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Disease management (DM) in the US can trace its roots back to the mid-1980s with the early work of California health plans and has come a long way since then. However, it wasn't until the mid 1990s that disease management became part of mainstream thinking, after several private for-profit companies introduced outsourced disease-management programs to large commercial health insurance providers. The "process/evolution" of DM in the United States has been and continues to be the major difference between disease management in the US and the UK...and other countries.