The Taconic IPA has provided services in team based, patient centered medical home (PCMH) transformation by providing practice re-design strategies that enable practices to become PCMH’s and providing standardized evidence-based protocols and processes for managing chronic and complex illness, including integration of medical and behavioral care through integrating care coordination into practice workflow; embedding RN case managers into practices to manage the highest cost and highest risk patients; developing transitional support strategies to coordinate care across settings; supporting practices in the implementation of patient self management strategies; identifying and monitoring quality, utilization and satisfaction metrics for comparative analysis and benchmarking; utilizing HIT to enhance care coordination and improve safety; assisting with NCQA accreditation and quality improvement efforts; and promoting population management, value based purchasing and pay for performance strategies.