Consultation psychiatry in the medical home and accountable care organizations: achieving the triple aim.

We are in a time of increasing concern about unsustainable increases in health care costs to Medicare, Medicaid, employers and individuals. At the same time, more than half of patients with mental health needs do not receive care in any given year [1], and untreated mental disorders can be important drivers of high health care costs. As in the rest of health care, we are challenged with achieving the “triple aim” of improving access to care while at the same time improving quality and outcomes of care and reducing total health care costs [2]. To achieve this triple aim, psychiatrists of the future will have to shift professional roles. In addition to traditional consultation liaison activities focused on individual patients in outpatient clinics or hospital settings, psychiatrists should have important roles in monitoring behavioral health needs, treatments and treatment outcomes for defined populations of patients and providing supervision and guidance to interdisciplinary teams of primary care and behavioral health providers caring for a defined panel of patients. Two important concepts that are being advocated to improve patients' experience and satisfaction with care as well as the quality and cost-effectiveness of medical care are primary care-based patient-centered medical homes and accountable care organizations (ACOs). The principles of the medical home are aimed at enhancing the potential benefits of primary care by emphasizing access to care, long-term relationships with health care providers, and coordination and comprehensiveness of care [3]. These principles also emphasize the importance of health care teams using