Depression is a common cause of illness with significant social, vocational, and economic consequences. As one of the most treatable forms of mental illness, depression often is under-recognized and under-treated. The annual cost of depression to the United States economy is approximately $43.7 billion, with 55 percent (or $23.8 billion) accounting for missed work and lowered productivity. The prevalence rate of depression is estimated at 12-20 percent. The depressed patient utilizes two to three times more health services.1There is little in the literature to demonstrate the care of the depressed person across the continuum in an integrated health care system. This article reviews the development and implementation of the treatment of depression care across multiple sites along the continuum. The care management depression team utilized the principles of performance improvement; Plan, Do, Check, Act framework for the initiative.