Group Health's governance as a nonprofit member-owned cooperative has attracted national attention recently as healthcare reform discussions in Washington DC look toward insurance cooperatives as a possible alternative to a "public option" health plan. But the key to its ability to control costs, its leaders say, is in the integration of its insurance, hospital, clinic and pharmacy management functions. The medical home model is another concept getting attention during the national debate on healthcare reform. Premera Blue Cross, the largest insurer in Washington, and Swedish Health Systems, the largest nonprofit healthcare provider in the Seattle market, have rolled out a new out-come-based medical home initiative at Swedish's Ballard Clinic. The new payment structure includes incentives for Swedish in delivering quality care to Premera's participating members. Required "cost estimators" in Oregon might have a more far-reaching effect than just giving online price information to consumers. It might result in a marketplace where providers compete more keenly on cost and quality.