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The driving influence of managed care and cost containment is causing home care organizations to reconceptualize their roles in the health care delivery system while stimulating massive changes in agency structure, operations, and services. Medicare-certified home health agencies, which have flourished under a per-visit, fee-for-service reimbursement model, are increasingly delivering care under managed care reimbursement models. Conducted at this pivotal point in time, the book examines the intersection of two rapidly growing health care sectors: home health and managed care.The environment surrounding the transition from traditional reimbursement to managed care is uncertain and rapidly changing. Strategies organizations are using to cope with this uncertainty and HHA administrators' perceptions of the two greatest impacts of managed care are described.Despite considerable variation in agency characteristics, more similarities than differences are found among HHAs. The research concludes that market and environment pressures within heavily HMO-penetrated communities encourage all HHAs to become similar, regardless of whether the HHAs have managed care contracts.