Telephone triage, or telephone advice counseling, is becoming a key managed care point-of-entry tool for patients and health plan members accessing the health system. Telephone triage functions as a logical front-end for health plans, integrated physician groups, or integrated delivery systems that want to shift their managed care efforts toward demand management. Key components of telephone triage include patient education, patient information, and guided access to appropriate care. Telephone triage generally requires 24-hour staffing by registered nurses and a computer software package based on either clinical protocols or clinical algorithms. Organizations can either install an in-house system or purchase this service from a vendor, health plan, or another provider. The decision to develop a telephone triage service in-house or to out-source it is determined largely by volume and the user's strategy for moving to successive levels of risk management.