Last weekend NESCSO, the Millbank Fund and the New Hampshire Department of Health and Human Services convened a group of twenty-two state executive and legislative branch health policymakers in Portsmouth, NH to consider the future of hospitals in the region. All six New England states were represented. Hospital roles are evolving quickly with national and state health reforms, implementation of the Affordable Care Act, community health needs assessments, and value-based purchasing. The group discussed hospital and payer consolidation, payment reforms, quality improvement, and the states’ role in protecting capacity while controlling costs. The group also emphasized the need for simple communication tools to help legislators and the public understand complex shifts in the region’s health care system. Congratulations to CT’s Medicaid Director, Kate McEvoy, who now chairs the NESCSO Board of Directors.