Two collaborative efforts involving multiple health insurers in Pennsylvania have the potential to improve the quality of healthcare in the state. The first is a transparency effort involving how care is delivered at 160 hospitals in four major categories of medical care. The second is a medical home initiative offering up to $13 million in incentives for primary-care physicians who coordinate care in specified ways. Meanwhile, enrollment in the private fee-for-service segment of Medicare Advantage has grown by 45 percent in 2008. Managed care companies are awaiting decisions on new contracts to serve Medicaid beneficiaries in the Lehigh/Capital regions. In the northeastern region of the state, commercial enrollment for the Blue Cross plan has been slipping as the company and its local competitor, Geisinger Health Plan, face competition from national insurers. And a new contract between Aetna and an ambulance company in the Philadelphia area is the first of its kind for Aetna in the region.