What impact does the dissemination of report cards of health plan performance or linking reimbursement to plan performance have on consumer selection of health plans? Researchers conducted the second phase of an evaluation of "value-based" purchasing efforts, where purchasers attempt to measure and compare providers and health plans and hold them accountable for achieving cost and quality goals. The first phase of this project was completed under a prior HCFO grant, Evaluating Business Initiatives in Health Care Purchasing. The project expanded beyond private employer coalitions to include state government purchasing and to evaluate the use of performance-related information and the impact of financial incentives. The researchers assessed five purchasing initiatives which provide report cards to consumers or tie reimbursement to performance, selecting a combination of initiatives by private business coalitions, states as employers, and state Medicaid programs. The objective of the project was to help public and private policymakers better understand the effects of disseminating performance information to consumers and of tying payments to plan performance.