In chapter I I presented various ways of understanding managed care, noting that a full comprehension of its dynamics involves looking at managed care functionally, systemically, conceptually, and operationally. To this point I have considered it functionally, systemically, and conceptually. Now I tum to the operational perspective. Operationally, managed care constitutes a sweeping revision of the process of providing behavioral health care. This operational process is most easily understood by imagining two simultaneous pathways: a procedural pathway interwoven with a clinical pathway.