Health care professionals must have provide the best quality of care while dealing with patients Quality of healthcare is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Managed care is a system of care delivery involving complex organizational arrangements between institutions and clinicians explicit financial incentives defined access to service controls on the use of services 3 coordination and integration of services McConnell C 2010 Cost balance is health professionals trying to balance the cost while improving the quality of care Although these health professionals are for improving the quality and cost balance in healthcare it is taking a strain on them with the rising cost of healthcare especially since the Affordable Care Act ACA has increased the number of people with insurance seeking medical care Cost balance is becoming important because one third of health spending is wasted on unnecessary services fraud and other problems Institute of Medicine 2012