Problems associated with health care in the United States will be resolved when the four dimensions of health care reform are addressed: (1) How do we reduce variation and confirm quality care? (2) How do we make necessary/appropriate care accessible to all citizens? (3) How do we pay for health care? and (4) How do we stop the drain of dollars paying for ineffective care? In this article, the authors address the first question about how quality is confirmed. They make six specific recommendations to those MCOs that intend to move beyond just establishing a quality management program.