Integrating Care to Achieve Quadruple Aim

Quadruple Aim in the context of behavioral health

Behavioral health and primary care integration is defined as ‘‘the care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population’’.1

Successful Integrated care requires a team-based approach in both implementation and execution:1

  1. Behavioral Health Consultants (BHCs) and primary care physicians (PCPs) provide care within the same system and location and function as members of the same clinical team
  2. BHCs and PCPs share the same health records, treatment plans, and other resources such as a common workspace, reception desk, waiting area, and support staff
  3. Interdisciplinary collaboration with strategic planning, mission-setting, information technology, and financial operations
  4. Patients likely perceive these behavioral health services as seamlessly linked to their medical care

Integrated care can vary greatly based on the type of primary care clinical practice. Many hybrid and innovative integrated care models have been developed by healthcare organizations, which consider local conditions and needs.1

Successful implementation of Quadruple Aim may support organizations in care coordination and quality improvement efforts in behavioral health

  • With the implementation of the Affordable Care Act (ACA), we are entering a transformative era in which value will gain increasing importance over the volume of services provided, and as such, we are seeing a shift from how much is spent on care delivery to how well available resources are utilized2
  • While health reforms are taking effect, the health system is evolving in positive ways, including an evolution from siloed to more integrated behavioral health services2
  • Population health is at the center of changes taking place across the health care landscape. And, a population framework is an ideal mechanism for optimizing care of patients and understanding where behavioral health fits in the larger context of integrating care2
  • Mental illness is a major driver of health care costs in the US, where 1 in 4 people struggle with a behavioral health or substance abuse problem at some point in their lives2


  1. Vogel ME, Kanzler KE, Aikens JE, Goodie JL. Integration of behavioral health and primary care: current knowledge and future directions. J Behav Med. 2017;40(1):69-84.
  2. Clarke JL, Skoufalos A, Medalia A, Fendrick AM. Improving health outcomes for patients with depression: A population health imperative. Report on an expert panel meeting. Popul Health Manag. 2016;19(Suppl 2):S1-S12.