health plans offering disease management programs grew to 58% in 2003, up from 41% in 2002. It was reported that $85 million was spent on disease management in the United States in 1997, and $600 million in 2002. Between 2000 and 2005, the compound annual growth rate of revenues for disease management organizations was 28%. In 2000, the Boston Consulting Group estimated that the U.S. market for outsourced disease management could be $20 billion by 2010; however, in 2008 the Disease Management Purchasing Consortium estimated that disease management organization revenues would be $2.8 billion by 2010. As of 2010, a study using National Ambulatory Medical Care Survey data estimated that 21.3% of patients in the U.S. with at least one chronic condition use disease management programs. Yet, management of chronic conditions is responsible for more than 75% of all health care spending. During the 2000s, payers have then embraced disease management in many other world regions. In Europe, notable examples include Germany and France. In Germany, the first national disease management program for diabetes enrolled patients in 2003. They are funded and operated by individual sickness funds that in turn contract with regular health care providers. In France, the program Sophia for diabetic patients was introduced in 2008. It is financed and operated as a single national program by statutory health insurance, which has contracted with a private provider for support services. The introduction of these programs was in part facilitated by support from international organizations or firms and study trips or other forms of exchange with Anglo-Saxon countries. Process The underlying premise of disease management is that when the right tools, experts, and equipment are applied to a population, labor costs (specifically: absenteeism, presenteeism, and direct insurance expenses) can be minimized in the near term, or resources can be provided more efficiently. The general idea is to ease the disease path, rather than cure the disease. Improving quality and activities for daily living are first and foremost. Improving cost, in some programs, is a necessary component, as well. However, some disease management systems believe that reductions in longer-term problems may not be measureable today, but may warrant continuation of disease management programs until better data is available in 10–20 years. Most disease management vendors offer return on investment (ROI) for their programs, although over the years there have been dozens of ways to measure ROI. Responding to this inconsistency,