With our recent blogs on August 3 and August 17 focused on innovative care models, it seems appropriate to pause and review the historical context that served as the foundation for many current innovative efforts. While the focus of today’s article is primary care, many of the learnings have broad applicability. Interestingly, much of the groundwork for current innovations to improve care was provided in 1978. At that time the Institute of Medicine (IOM) proposed a definition of primary care as “…the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” In her seminal book published in 1992, Dr. Barbara Starfield made the case for primary care driving improved quality and lower costs across the globe.1 She was able to show that primary care availability positively correlates with improved health outcomes and lower cost trends. Perhaps less well known from that same book is her delineation of the four pillars of primary care. Building on the definition created by the IOM, she described four essential elements of primary care as: