"PharmAccess is focused on improving access to quality, sustainable healthcare... On the other side, AAR Insurance is an expert in insurance. When we combine the two, we have something stronger."
- Justine Kosgei, (CEO AAR Insurance Kenya)
Shifting healthcare towards wellness and prevention
Digitalization, quality improvement, and economic recovery are driving forces behind Kenya’s transition towards universal health coverage (UHC). In addition to governmental support, the success of this transition depends on actors throughout the health ecosystem, including insurers.
AAR Insurance is a leading medical and general insurance company that currently serves over 250,000 customers across East Africa. We spoke to Justine Kosgei, CEO & Principal Officer of AAR Insurance Kenya, about the company’s role in UHC, its collaboration with PharmAccess, and the role of AI.
Kenya is widely regarded as one of Africa's most ambitious drivers of universal health coverage. As a leading private insurer, what role do you see AAR Insurance playing in reaching those who are still uninsured, and where do you see the greatest barriers to closing that gap?
The government in Kenya has taken bold steps. The Social Health Insurance Fund (SHIF) is part of the universal health coverage agenda, which is really a good thing. We see private health insurance as a complementary service to this, and it's very important that both work together.
Our role has three dimensions. First, we develop products that complement what the government is offering — affordable products that ride on the care providers already identified and working within the system. Second, we use technology to execute and provide services at a lower cost. And third, we bring in quality assurance elements in a less costly way that still enables access.
The biggest barrier is price. Technology, partnerships to distribute, managing costs through automation, that's how we address it.
AAR Insurance has been working with the CarePay platform for several years now. How has it changed the way you operate, and what sets it apart from other digital claims solutions?
The platform has been transformational to our business, both operationally and strategically. Historically, health insurance has been largely manual and administratively expensive. CarePay has enabled us to have the full member journey digitalization, which has improved a lot of KPIs — turnaround times, reduced leakages from system inefficiencies, and transparency. Providers and customers can view their own information without needing to come to us. Access to services is almost real-time.
What differentiates this platform is that it's not just a claims payment system, it is an ecosystem platform. It brings visibility across all channels, connects every player seamlessly, and enables smart healthcare management because the data is available for everyone.
It also enables inclusion, as it's cheaper — it can cover more people at a lower unit cost. More than 21% of our business is now done with customers who, with conventional methods, would have been unaffordable to serve. That inclusive aspect is significant.
An insurer and an NGO working together is not an obvious combination. What makes the partnership with PharmAccess work for AAR Insurance, and what initiative or outcome are you particularly proud of?
PharmAccess is focused on improving access to quality, sustainable healthcare, and brings a lot of expertise when it comes to healthcare systems strengthening. On the other side, AAR Insurance is an expert in insurance. When we combine the two, we have something stronger.
One area we are very proud of is the progress we are making in shifting healthcare from predominantly paid claims towards proactive wellness and prevention. The Keep Well project where we work with PharmAccess and is designed to support early detection and proactive management of chronic conditions such as diabetes and hypertension, using technology and AI to enable continuous tracking, access to care, specialist access, and data-driven monitoring. We have an app in place for members, providers in place, and it is making progress.
There is also MomCare, which we are also working with PharmAccess and is designed to help improve access to care for mothers and children. Beyond capacity building, these are major initiatives that demonstrate that impact and commercial goals can actually come together. We have been actively working on these projects for about a year and a half.
AI and data are reshaping financial services globally. Where do you see the most transformative potential in health insurance, and is AAR Insurance putting the capabilities to work?
One major area is fraud, waste, and abuse management. We use AI to identify abnormal utilization patterns faster and more accurately than before. This is already built into the analytics engines we use together with CarePay, and it has had immediate financial impact on the business.
The second area is internal operations — automations in claims and communications, including decisions on which claims to pay and which to reject. This has improved speed and accuracy, and enhanced relationships with hospitals, providers, and members.
We are at early stages, even though we have already seen big impact. We see that the biggest impact will come when we expand this into preventative healthcare. We are already looking at predictive AI: using data to identify members at risk and ensure early interventions before conditions develop and become expensive. If we can do this at scale, the impact will be very big.
We also have to be careful — a lot of regulation is coming around data and AI, and we are making sure we are ready for that.
If you could put one thing at the top of the shared agenda for AAR and PharmAccess over the next two years, what would it be, and why does it matter now?
For us, it is prevention and wellness — and specifically, scaling Keep Well. This is mainly because we are seeing a growing burden of diseases such as diabetes and hypertension. The question is no longer just about expanding access to care. We need very proactive early detection and proactive management. That is where I see a lot of opportunity.
Population health management, done effectively, makes severe and costly conditions manageable across the population. I see a big impact coming from the prevention and wellness part. By bringing people and organizations together — from the private sector, where there is a lot of innovation, to the public sector to enable the right environment — we can build private-public partnerships that work together towards a stronger, more inclusive healthcare system. So that healthcare is affordable, and above that affordability, that the preventative part of healthcare is also there.
Disclosure statement This report contains a combination of original photographs, licensed imagery, and AI-generated illustrations.