The patient-centered medical home (PCMH) movement has reached a sink-or-swim moment. Government and private payers are evaluating their return on investment, and many studies of PCMH interventions have not demonstrated savings despite extra investment.1 However, a few cases of the PCMH resulted in the contrary: large reductions in emergency department (ED) visits and hospitalizations.2,3 The difference between successful and unsuccessful examples is glaring. If medical homes emulated best practices to gain PCMH status, the transformation would prove worth the investment.