As part of the Agency for Healthcare Research and Quality (AHRQ)'s Infrastructure for Maintaining Primary Care Transformation initiative, NASHP worked with four states (Idaho, Maryland, Montana, and West Virginia) that sought to adapt aspects of North Carolina’s nationally recognized model of primary care practice transformation. In this report NASHP authors Larry Hinkle and Felicia Heider summarize the value of primary care transformation for the states, describe the North Carolina model, and outline states ' successes, challenges and lessons learned.