12/06/16  Portland, Ore.

By Jennifer DeVoe, M.D., D.Phil., OHSU Family Medicine Chair

Some days, the quadruple aim seems like such an elusive goal. It felt far from my reality a few weeks ago when I was feeling overwhelmed and inadequate in my efforts to address one patient's struggles with homelessness and another's suicidal ideation(s). Feeling a heavy weight of despair and holding back tears, I excused myself from an exam room to regain my composure. As I closed the door behind me, a team member appeared, greeted me with a hug, and offered to call for a behavioral health consult. Our behavioral health colleague arrived a minute later, easing my fears and offering her compassionate care to this patient in great need. After this successful warm handoff, my colleague remarked: "we are saving so many lives!" This profound observation was an excellent reminder of the important work we do every day. I held my head higher for the rest of the afternoon.

After completing a visit with my last patient that day, I turned to the dozens of email messages in my neglected inbox. One caught my eye: a recent discovery from a study conducted by colleagues at Portland State University – for every additional $1 Oregon Medicaid invested in patient-centered primary care homes, the Medicaid program saved $13. The dollars saved represent valuable resources that can be invested in other public services to relieve homelessness, hunger, unemployment etc. Wow, I thought to myself, we are saving lives AND saving money. All of a sudden, achieving the quadruple aim felt within reach!

In primary care, we rarely think of ourselves as life savers doing heroic work; we are more likely to say: "I was just doing my job." I am grateful and proud to have the opportunity to be in a profession that is saving lives, preventing disease, improving health, and reducing health care expenditures. We must embrace our unique combination of roles and take great pride in the important clinical, scientific, and educational work we do every day.

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