After more than 13 years as the president and CEO of the Washington-based National Business Group on Health, Helen Darling plans to retire at the end of April. She recently spoke with Business Insurance Associate Editor Matt Dunning about the rapidly changing health care marketplace and the challenges employers face in providing health benefits to their workers. Edited excerpts follow.

Q: During your time with the NBGH, what are some of the key changes you observed in group health benefits?

A: Well first off, just look at how expensive they are. It's close to $15,000 per active employee now. It's had the effect of making employers say they can't continue to subsidize this system the way they have in the past. We've seen a movement toward more of a defined contribution model in health care. More employers, including the government, are saying they can only provide so much, and plan members are going to have to spend more of their own money. There's much more shared cost than ever before, and much more talk about the fact that the employee has to be very actively engaged. If they're not, they're going to be spending more of their own money, but they're going to do it in an uninformed way.

There's been more change in total in the last three to five years than I saw in my prior 25 years in health care. The most rapid change has been to what I call the hybridization of American health care. We now have integrated delivery systems like (accountable care organizations) and patient-centered medical homes. We have insurance companies acquiring physician offices and hospitals acquiring or creating insurance companies. Sometimes it's really hard to tell them apart, because they're becoming so intertwined.

Q: What do you see as some of the biggest challenges lying ahead for both the NBGH and the employers that it serves?

A: I think it continues to be controlling costs. You can't get the growth rate of health care costs down to zero, but you can get it closer to 3% instead of 6%, 7% or 8%. For employers, the challenge is to find ways to keep doing that and to recognize that they can't stop. It's like trying to maintain your own weight. You can't get up on any day and ignore the problem. You've got to get up every day and keep working on controlling costs. Organizations need to keep sending that message, and keep providing more tools and resources to make it possible, because the world is changing very rapidly.

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Q: In an ideal world, how would you see employer-sponsored health benefits change 10 years from now?

A: In an ideal world, everyone should have access to quality, safe, evidence-based health care that is affordable for workers, employers and the taxpayers. It's possible that could occur through a combination of public-sector programs and private-sector sponsorship. I think it would have to look different, more like the defined contribution model and that sort of thing, but having employers — especially large employers — remain part of providing health care helps to keep pressure on providers to keep health care cost-effective and efficient.

Q: Finally, what are your plans after you step away from the National Business Group on Health at the end of April?

A: The NBGH board asked me to spend about 20% of my time through the end of 2014 assisting in the transition. I'm also chair of the board of directors of the National Quality Forum, which I will continue to do at least until the end of the year. I'm on a couple of other nonprofit boards that I will continue to serve on until those terms end, which will be within a year or two. After that, I hope that I will continue to have opportunities to speak about this problem of affordability and what the cost of health care has done to our other investments in the nation, such as education for children and education and training at the university level.