Small states are uniquely positioned to bring stakeholders together. New Hampshire’s SIM model, working with over 1,200 stakeholders, recognized that moving from volume to value required a new infrastructure that included the integration of social networks and community into health care delivery, strong health information exchange and payment reforms. With a solid commitment to innovation and public service, the Department of Health and Human Services is using Medicaid waiver authority to assimilate these changes into regionally integrated physical health, mental health and substance misuse services. By 2020, the NH Medicaid program will move 50% of its Medicaid payments from its current mix of Category 2 (fee-for-service with some links to quality and value) to a mix of Category 3B (APMs with Upside Gainsharing/Downside Risk) and Category 4 (Population-Based Payments). NH will continue to work collaboratively with its Integrated Delivery Network partners and its Medicaid managed care partners to design and implement the Alternative Payment Model.