BUSINESS COALITIONS ON HEALTH - THEIR ACTIVITIES AND IMPACT

Background: Business coalitions on health-generally nonprofit, communi ty-based membership organizations primarily composed of local employer s-attempt to manage the cost and quality of health care delivery. They are also active in other areas, including member education, data coll ection, and selective contracting. Issues: With reference to projects related to public accountability for hospital quality of care, coaliti ons have been involved in legislative support of state public database s, efforts to develop severity-adjusted information on hospital qualit y, group purchasing from selected hospitals based on cost and quality- an activity conducted in more than 20 locales, and consumer education. Conclusions: With health care reform, coalitions will need to shift f rom looking solely at individual physicians and hospitals to looking a t them in the context of managed care. Balancing the tension between c ontinuous quality improvement activities and public accountability wil l also be an important issue for coalitions. The future of coalitions after health care reform is uncertain, with scenarios ranging from the ir demise to their expansion as active purchasing coalitions or their assumption of new roles and activities. Whatever the future viability and focus of health care coalitions, they have effectively served as c hange agents in their communities.