While some states have implemented programs in recent years to improve the quality of care and overall health system performance, many find themselves under-resourced and ill-equipped to address these issues on their own. Building on findings from the Commission on a High Performance Health System's State Scorecard, the proposed State Quality Institute will assist eight state teams in developing and implementing sustainable quality improvement action plans centered around value-based purchasing, quality reporting, care coordination, or chronic care management. The Institute will enable state teams to consult in person with experts in each of these areas and receive additional technical assistance through site visits, Web-based conferences, and other means. State teams will share their experiences with one another and report on their progress. AcademyHealth will disseminate results to state health policymakers through reports and issue briefs.