Big, employer-paid health policies are still the bread and butter of the insurance industry, but that's not the growth segment it used to be. Today, the industry's forward-thinkers are focusing on "retail" -- pushing products, policies and health advice directly to the consumer, rather than the employer.

Eyeball-glazing terms such as "one-to-one marketing," "consumer engagement," "retail segmentation" and "multidimensional brand experiences" are being thrown around by health insurers in the same way they might be used at teen retailer American Eagle Outfitters' headquarters.

Because of the economy, because of the reform winds, because of new technologies, health insurance is increasingly -- if slowly -- becoming an individual, personalized commodity.

"There is a fork in the road," said Matt Fiddler, director of retail marketing at Pittsburgh's Highmark Inc., the region's largest health insurer. "Consumer expectations have changed immensely in retail, let alone retail insurance."

Insurers, by necessity, are changing, too.

But what's the end game?

Well, there's the obvious -- reaching new customers in new places means new revenue streams. But it's also about involving consumers to the point that they are aware of their own medical- and health-related decisions, their responsibilities as consumers of care.

The hope is that engaged consumers will ultimately be healthier ones. They'll use their benefits less often, and when they do use, it will be in a preventative fashion to catch problems sooner rather than later. Healthier customers, in the end, reduce costs across the system.

And retail-style sales techniques may be one approach to creating engaged consumers.

Highmark, for example, is taking the retail side of the equation literally, having opened a store in the North Hills (and another near Harrisburg) called Highmark Direct, where individual buyers and small-business clients can get information on products.

Foot traffic has exceeded expectations -- 7,000 or so at both stores since March -- and for the most part, customers have avoided the temptation to use the store as a place to vent about their coverage problems.

It's not just health insurers pursing new retail strategies. All sorts of service firms, from electricity providers to credit card companies, are toying with "consumer-driven" sales theory.

"I call it retail for nonretailers," said Diane Rambo, creative director at Columbus, Ohio-based Big Red Rooster, the branding and design firm responsible for the sleek new Highmark retail outlets. "They wanted to extend themselves out into the public .... What would happen if they were actually in the fiber of your day, next to Walgreens?"

One-on-one engagement goes beyond the physical retail space. In March, Highmark rolled out two new "mobile marketing vehicles" -- big trucks that can serve as information depots, enrollment centers and conference rooms.

Not every experiment is a hit. Two Decembers ago, Highmark Inc. unveiled its new, just-in-time-for-Christmas gift idea -- a Visa "healthcare gift card." It could be loaded with as little as $25 and as much as $5,000, to be spent at the doctor's office, the gym, the local pharmacy or anywhere else health-related.

Highmark was hoping to take the product national, thinking it might be a big hit among post-college youngsters without health insurance and seniors on fixed incomes.

But Highmark and Visa sold fewer than 1,500 in all, with an average "load" of about $200. As a result, Highmark has stopped selling the cards, and the Web site that sold them, givewell.com, now informs former buyers to call 1-866-466-8019 if they have any lingering service questions.

The fate of the product illustrates the hit-and-miss nature of the industry's quest to become less reliant on employer-driven group plans and more focused on individual products and out-of-the-box moneymakers.

"We may have some wins. May have some losses," Highmark's Mr. Fiddler said. "In the grand scheme of gift card transactions, is it comparable? No." But the cards are "one tool in the toolbox," he said, and could be tweaked down the road and reused in a different way.

Each new product, and its relative success or failure, tells Highmark a bit more about customers and what they want, he said. Gift cards are a piece of the puzzle. Individual policies are another piece. Vans and retail stores are yet another.

"One-on-one marketing only works when you understand the 'ones,'" Mr. Fiddler said.

Like most other health insurers, UnitedHealth has built an incentive program to help understand the "ones." Finding out which customers want to be "engaged," and which ones don't, help a health insurer better focus its marketing efforts.

By offering discounts or gift cards in exchange for, say, filling out a health risk assessment survey, a company finds out which customers are willing to take their health care a bit more seriously if given the right nudge.

"It isn't enough to give [customers] the tools and information," said Sue Shick, the new CEO of UnitedHealth's Pennsylvania division.

"Those kind of carrots and those incentives really work."

Along those line, UnitedHealth also offers health care "discount programs" to some members, a menu of health-related services -- gym memberships, smoking cessation -- for which the members receive what are essentially health care coupons. UnitedHealth says the coupons connect most strongly with women, who make most health care decisions in a family.

Here's another tool: Earlier this year, UPMC Health Plan unveiled its new "dynamic" ID card. The multipurpose card, with a magnetic strip on the back of it, can tell a doctor about a patient's health history or how much the co-pay will be at this particular office.

Certain customers also get a MasterCard version of the dynamic ID, giving those policyholders the ability to link up to a spending account or know how much is left on their deductible.

"We are definitely the first in this market," said Mary Beth Jenkins, chief operating officer of UPMC Health Plan. "Other plans have done it in pilot form. We really have it out there for all of our members."

UPMC Health Plan also is planning to offer short-term, individual products (something Highmark and UnitedHealth have been doing for years), perhaps as early as this year.

Ms. Rambo, of Big Red Rooster, says there's irony to be found in the multifront push toward retail. Earlier in the decade, with the rise of Amazon.com and eBay, prognosticators were predicting the demise of retail. Bricks-and-mortar was out, "clicks"-and-mortar was in.

But some problems are better solved face to face.

"When cell phones first came out, it was all about acquisition [of customers] at first, not retention," she said. Now, everybody has a cell phone, and organic sales growth possibilities for suppliers are limited, so wireless companies are fighting for existing customers among various other carriers.

It's the same in health insurance. Fewer customers are tied to a specific insurer through their employer; more of them are free agents, so to speak, looking for the best deal.

And to them, "Service is important," Ms. Rambo said.