Mary McWilliams, president of Regence BlueShield since 2000, has been founding CEO of two other health plans: Providence Health Plans in Oregon and PacificCare of Washington. She graduated from Wesleyan University and received a master's degree in health administration from the University of Colorado. She has lived in the Pacific Northwest for 25 years and just completed a term as chair of the Greater Seattle Chamber of Commerce.

What do you do to stay healthy?

I set my alarm for 5:45 a.m. for a daily aerobics class at 6:15. The only hard part is the alarm. I got "most improved" in step class for my efforts.

What is your guilty pleasure?

Wine and chocolate, but not together.

In the 1970s, insured employees paid about 30 percent of their health care costs. Today it's less than 15 percent. What does that tell you?

While consumers are paying more for health care, their share of costs hasn't kept up with rising cost of care. Moreover, health insurance, particularly when paid by employers, insulates consumers from understanding the true cost of their care. We don't act as if we are paying for health care from our own pockets.

How popular are the high-deductible health plans with corresponding health-savings accounts?

Just like individuals who pay for their own coverage, increasingly employer groups are offering high-deductible health plans with Health Savings Accounts to put employees in charge of paying for their health care. Paying from an HSA rather than from insurance coverage makes patients smarter shoppers.

Should health care providers be reimbursed for the quality of care and not just for their services?

We need a major redesign of how providers are paid to reward for quality and for managing within a budget for health care, rather than for simply providing more services. This will require a national solution ultimately.

What's the biggest challenge to providing affordable health care in Washington?

There's no single factor, but variation among providers in the cost and quality of health care is a big driver. There's no cookbook for medical care, but there are evidence-based guidelines for best practices for many conditions. That's why we support the Puget Sound Health Alliance, which is mobilizing a community-wide effort to measure and improve the quality of health care.

What is Regence doing to improve the delivery of health care to its members?

We're starting with ourselves as an employer to be the change we want to see. We're offering navigation, advice, and rewards to help all our members manage their own health care. We have a new suite of products that represent an approach we call "self-managed care."

If you could have any job other than the one you have, what would it be?

Perform in musical theater.

Do you have a mentor?

Don Brennan, former CEO of the Providence Health System, and now chair of Washington Health Care Forum. I've watched Don play Solomon, trying to balance the interests and views of various individuals and groups.

What advice would you give someone going into the health care field?

Get a graduate degree, and then get into a new facet of health care, like performance measurement or an application of health information technology. Rest up; it will take a lot of energy.

Is there anything in your life you'd like to do over?

I wish we'd taken family vacations at spring break more often. Only after my kids were nearly grown did I realize that we should have taken more opportunities to get away as a family, like spring break. There are precious few times when a family can make memories together.