Cost, Quality, Access: More Dialogue Needed Between Purchasers and Providers

Seminars on identifying issues facing health care purchasers and providers

In 1999 Columbia University, New York, convened two seminars to help develop a dialogue between members of the business community and medical professionals on how they could work together to have a more positive impact on the quality of health care.

The International Center for Health Outcomes and Innovation Research – a health care research center based at Columbia Presbyterian Medical Center in New York City — organized the meetings to address growing concerns that technical, professional, and cultural barriers between the business and medical communities have created inefficiencies in the health care system, particularly in regard to purchasing decisions.

These meetings were designed to help plan the agenda for a longer-term project whose objectives were twofold:

  • To help initiate a broader national dialogue between purchasers and providers that would address critical issues of cost, quality, and access in health care policy.
  • To demonstrate how purchasers and providers, working together, can develop practical and workable health care strategies and models.

Key Results

  • The meetings were held at The New York Academy of Medicine in New York City on May 12 and November 4, 1999. Some 24 participants representing 23 organizations (primarily major employers, employee organizations, managed care and health provider organizations, foundations, and government) attended each meeting.

    Paul A. Volcker, former chairman of the board of governors of the Federal Reserve System, and David Skinner, M.D., who was chief executive officer of New York Presbyterian Hospital at that time, co-chaired both meetings.

    At each session an outside expert provided case studies on innovative purchasing strategies (e.g., partnerships between businesses to enhance the value of their health care spending through initiatives too large for them to pursue individually, and partnerships between purchasers and providers).

    Discussions were also informed in part by a background paper on promising models of quality measurement and improvement, which was prepared by Jack Meyer, president of the Economic and Social Research Institute, a nonprofit research organization based in Washington, D.C. (See the Bibliography for complete details.) The Commonwealth Fund provided an additional $25,000 for the meetings.
  • The principal outcome of the sessions was an agreement among participants to establish The Health Council, a permanent independent organization designed to conduct research, formulate policy, and to speak out for the implementation of its recommendations on issues affecting the long-term future of health care in the United States.

    The Health Council would be distinguished by the following five characteristics and abilities:
    • A focus on developing partnerships between purchasers and providers.
    • Avoidance of lobbying and partisanship.
    • Policy-level participation by top leadership in business and the health care industry.
    • A long-term perspective.
    • Identification and promotion of strategies for improving health care cost, quality, and access.

    The membership of its volunteer board of trustees would be drawn primarily from innovative and creative thinkers in the health care purchaser and provider communities.

    The Health Council would produce policy statements and research studies and market them to government policymakers and key constituencies in business, medicine, education, labor, and the media.
  • According to the project director's final report to the Robert Wood Johnson Foundation (RWJF), comparisons with other leading health care organizations indicated that The Health Council would occupy a distinctive niche in the policy community. However, the original project director (Keith Reemtsma, M.D.) died and these plans are on hold while new leadership for The Health Council is sought, along with an institution that would house the organization.


RWJF supported the project with a grant of $49,478 between February 1999 and January 2000.

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