This Evaluation Highlight discusses the early accomplishments, challenges, and lessons learned from the following four states pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. It describes the states’ efforts to select meaningful measures, adapt health plan and state-level measures for practice-level reporting, and use technology to collect measurement data. The analysis draws on semi-structured interviews with demonstration staff, providers, and stakeholders and semi-annual reports the states submitted to the Centers for Medicare & Medicaid Services.