It all started with a challenge. In 1992, Claire Rosse, MBA, RN, was working for a subsidiary of Blue Cross when a client asked her to "come up with a better way to manage costs that was not so irritating to employees."

"I started to do some research and found that, on average, 50% of people do not comply with their treatment plans," Rosse says. "I also started looking at the data and discovered that 3% to 5% of the people were responsible for 50% to 60% of this group's costs." Her solution: "If you can find people early in their disease process and help even a small percentage of them improve their outcomes, the end result is you save money."

The result for Rosse has been advantageous as well: she's now president and CEO of FutureHealth, a multimillion-dollar, integrated risk management company providing services to 450 employer groups that cover about 450,000 members. Mostly run by nurses, it uses a proprietary system, RiskScreen, to identify patients in an insurance pool who are likely to require the most expensive health care; once identified, one of the company's staff of 60 RNs contacts these patients to develop health plans, teach self-management skills, and improve treatment adherence.

What's next? Rosse has developed a system in partnership with the Applied Systems Lab at Johns Hopkins University that "will actually store profiles of people with their attributes and match those to the outcomes that produced better results." Rosse explains: "Once we get these profiles together we'll have benchmarks and also best practices for what works with particular patients, taking into account a lot of their demographic and family issues."