Business coalitions on health: their activities and impact.

BACKGROUND

Business coalitions on health-generally nonprofit, community-based membership organizations primarily composed of local employers-attempt to manage the cost and quality of health care delivery. They are also active in other areas, including member education, data collection, and selective contracting.

ISSUES

With reference to projects related to public accountability for hospital quality of care, coalitions have been involved in legislative support of state public databases, efforts to develop severity-adjusted information on hospital quality, 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 from looking solely at individual physicians and hospitals to looking at them in the context of managed care. Balancing the tension between continuous quality improvement activities and public accountability will also be an important issue for coalitions. The future of coalitions after health care reform is uncertain, with scenarios ranging from their 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 change agents in their communities.