For several decades, business and health coalitions have played an important role in representing the interests of business in the health care arena. During the 1990s, these coalitions focused their efforts on supporting purchasing activities related to health insurance benefits and direct health care. Based on a national survey conducted in 2006, and prior similar surveys, we find that business and health coalitions have invested in pooling regional health care data, promoting public reporting of quality and cost information, and coordinating pay-for-performance initiatives. In addition, many business and health coalitions are broadening their membership to include other stakeholders and to support community health reform efforts with far-reaching benefits. Through this work, coalitions increasingly are recognizing and embracing their role as catalysts for local market reform.