Abstract Health care is rapidly changing in the United States. Not only are providers being reimbursed differently; patients are being treated differently. This is due the failed health care delivery system known as Fee for Service. Fee for Service reimbursement is based on the assumption that health care is provided in a set of identifiable and individual units of services. Many are hopefully that the health care delivery system of managed care will be the answers to our failed system. Managed care is detailed and can be complicated, however the “work smart, not hard” phrase I am sure we have all heard, applies to the new delivery system. Many health care providers are not ready for this huge transition and some are trying to avoid it, however some providers have decided to take charge and have been preparing for a long time. Managed care is a system that is based off of quality and cost effectiveness of health care delivery. Many different elements are required to achieve this goal. The most essential element of managed care is the primary care provider, also known as the PCP or gatekeeper of the patient’s health care. The PCP was given the nick name ‘The Gatekeeper’ because many managed care plans require members to obtain approval before receiving certain services. This was put in place by insurance carriers in order to prevent members from obtaining unnecessary services. (Concepts: Health Determinants) Another method insurance carriers use to insure their members are receiving quality health care is by offering financial incentives. These incentives are determined by HEDIS (Healthcare Effectiveness Data and Information Set) Scores. The Healthcare Effectiveness Data and Information Set is a widely used set of health care performance measures that is developed and maintained by the National Committee for Quality Assurance. Preventative examinations and screenings such as colorectal cancer screenings, eye exams, and mam