Health plans in Massachsuetts, coming off one of their toughest years financially, are battling state regulators over premium increases, and the battle is hitting insurers' bottom lines. Maine is set to move away from its primary-care case management Medicaid program and into managed care, opening the door for Medicaid HMOs or even local accountable care organizations to gain contracts. In Rhode Island, the state's largest insurer—Blue Cross & Blue Shield—has launched its first value-based benefit design initiative, rolling it out for members in its Direct Pay line of products. Blue Cross Blue Shield of Massachusetts, the state's largest insurer, is continuing to sign providers to its Alternative Quality Contract, which seeks to re-shape the way providers are paid.