dropped by up to 15%, allowing members to extend their coverage. 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 optimizing pricing, enabling premiums as low as KES 500 per month. “AI has streamlined our administrative processes, allowing 80% of claims to be processed faster while maintaining accuracy, efficiency, and predictability,” she said.

Beyond streamlining operations, AI is enhancing real-time monitoring for healthcare providers by preventing duplicate treatments, detecting anomalies, and flagging high utilization. These advancements promote better collaboration between providers and insurers, ultimately leading to improved patient outcomes and cost savings.

Looking ahead, AI is expected to play an even greater role in diagnostics, treatment recommendations, and drug development. However, human oversight will remain critical to ensuring that 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 measured approach: “AI is strong in areas like reading, summarizing, 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 continues to evolve, experts anticipate its increasing role in diagnosis, treatment planning, and even surgery. By reducing time spent on administrative tasks, healthcare professionals can dedicate more attention to patient care, ultimately supporting more individuals.

The potential for collaboration in AI-driven innovation remains vast. Industry leaders agree that leveraging connected intelligence can pave the way for simple, affordable solutions that expand insurance coverage, particularly for underserved Kenyan populations.