When industry leaders were recently asked what they see as the biggest opportunity for private health insurance (PHI) over the next five years, a clear pattern emerged. More than two thirds pointed to technology, data and integration as the defining forces that will shape the sector’s future.
Technology as the Accelerator
AI featured in almost every response. Leaders see it as a powerful enabler to improve efficiency, remove manual work and free teams to focus on what matters most, care and connection.
Some described how automation could simplify processes and elevate the member experience, helping funds strike the right balance between technology and humanity. Around 70 percent of respondents mentioned AI, automation or digital transformation as a key opportunity area for PHI.
Turning Data into Decisions
Roughly half of leaders highlighted the potential of integrated data. They believe that the funds best able to connect information across systems and put insights in front of the right people, whether clinicians or members, will set the benchmark for value and experience.
As one leader put it, “Using integrated data and other techniques to get the right information in front of the right people to manage their health in the most effective manner, with the best experience and outcome.”
This shift moves the focus from collecting data to actually using it, helping members and providers make better decisions that improve both outcomes and experience.
“Using integrated data and other techniques to get the right information in front of the right people to manage their health in the most effective manner, with the best experience and outcome.“
Prevention and Out of Hospital Care
About a third of leaders identified prevention and out of hospital care as critical areas for growth. These approaches were seen as both cost effective and member centric, helping people stay healthy and reducing reliance on hospital based treatment.
Several leaders spoke about investment in rehabilitation, community health programs and preventative models that keep people well for longer. This reflects a broader shift from funding illness to enabling wellbeing and building more sustainable health outcomes.
The Payvider Evolution
A smaller but growing group of leaders spoke about the rise of the payvider model, where insurers take a more active role in care delivery. They see potential in combining funding and care, with shared accountability for outcomes and stronger integration between insurers and healthcare providers.
This evolution represents a more connected and coordinated approach to health, where funds can play a direct role in improving quality, access and member outcomes.
Collaboration for a Sustainable Future
While technology and data dominated the discussion, several leaders also pointed to something deeper. They argued that sustainability will only be achieved when the whole ecosystem works together.
As one response explained, “The community needs to find a solution to the core problems of health. We keep identifying symptoms as the problems and kick the can down the road. The real solution can only be found if all parties work together.”
This view reflects a growing recognition that innovation alone will not fix the system without collaboration between PHIs, hospitals, clinicians, governments and members.
A Connected Health System
Across every response, the message was consistent. The future of PHI will depend on creating a connected, technology enabled health system that uses AI and data to power better decisions, automates where it can, and unites stakeholders around a shared goal.
For those willing to lead this transition, the next five years represent an opportunity to redefine what private health insurance means to Australians and to the health system it supports.
Want to See What This Future Looks Like?
The 2025 PHI Innovation Report explores these themes in depth, drawing on insights from across Australia’s leading funds. It highlights how technology, integration and collaboration are already reshaping the sector, and what separates funds that are adapting from those at risk of falling behind.
If you want a clearer view of where PHI innovation is heading — and how your organisation compares — register now for the report. You’ll also receive an invitation to the PHI Insights Playback Webinar, where we’ll unpack the key findings live.