Amendmnt 1 To Services Agreement

Exhibit 10.18

SPECIFIC TERMS IN THIS EXHIBIT HAVE BEEN REDACTED BECAUSE CONFIDENTIAL TREATMENT FOR THOSE TERMS HAS BEEN REQUESTED. THE REDACTED MATERIAL HAS BEEN SEPARATELY FILED WITH THE SECURITIES AND EXCHANGE COMMISSION, AND THE REDACTED TERMS HAVE BEEN MARKED IN THIS EXHIBIT AT THE APPROPRIATE PLACE WITH TWO ASTERISKS [**].

Amendment No. 1 to Services Agreement Reference is made to that certain Services Agreement, dated as of July 24, 2000, between Tenet HealthSystem Medical, Inc., for itself and its affiliates, and Innovative Managed Care Systems, Inc. (the " Agreement" ). The parries to the Agreement wish to amend certain terms and provisions as described in this Amendment No. 1 to the Agreement (" Amendment No. 1" ). Unless otherwise specified in this Amendment No. 1, all other terms and provisions shall remain in full force and effect and unchanged. Capitalized terms used herein without definition shall have the meanings ascribed thereto in the Agreement.

The parties hereto hereby agree to amend the Agreement, effective as of the date hereof, solely as follows: 1. Sections 4.1 and 4.4 are hereby revised, in each case, solely to change the stated notice period from one hundred eighty (180) days to three hundred sixty 360 days. 2. A new Section 7.7 is added to the Agreement as follows:

7.7 The fees payable under the terms of this Agreement shall be subject to annual increases, provided that IMaCs provides Tenet with written notice of any such increase at least 90 days prior to the expiration of each one-year period. Annual increases shall in no event exceed the lesser of: (i) a percentage increase equal to the percentage increase in the Consumer Price Index for Urban Consumers, All Cities Average, For all Items (1998=100), as published by the Bureau of Labor Statistics of the United States Department of Labor during the most recent twelve-month period for which such figures are available; or (ii) four percent (4%). 3. Schedule C to the Agreement is hereby replaced in its entirety with the Schedule C attached hereto as Exhibit A. Except as otherwise provided herein, all provisions of the Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parries have caused this Amendment N ...