As the nation moves toward comprehensive healthcare reform, co-ops are gaining national recognition as a possible alternative to a public healthcare option. Wisconsin's co-ops have been successful, but took time to build. Meanwhile, local employers are moving toward value-based benefits design as a way to curb costs and increase drug complaince. Health plans statewide have been impacted by the economy, but the provider-owned HMOs are holding their own when it comes to commercial enrollment numbers.