Employers have great—if, to date, underutilized—market leverage in buying health care, and often can influence other stakeholder groups, even exercising a leadership role. If fully engaged, they can push hospitals and health plans in their communities to improve care for their employees at a manageable cost. In short, employers can be a key change agent to improve health care quality—but only if motivated and mobilized.

This issue brief describes what is needed to fully "engage" employers. Aligning Forces for Quality (AF4Q), a national program of the Robert Wood Johnson Foundation, is working with its local alliances to do just that. By encouraging the business community to take actionable, concrete steps to engage in health care quality and cost, AF4Q is seeking to leverage employers to spur quality improvement and lower costs. The goal: to apply market pressure where applicable, to support healthy behaviors, and to communicate directly with employees in order to improve care at a manageable cost.