The Michigan Department of Health and Human Services (MDHHS) has entered into a cooperative agreement with the Centers for Medicare & Medicaid Services (CMS) to reform multi-payer health care payment and delivery systems in Michigan. The Michigan SIM initiative is seeking to achieve better care coordination, lower costs, and improved health outcomes for Medicaid beneficiaries across the state. Core components to SIM include support quality improvement and cost savings in qualified Patient Centered Medical Homes (PCMHS), supporting the development of Community Health Innovation Regions (CHIR) to support partnerships across health and community sectors to address Social Determinants of Health, promoting Alternative Payment Models (APM) to align medical reimbursement with health outcomes instead of services rendered. MPHI supported the state during the extensive stakeholder engagement and planning phase for SIM in 2013. Currently, MPHI is supporting the implementation of SIM through coaching, CMS reporting, and the coordination of the state-led evaluation.