Member Requirements: Three representatives of self-funded purchasers for employees; Two representatives of health carriers or third party administrators that have the most fully insured and self-funded covered lives in Washington state; One representative of a health maintenance organization having the most fully insured and self-insured covered lives in Washington state; One representative of a national health carrier, chosen from among three nominees submitted by the association of Washington health plans ; Two physicians, one of which is a primary care provider (either a family physician, an internal medicine physician, or a general pediatrician), representing clinics with fewer than 50 physicians, selected from lists of nominees submitted by the Washington state medical association ; Two physicians representing the largest hospital-based physician systems in the state, selected from a list of five nominees submitted jointly by the Washington state medical association and the Washington state hospital association; One osteopathic physician selected from a list of five nominees submitted by the Washington state osteopathic medical association; Three representatives of hospital systems, at least one of which is responsible for quality, submitted from a list of six nominees from the Washington state hospital association; Two representatives of state-purchased health care programs; and One representative of the Puget Sound Health Alliance.