In April 2008, The Commonwealth Fund launched a five-year initiative to help safety-net primary care clinics become patient-centered medical homes and achieve benchmark levels of quality, efficiency, and patient experience. Due to the high caliber of the applications and enthusiastic cooperation of several local foundations, the initiative will expand from 50 clinics in four states to 68 clinics in five states: Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania. Over the next year, project staff will provide the states with technical assistance for improving the management, reorganization, and delivery of primary care. Early challenges and lessons learned will be disseminated nationally through a listserv, webinars, online resources, and Fund publications. Cofunders will likely include the Colorado Health Foundation, Jewish Healthcare Foundation, Northwest Health Foundation, Partners Community Benefit Fund, Beth Israel Deaconess Medical Center, Blue Cross Blue Shield Foundation of Massachusetts, and The Boston Foundation. Support from these cofunders will allow the Fund to expand the initiative from four to five regional organizations.