Why Connected Data Is the Competitive Edge for Health Insurers

Most health insurers are digitising and aim to turn these investments into a competitive advantage. Across Kenya and other emerging markets, insurers are investing heavily in digital transformation – automating claims, launching apps, streamlining payment flows to reduce costs. Yet the operational and strategic gains remain limited.  

The real shift is happening around connected, real-time data. Only a handful of insurers are using connected, real-time data to drive decisions across pricing, product development, and provider management. Those who do are already pulling ahead on cost control, customer retention, and creating products and services to serve the next wave of customers.  

As recent industry reports highlight, insurers are no longer treating IT modernisation as a back-office efficiency play. They are embedding real-time technology as a strategic play, linking pricing, underwriting, claims, and customer engagement through connected platforms. The payoff is measurable: faster product launches, improved customer loyalty, and more effective cost structures.  

At M-TIBA, for instance, this transformation is evident daily—insurance partners have processed claims five times faster and cut avoidable medical costs by 15%. But real-time data does more than drive efficiency. It’s now the backbone of personalising member engagement, managing provider networks in real time, and giving pricing teams instant insights to respond to trends. This is how leading insurers are pulling ahead—and why connected data is now essential, not optional.  

The recent AKI Insurance Industry Market Report highlights that medical insurance remains a significant contributor to Kenya’s insurance sector, generating KES 64.34 billion in revenue. Despite this substantial contribution, insurers are facing growing financial pressures. The combined ratio for medical insurance stood at 103.6% in 2023, meaning that insurers are paying out more in claims and expenses. This trend highlights the urgent need for insurers to adopt more efficient, data-driven approaches to manage costs while improving customer experience. 

Other industries, like banking, already deliver real-time customer experiences. If a bank detects a suspicious transaction, it often calls the customer immediately, setting a high bar for responsiveness and transparency. Yet when the same person interacts with health insurance, they face slower response times and fragmented communication. This gap between what customers expect and what they experience erodes trust.   

Traditionally, pricing relied on data that was often up to six months into the business cycle. That is no longer sustainable. Today, insurers have access to live patterns of member utilisation, provider performance, and cost behaviour. Pricing and actuarial teams can now identify cost drivers early, test targeted incentives, and adjust coverage tiers in real time, and this is fundamentally a different way to manage risk.  

Real-time data is also transforming how teams across the organisation operate—enabling faster collaboration between underwriting, customer service, and provider relations. Product teams can respond more quickly to emerging trends. Commercial teams gain visibility into scheme performance and provider quality. Even small signals—like a surge in pre-authorisation requests or an increase in specific demands—can now trigger timely action. This operational agility is becoming a critical differentiator as insurers navigate rising costs, evolving regulation, and growing member expectations. 

Connected data is central to growth, profitability, and long-term sustainability. Insurers that are leveraging this are reporting stronger NPS scores, stronger provider relationships, and lower admin costs.   

As costs rise and consumer expectations accelerate, the ability to act in real time will be a baseline requirement. Insurers who make connected infrastructure core to how they build, price, and deliver their products will unlock deeper, more scalable value across the entire value chain. Those who hesitate risk being left behind in a market that is moving faster—and expecting more—every day.  

Witten by Shadrack Kiratu, the Head of Pricing and Portfolio Management at M-TIBA.