Practice managers are facing challenging expectations when deploying a managed-care paradigm. The problem addressed in this study was a gap in knowledge regarding practice managers' decision-making strategies that affect, or could be perceived to affect, a climate of excellence with business and client relationships, primary health care, physicians, and patients in a managed-care paradigm. The purpose of the qualitative exploratory study was to explore practice managers' decision-making strategies affecting primary health care, physicians, and patients. Guided by Simon's ideology of decision-making strategies in a management environment, the overarching research question and 3 subquestions centered on how practice managers delineate their decision-making strategies and how those strategies affect primary health care, physicians, and patients. To close the gap in knowledge, the study included (a) a homogeneous purposive sampling of 14 practice managers (n = 2, pilot study; n = 12, main study) as research participants; (b) face-to-face interviews with semistructured, open-ended questions to collect data; and (c) in vivo and pattern coding during data analysis. The study results indicated a need for change agents, interactions, partnerships, and accountability in a managed-care paradigm. Managing health care is complex and practice managers will continue to be challenged. Alliances between practice managers and stakeholders are recommended to meet those challenging expectations. As a result, positive social changes may be observed in improved access to primary health care, better health care treatments, and collaborative interactions in a managed-care paradigm.