Beginning in January 2010, Tennessee plans to test a statewide database that will include claims data from claims paid by most of the payors in the state. The database is designed to improve transparency and efficiency of healthcare. Large state-licensed health plans must participate in the database, and are generally supportive. The emergence of pharmacy kiosks or dispensaries at doctors' offices is a new wrinkle in the distribution and marketing of prescription drugs in Tennessee. Insurers have yet to come up with a consistent policy regarding this practice, which seems to be gathering steam as doctors look for additional revenue. Coinsurance appears to be making a comeback, at least in east Tennessee, where several plans are promoting it as a way to keep premiums down and shift cost to employees. Bluegrass Family Health continues its push into Tennessee from its home turf in Kentucky. BlueCross BlueShield of Tennessee continues to dominate the state's PPO and other market segments despite a hit in investment income in 2008.