Germany and the U.S. share a keen interest in exploring the potential of care management programs for the chronically ill. Despite obvious health system differences, in both countries there has been a proliferation of disease management models, initiated by a variety of actors, paid for in different ways, targeting different types of population groups, and encompassing a broad menu of interventions and services. Comparison of three case studies from the U.S. and four from Germany reveals greater differences among models within countries than between them.