This Evaluation Highlight is the first in a series that presents descriptive and analytic findings from the 18-state evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)'s Quality Demonstration Grants. In this Highlight, we discuss the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. Our analysis is based on work completed by the States during the first two years of their five-year demonstration projects. These two years included a one-year planning period followed by a year of implementation.