Quadruple Aim in the context of behavioral health1

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".2

Successful Integrated care requires a team-based approach in both implementation and execution:2
  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.2

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 utilized3 
  • While health reforms are taking effect, the health system is evolving in positive ways, including an evolution from siloed to more integrated behavioral health services3 
  • 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 care3 
  • 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 lives3

IDEAL Discharge Planning Implementation Checklist4

"The goal of the IDEAL Discharge Planning strategy is to engage patients and family members in the transition from hospital to home, with the goal of reducing adverse events and preventable readmissions." ​
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Re-Engineered Discharge (RED) Toolkit5

Help ensure a smooth and effective transition at discharge
"The Re-Engineered Discharge (RED) consists of a set of 12 mutually reinforcing actions that the hospital undertakes during and after the hospital stay to ensure a smooth and effective transition at discharge." ​ 

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  1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12:573-576.
  2. 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.
  3. 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.
  4. Guide to Patient and Family Engagement in Hospital Quality and Safety, 'Strategy 4: Care Transitions from Hospital to Home: IDEAL Discharge Planning.' Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_1_IDEAL_chklst_508.pdf
  5. Re-Engineered Discharge (RED) Toolkit. April 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html. Accessed on June 3, 2022.