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Management which made a tremendous difference for them and improve their strategies to coordinate across agencies and from the state to the local level in making sure their vision was shared and clearly communicated and articulated. States are going to drive consumers experience of the aca and key lessons that come from what we observed from this work are first, that states are most successful when they can keep consumers in mind. That means not just the enroll ees walking in the door but the workers who are trying to engage and support their vision. And as well, the stake holders who are involved in that. All of these individuals and groups can be key supports and help the state achieve its goals. As i mentioned before, leadership and vision have been essential to helping our states. Achieve their accomplishments so far. I think they are going to be really important in aca. We learned that nothing implements itself and that change particularly culture change is going to take time. We

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