How Phoenix Health Fund is tackling preventative health

Preventative healthcare is on the radar of most Australian health insurers amid a growing chronic disease burden - but according to Tracy Shepherd of Phoenix Health Fund, the sector could still be missing opportunities to promote member wellbeing.

Tracy, who is due to speak at the Health Insurance Summit later this month, says this is, in part, a semantics issue, with prevention often meaning “different things to different people”.

Equally, it’s about prioritisation, she argued, with prevention best served as core member support, not an optional extra.

“[At Phoenix Health] our approach is shifting from a traditional reactive health model — where support often starts after a hospital admission or diagnosis — to a more proactive model that uses data, education, partnerships and targeted programs to identify members earlier and connect them with the right support before their health risks escalate,” she said. “Our prevention strategy is focused on improving member wellbeing, reducing avoidable hospital utilisation, and supporting the long-term sustainability of the fund.”

Tracy claimed shifting the focus away from the traditional reactive model was crucial for driving down expenditure in the current climate, where three in five Australians currently lives with one or more chronic disease.

However, she said the current funding model was particularly constraining insurers in terms of early intervention.

“As [health] funds, we struggle with that. The current legislation is heavily weighted towards Chronic Disease Management not early intervention models of care.

“We could do a lot more if we didn’t have those funding barriers. We’ve got so much data to inform and support members in this early stage, but not those financial levers,” she said.

Three phases of prevention

Tracy suggested the best results come when prevention is considered and funded across three distinct phases:

Early Education and Member Awareness

This first phase is about helping members understand their health risks and the value of acting early. Here, the insurer helps members understand their risks and available support.

Tracy says member education is a recurring feature in Phoenix’s prevention materials.

“We offer education about routine screening, lifestyle programs, health and wellbeing services, and the significance of early engagement,” she said.

Data-led risk identification and health economics

In the second phase, insurers use data and tools to understand where prevention can make the greatest difference and identify members who may benefit from intervention.

Phoenix’s data model works to support risk stratification, proactive outreach, and program matching. It also provides a way to analyse program outcomes, effectiveness and potential return on investment over time.

“This is where health economics becomes critical. Prevention needs to demonstrate both clinical value and financial value,” Tracy said.

“For health funds, prevention needs a strong economic story. It is not enough to say prevention is important; we need to show that it improves health lifestyles and outcomes, reduces avoidable utilisation, and supports sustainable funding models.”

Targeted intervention, partnerships and CDMP

In the third phase, members are connected to the right intervention. Here prevention program, health and wellbeing pathways, or Chronic Disease Management Programs come into play – especially those in areas such as mental health, diabetes, weight management, osteoarthritis and heart health.

“Once we identify the risk, the next step is making sure the member is engaged and has a practical pathway — whether that is education, digital support, GP-led care, a CDMP program, or a more structured clinical intervention,” Tracy said.

Collaborations

To boost the sector’s prevention efforts, Tracy said cross-sector collaborations are key.

The industry is already working closely with Allied Health professionals, clinicians and GP practices, exploring different ways to offer prevention services to members.

In her role at Phoenix Health, Tracy has personally worked with GPs, to develop a diabetes program, delivered through the GP practice via a team of nurses, dieticians and a diabetes educator.

“The member is the centre of everything, it’s about being very collaborative, finding those like-minded clinical partners who are passionate about prevention, and doing whatever we can within the current funding parameters,” she said.

Further insight

Sharing more on what Phoenix Health Fund is doing in the prevention space, Tracy Shepherd will join a panel of experts at the upcoming Health Insurance Summit.

This year’s event will be held 21-22 July at the Crown Conference Centre Melbourne.

Learn more and register your tickets here.