In response to the Affordable Care Act and other reforms in the healthcare market, new models of care are being tested and implemented across the country. Care and payment models such as patient-centered medical homes, Accountable Care Organizations (ACOs), and bundled payments depend on linkages between different types of healthcare providers to ensure continuity of care. To addresses concerns that healthcare in rural areas may be more fractured and thus a difficult place for these models to succeed, we measured continuity of care using detailed data on a sample of Medicare beneficiaries from 2000-2009.