The role of employers in community health care systems.

Employers can play an important role in shaping community health care systems through their direct efforts to institute system change, their negotiations with health plans, and their decisions concerning the structure of health benefits for their employees. This paper describes recent employer initiatives in all three of these areas, using data collected from interview respondents in the twelve communities that are part of the Community Tracking Study being carried out by the Center for Studying Health System Change. During the recent period of relative health premium stability, employers have responded to employees' concerns about managed care by favoring looser, less structured managed care plans offering broader networks of providers or out-of-network options.