Some private sector quality initiatives could potentially have a significant impact on the quality of rural healthcare, particularly in rural markets that are dominated by a single large insurer, as these insurers are likely to have both the resources to implement an initiative and sufficient leverage to motivate rural provider participation. This project examined private sector quality reporting and quality improvement initiatives being implemented by dominant insurers in states with significant rural populations. The policy brief profiles twelve different initiatives (half focused on physician quality improvement, half focused on hospital quality improvement).