Large increases in health care costs combined with an economic slowdown have created pressures for health plans and employers to reconsider cost containment strategies that were scaled back after the managed care backlash. In this paper we examine how plans' approaches to cost containment and care management have evolved since 2001. Plans reintroduced and refocused some utilization management techniques during 2002 and 2003 while continuing to invest in disease and case management. Some also began to experiment with new variants of managed care, including tiered provider networks and incentive-based provider payments. However, few respondents believed that these strategies alone would greatly reduce future costs.