Those were the good days, weren't they? Faced with a hidebound and opaque health care system, architects of the earliest disease management (DM) programs were confident that they had the answer. The twin challenges of quality and cost of chronic illness could be attacked by "systematizing" health care with a special focus on patient self-care coaching. The underlying business model appealed to the prevailing notions of consumer empowerment, unfettered markets, and bypassing the inertia of a slow-moving physician community. In turn, investors and payers were confident that insurance claims expense would decline and that the savings would translate into profits. Remote telephonic patient education programs rapidly expanded, call centers began to occupy entire floors in business centers, and asthmatic, diabetic, and other populations with chronic illness were tackled with industrial gusto. As more DM programs were launched, reports of downward utilization patterns in commercial and government managed care programs tur-bocharged an industry with hundreds of millions of dollars in annual revenue.
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