Robust primary care is vital for older Americans and patients with chronic diseases. Patients with heart disease, arthritis, diabetes, and other chronic illnesses account for approximately 90 percent of the health care dollar,much of which is wasted on fragmented, disorganized care. Several pilot projects have shown that intensive primary care (sometimes called the advanced medical home or “ambulatory intensive care”), which addresses the multiple needs of chronically ill patients, can improve health, reduce emergency department visits and hospitalizations, and bring down costs. Some of the common elements of these successful projects include a team of physician and non-physician providers; home visits; attention to mental health and social needs; and telemedicine.