Original ArticlesHow Do Innovative Primary Care Practices Achieve the Quadruple Aim?Wagner, Edward H. MD, MPH; LeRoy, Lisa PhD; Schaefer, Judith MPH; Bailit, Michael MBA; Coleman, Katie MSPH; Zhan, Chunliu MD, PhD; Meyers, David MDAuthor Information MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, Washington (Dr Wagner Mss Schaefer and Coleman); Abt Associates, Cambridge, Massachusetts (Dr LeRoy); Bailit Health, Needham, Massachusetts (Mr Bailit); and Agency for Healthcare Research and Quality, Rockville, Maryland (Drs Zhan and Meyers). Correspondence: Katie Coleman, MSPH, MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101 ([email protected]). The authors declare they have no conflicts of interest to report. Journal of Ambulatory Care Management: October/December 2018 - Volume 41 - Issue 4 - p 288-297 doi: 10.1097/JAC.0000000000000249 Buy Metrics Abstract The Patient-Centered Medical Home (PCMH) now defines excellent primary care. Recent literature has begun to elucidate the components of PCMHs that improve care and reduce costs, but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. We report the findings from 38 such practices that fill this gap. We describe how they execute 8 functions that collectively meet patient needs. They include managing populations, providing self-management support coaching, providing integrated behavioral health care, and managing referrals. The functions provide a more actionable perspective on the work of primary care. © 2018 Wolters Kluwer Health, Inc. All rights reserved.