Blue Cross Blue Shield of Massachusetts is reacting to market conditions in a number of ways, through talks with Excellus BlueCross BlueShield of New York about a potential collaboration in the ancillary products arena, through a new provider contracting system based on quality standards and the expansion of a wellness component to its product offering to municipalities. Two programs targeting the uninsured in Maine and Vermont are facing funding difficulties. Vermont officials say their Catamount Health program isn't sustainable without federal health, and the Dirigo program in Maine is at a funding crossroads after voters rejected a funding mechanism in the November elections. The medical home concept is making headway in Rhode Island and New Hampshire with 11 pilot sites selected in New Hampshire and the state's top insurers all involved in the two-year pilot program. Rhode Island, meanwhile, is forging ahead with its plan to reshape its Medicaid program by receiving a set amount of funding from the federal government, but be responsible for costs that go over that amount. In return, Rhode Island Medicaid would have flexibility to design benefits and manage the Medicaid program outside the usual rules.