In addition to the participants of the Quality Improvement Institute, other states are promoting the chronic care model and medical homes, supported by payment reform and patient registries. The states are planning and implementing changes in public coverage programs, but they are also working with private insurers and medical practices to redesign care delivery throughout the health system. The intent is to transform the system from one that reacts once someone gets very sick to one that provides proactive, comprehensive, and coordinated care to keep people with chronic illnesses as healthy as possible. The following Snapshots summarize such activity in Vermont, Pennsylvania, and Minnesota.