Fallon Community Health Plan, based in Worcester, Mass., is reacting to local market dynamics in announcing its intention to expand into neighboring New Hampshire. The Massachusetts market is dominated by Blue Cross Blue Shield of Massachusetts, and local carriers have looked to regional expansions to expand and grow business. In Rhode Island, local insurers Blue Cross Blue Shield of Rhode Island, UnitedHealthcare of New England and Tufts Health Plan were denied their bids for rate hikes by the state insurance commissioner. The medical home concept, which is gaining steam nationwide, is making headway in New England as well. Vermont is two years into a medical home pilot, while Massachusetts's top insurer-BC/BS of Massachusetts-is launching a pilot of its own while the state works on a statewide initiative. In New Hampshire and Maine, actions by the respective state legislatures may allow Harvard Pilgrim Health Care to incrementally expand its capacity in both states. Still struggling with a sagging economy and rising costs, Massachusetts is looking at new ways to curb costs, with talk swirling around moving the healthcare payment system more toward a global cap arrangement. Vermont and Maine are reaping the benefits of a multi-state drug purchasing pool for its respective Medicaid programs.