As plans merged it became clear that most employer coalitions were paying attention to cost, but not necessarily to the quality of care provided by plans. A few of the employer coalitions groups did, however, realize they needed to pay attention to quality and responded by directly contracting with health care providers. The majority of coalitions are formed by employer groups. While many of the larger purchasing coalitions include companies and public employers that are unionized, union involvement in coalitions is generally low. The majority are in construction trades, retail and the service industry, and a few include unions representing school employees, public safety workers and state employees.
Coalitions vary in size and location.
For example, the Cooperative Health Network covers 14,000 people in Ohio and includes four health funds while the Health Care Cost Containment Corporation of the Mid-Atlantic Region covers 350,000 people in Washington, D.C., Maryland and Virginia, and includes 55 funds. A. Unions can be more active purchasers in a couple of ways. A. Coalitions should seek to contain cost and enhance quality through bargaining strength, enhance competition among plans, and gather and share information on providers, terms of contracts with insurers and satisfaction with care and services. A few coalitions have the limited purpose of collecting information on clinical quality or sponsoring member satisfaction surveys. Roles of coalitions vary.