Commentary The Veterans Health Administration (VHA), the largest

integrated health care delivery system in the United States, has transformed itself over the past 15 years from a hospital-centered health care system to one that has a robust primary care infrastructure and access points throughout the United States.1 Eligibility reform was a major component of system transformation, and VHA now provides care to more than 8 million veterans, 40% of whom live in rural or highly rural areas. Over the past 4 years, a major focus of ongoing transformation initia-tives has been the adoption of a patient-centered medical home model, called the Patient Aligned Care Team (PACT) within VHA, which has configured interprofes-sional teams to deliver care focused on veterans ’ needs. Facilitating access to specialty care services continues to be challenging.2 To address these issues, VHA launched