The patient-centered medical home provides an operational framework for implementing the Institute of Medicine's 6 quality aims within primary care. Successful implementation of the patient-centered medical home necessitates transformation at the group practice level. This article describes a conceptual model for transformational clinical leadership, based on the paradigm of the care pilot and the tools and training for effective implementation of this role within primary care group practice. In addition, we propose an innovative academically based system to train and support the care pilot and practice transformation in primary care and rural practice settings.