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.