The zenith of implementing the Respecting Choices systems approach to person centered and family oriented care is to provide person-centered decision making for each individual that honors current and future healthcare preferences. It is essential to understand that challenges exist for a quaternary health system to honor each individual’s preferences. Challenges include but are not limited to; (1) assuring conversations are initiated and completed (2) broken or insufficient communication regarding healthcare preferences as result of conversations, and (3) difficulty in healthcare providers accessing information on preferences in real-time. This presentation will describe how a multidisciplinary ambulatory care team implemented this person centered decision making as foundational to achieving the quadruple aim. Outcomes include: For calendar year 2017: 334 enrolled. After enrollment: 90% had a person centered decision making conversation started, 80% had an Advance Directive uploaded into the EHR and 97% had a documented code status. Median survival after enrollment is 36 months with a overall cost of care reduction of $455 per member per month during the time enrolled in the program. Further, 70 (43%) transferred to hospice with an average LOS in hospice of 50 days, and a median LOS in hospice of 29 days. This is compared to an overall hospice average LOS: 61.6 days and median LOS of 16 days. Likelihood to refer this program to others is 95%. Provider satisfaction is one of the highest of the 3600 providers in the delivery system.