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INTRODUCTION The Transforming Clinical Practice Initiative (TCPI) was a 4-year national, voluntary, collaborative, peer-based learning initiative to improve quality of care and prepare ambulatory care practices of all specialties to [...], To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment. Transformation in 5 of 8 domains contributed to reduced ED visits. Key words: Medicare; ambulatory care; emergency department; practice transformation https://doi.org/10.1370/afm.3119