NucleusIS: Technology for Africa’s healthcare value chain

In Nigeria and Ghana, health insurance penetration stands, respectively, at a mere 5% and 38%. For most people in these countries, health insurance plans are neither accessible, nor attractive nor affordable. Over 90% of coverage is paid for by employers, and health insurance companies manage risk by pooling groups of employees because the sector struggles to register and collect payments from individuals who aren’t in paid employment. Other reasons why the retail space remains largely untapped include identity fraud, inefficient manual processes, fragmented interactions with healthcare providers and a lack of the data and technology required to scale insurance schemes.

NucleusIS aims to increase the number of insured lives, lower costs and, ultimately, improve health outcomes in Africa by offering technology that connects the key players in the health delivery value chain for interoperability and efficiency. Its omni-channel digital platform allows health insurance companies and Health Maintenance Organisations (HMOs) to seamlessly interact with hospitals and enrolees by partly automating enrolment, claim submission, management and approval. The solution can be connected with large retailers such as telecoms and mobile money operators, enabling access on a broad range of devices. Insurance companies and HMOs can thus deliver coverage more efficiently and manage risk while reducing their costs and scaling their services. NucleusIS also advises clients on product improvements, notably, a public health insurance company’s addition of pregnancy and childbirth coverage in the first year of family plans and launch of a plan for seniors including care for diabetes and other chronic conditions – now that client’s two fastest-growing products.

All these services make health insurance more accessible for people with low or irregular incomes as well as for informal worker segments. Since late 2021, NucleusIS has also been piloting the sale of plans on credit or on accumulated savings, an unprecedented offer in Nigeria.

HMOs that use NucleusIS’s technology report an average reduction of 20% in claim obligations due to better detection of inconsistencies in billing and a yearly increase of 4-15% in number of lives insured (perhaps partly through higher customer retention). As of the end of 2021, the venture was working with 12 HMOs in Nigeria (covering 20% of all lives in that country) and one HMO in Ghana and had migrated 7 100 hospitals in Nigeria and 814 in Ghana (in process), four pharmacy groups in Nigeria and 966 000 individuals in the two countries combined onto its platform. On the retail side, it had enrolled 10 800 people as of late May 2022, an exponentially growing figure.

NucleusIS will use 80% of the award grant to scale its credit scheme for enrolling individual users and groups (cooperatives, SMEs and religious organizations) – specifically, to explore a model whereby HMOs would enrol referred clients without an upfront premium payment, instead accepting monthly payments thereafter. The Swiss Re Foundation funding will be used to guarantee payments, shielding HMOs from direct financial exposure. In addition to credit financing, The remaining 20% of the grant will finance the hiring of strategic talent to develop and deploy an electronic medical record product for hospitals.

60 Decibels - NucleusIS Report

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