Introduction

In a boardroom in Seattle, a unique alliance of stakeholders in the health care system meets regularly to foment a much-needed revolution aimed at curtailing the system's costs and improving its quality of service. Representatives of some of the nation's largest health care purchasers -- employers such as Boeing and Starbucks -- sit beside representatives of the doctors and hospitals who provide care for their employees and the insurance companies that negotiate payments for that care. They are joined by other purchasers, unions such as the Teamsters, public officials, consumers, and health care experts. This group is called the Puget Sound Health Alliance. Its founder, Washington's King County Executive Ron Sims, realized that such an unorthodox alliance is the only way any of the stakeholders could hope to achieve the substantive reforms that they all desperately need.

Some stark findings by the RAND Corporation have sharply defined the problems they face. In a 2004 study, RAND found that patients in the Seattle area (one of eight regions studied) did not receive the recommended care from their doctors 41 percent of the time. Instead, they received wrong, too much, or too little care. That snapshot illustrates the broader problems confronting the U.S. health care system as a whole: It is inordinately wasteful, expensive, and often harmful to patients. The Puget Sound Health Alliance's early successes indicate, however, that it might serve as a model for advancing practical reforms that can dramatically rebalance the skewed health care equation.