The landscape of health insurance is changing. Three of Washington’s largest health insurance providers – Premera Blue Cross, Regence Blue Shield, and Group Health Cooperative – discuss how the health insurance industry has evolved over the last five years and what’s in store for the future.

Perhaps the most significant trend in the industry has been the movement away from managed care, and toward designing health insurance plans that give more control to the consumer.

“I think our whole focus has been on adding choice,” said Maureen McLaughlin, a vice president in Group Health’s health plan division.

“Five years ago we were in a very different health care environment,” said Scott Forslund, communications director for Premera Blue Cross and its affiliate, LifeWise Health Plan of Washington. “The nation was coming off our experiment with managed care and we experienced a ‘managed care backlash’” — a backlash in which consumers reacted negatively to the restrictive managed care networks and rules that kept consumers from making their own choices.

This increased desire for choice and flexibility has prompted health insurance providers to add new benefits packages to their product offerings, such as Premera’s Dimensions health care plans and Regence Blue Shield’s FourFront plans. These new plans allow employers to design more customized benefits plans for their employees, and offer options such as a series of pre-paid doctors visits upfront for the “casual user.”

Group Health, whose focus has traditionally been on the HMO model, has added more consumer-driven plans and deductible plans, and is in the process of launching a PPO plan in Spokane. McLaughlin cautions consumers against relying too much on these labels as strict definitions, though, in these days of changing benefit plans and evolving product offerings.

“We use labels like HMO and PPO because they are convenient,” she said. “But the truth is, a lot of things people didn’t like about HMOs have been eliminated, and some PPO plans have elements of medical management.” For example many HMOs today allow subscribers to self-refer to specialists and many PPOs require pre-authorization for potential big-ticket treatments, such as a hospital stay.

Another major change in health insurance benefits has been the recent introduction, through changes in legislation and the federal tax code, of health savings accounts (HSA) and health reimbursement accounts (HRA). Similar to flexible spending accounts (FSA), HSAs and HRAs are tax-free savings accounts that consumers can use to pay for qualified health care expenses. Unlike FSAs, however, the money saved in an HRA or HSA account can roll over from year to year. Money saved in an FSA account must be spent within the calendar year or is forfeited.

All three insurance providers offer HSAs, or are preparing to offer them, as part of their benefits products. Typically benefits packages that include an HSA have a higher deductible than plans without them. Group Health is also preparing to launch an HRA as part of its product offerings. Both employees and employers can contribute funds to either an HRA or HSA. The difference between the two savings plans, broadly speaking, is that if an employee leaves a company, they lose access to the funds in an HRA, but the money in their HSA can be taken with them.

The last few years have also seen a new focus on collaboration an education between health insurance agencies, providers, and consumers.

“We’re focused on the ease of doing business,” said Jonathan Hensley, vice president of sales for Regence Blue Shield. “We want to arm our members with information so they can have a more informed decision making process.”

Many health insurance agencies now provide a wealth of information to its subscribers and participating providers through their Web sites, as well as tools such as online claims submission, online eligibility review, health risk assessments, and more.

“Our investment in technology has been one of the keys in providing tools and services to providers and members,” said Hensley. “Now instead of picking up the phone at 8:30 on a Monday morning and sitting on hold, most of that [work] can be done on the Web.”

Group Health has established consumer groups and senior caucuses in the communities near their medical centers. These groups meet regularly to discuss health care issues, both to provide feedback to Group Health and to allow Group Health to educate its subscribers on important health issues.

Both Premera and Regence have developed awards programs for participating providers to recognize and encourage outstanding, quality care. Premera has also created an extensive “quality score card” in collaboration with a number of the major medical organizations in the country, to help rate levels of care being given by specific providers.

“We know that quality, cost, and satisfaction have to be looked at together,” said Forslund.

The common thread that runs through all of these changes, and one of the major issues that the entire health care industry faces today is cost. Health care costs are rising and everyone – from consumers to health insurance companies – are feeling the heat.

“We’re using more expensive health care more often,” said Forslund. Twenty years ago, he continued, the x-ray was the most common imaging technology used in medicine. Now, you’re more likely to get an MRI. A better picture, but also a significantly higher cost.

This country’s aging population and growing problems with obesity are also contributing to rising medical costs.

More questions than answers remain about solving this issue. Health insurance companies are working to address it in some ways by offering new plans that have higher deductibles and co-pays. Employers are trying to mitigate their costs by passing on more of the premium costs to their employees. Consumers can reduce some of their expenses through health savings plans and by making informed choices about their medical care. Whether these steps will be enough remains to be seen.

“The combination of new technology and new drugs, piggy-backed next to an aging population – we’ve got a significant problem trying to pay for all this,” said McLaughlin. “How we address that is something that needs to be on the national debate.”.