Here is a look at several active purchasing coalitions located in the United States:

The Buyers Health Care Action Group

Service area: Minneapolis/St. Paul, Minn.

Membership: 38 employers.

Accomplishments: Contracted with HealthPartners, a Minneapolis-based managed care company, to create a PPO program for more than 250,000 covered lives. Most of HealthPartners' administrative fee was based on performance standards set by the coalition. Began laying the groundwork for direct contracting to implement the present "care system" approach this year.

Priorities: Monitoring first year of new "care system" approach to health care, under which the BHCAG reorganized local primary care physicians, specialists and hospitals into umbrella groups that compete for members based on the health care coverage offered. Employees are allowed to select among higher- and lower-cost groups, which function as PPOs (BI, Dec. 23/30, 1996).

Other goals: Work with a health coalition in Sioux Falls, S.D., to reform its care system model; expand in 1998 to include all of North Dakota, South Dakota, Minnesota and Wisconsin.

The Alliance

Service Area: Madison, Wis.

Membership: 700 employers.

Accomplishments: Negotiated pro-vider networks with hospitals and clinics on a discounted, fee-for-service basis. Buyers have saved about 15% a year on average.

Priorities: Integrating quality measures in purchasing decisions; sending out patient satisfaction surveys.

Other goals: Find ways for employers to better use and understand technical data gathered by the Alliance; launch a smoking control initiative; and develop clinical outcomes measures in key diagnostic areas.

Chicago Business Group on Health

Service area: Chicago area.

Membership: 70 employers.

Accomplishments: Started Employers Purchasing Initiatives for Quality-EPIQual-to buy health services directly from hospitals, doctors and other providers; created the Quality Improvement Council to study clinical topics, such as cardiac care and Caesarean sections, and the Chicago Health Plan Value Project, an in-depth study of seven managed care networks.

Priorities: Involve unions and big public sector employers in the coalition's area.

Other goals: Act as a facilitator of information and research tool in a market that is highly fragmented and hard to integrate.

The Colorado Health Care Purchasing Alliance

Service area: Colorado.

Membership: 150 employers.

Accomplishments: Started the Cooperative for Health Insurance Purchasing, or CHIP, program in 1995, under which small employers are able to offer their employees the choice of four managed care networks providing different levels of coverage; employees choose the plan while employers choose coverage level. Quality report cards kept on each network with financial penalties imposed for failure to meet established performance standards or attain high satisfaction ratings.

Priorities: Increase membership size, build Cooperative for Health Insurance Purchasing, boost clout.

Health Care Payers Coalition of New Jersey

Service area: New Jersey.

Membership: 55 employers.

Accomplishments: Direct contracting program with 60 of 90 hospitals in state. Hospitals must pass quality screening before negotiating with the coalition.

Priorities: Get more health care data from providers; set up a "quality institute" through which payers, consumers and providers can discuss health issues.

Other goals: Set clear priorities, be realistic about potential new programs based on funding availability.