Learning to fly: building de novo medical home practices to improve experience, outcomes, and affordability.

While most approaches to improving primary care delivery involve making incremental improvements to existing practices, for the past decade we have been engaged in a different approach-to build new practices from the ground up to demonstrate a vision of what is possible. Our Iora model of care combines a new payment model which does away with all fee for service billing, a new delivery model focused on robust team-based population management, and a new IT system to drive this very different care. We have demonstrated in several pilots improved experience, outcomes, and lower total cost of care.