With the healthcare reform process stalled, direct contracting between employers or business coalitions and regional behavioral healthcare providers remains an effective way for employers to offer enriched managed behavioral healthcare services. This article examines the successful contractual relationship between the Procter & Gamble Company of Cincinnati, OH, and Bethesda Behavioral Health Services, a division of Bethesda Hospital, Inc., a multiservice regional healthcare provider also based in Cincinnati. Although Procter & Gamble has been committed to employee assistance program (EAP) services for more than 15 years, it determined in 1989 that a comprehensive managed care/EAP gateway plan best fit its employee relations philosophy and its need to improve the quality and reduce the cost of behavioral healthcare without reducing benefits. This article describes how that idea evolved into today's successful direct contractual relationship between Procter & Gamble and Bethesda.