The rapid growth of managed care is the response to limited financial resources and the demand for affordable healthcare services. Economic sustainability is a crucial aspect of health care. Managed care plans were developed to provide health care services, but also to be a method of collecting payment for services. There are different types of managed care plans. For example, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS) plans. For the brevity of this article, the HMO managed care system will be discussed as well as the relevance of the role of the advanced practitioner practicing within HMOs. The 1970s need for primary care settings to reduce and control employee benefit costs prompted the group's development. practice model or also known as HMO (Anderson & O'Grady, 2009, p. 380). HMO is a type of managed care system created for the purpose of providing health care to a large group of people. Its goal is to provide health care services at a lower cost and often at a fixed cost. The HMO plan is based on obtaining licensed health care services through the use of “in-network” providers. This meant that this HMO's plan would only cover licensed physicians and services. If, for any reason, a specialized or expanded service, such as a hospital admission or rehabilitation service, cannot be authorized, the "out-of-network" service must be approved by the HMO provider. The advantage of being “in-network” and limiting health care services within a plan is cost control. The cost of these plans is only a small percentage of the “out-of-pocket” expenses at the time of service. The disadvantage of this type of plan lies only in the fact that the doctors or services are "in network"... middle of paper ......09, p. 384). NPs may see patients with minor health problems. This would allow doctors to care for the most seriously ill patients. References Anderson, AR and O'Grady, ET (2009). The primary care nurse practitioner. In AB Hamric, JA Spross, & CM Hanson (Eds.), Advanced Practice Nursing an Integrative Approach (4th ed., pp. 380-402). St. Louis MO: Saunders.Aspen. (2008, September 1). Managed care. Managed Care Perspectives, 21, 1-6. Retrieved from http://web.ebscohost.com.ezproxy.graceland.eduHit Where It Hurts Why HMO Profits Are Declining Rapidly. (1997, October 27, 1997). Business Week, 42-43. Retrieved from http://web.ebscohost.com.ezproxy.gracedland.eduStevens, AB and Sanghi, S. (2010). Emerging frontiers in health care research and delivery. Clinical Medicine and Research, 3, 176-178. doi: 10.3121/cmr.2010.974