This issue of the journal focuses on care management/disease management. In an effort to be positive, I offer the following simplistic definition: care management represents any effort, typically facilitated by financial incentives, on the part of a group (not one) of health professionals to coordinate health services for a group of individuals with a chronic illness. This definition implies that to be successful care management must have the following characteristics:

* There is a financial incentive both to coordinate these services and to document that the care management is working

* There needs to be transparency so that all parties to the healthcare dinner table can clearly see the "games people play" to maximize their revenue.

* Care management can be maximally effective only if health professionals work with patients/families linked with community resources in an effort to maximize health of the entire community.

* The healthcare professionals must devise methods to empower patients/families.

* There needs to be creativity on the part of healthcare professionals as we explore new means/sites of care for empowering patients/families.

* Leadership and communication skills can significantly facilitate the process of creativity mentioned above.

This issue of the journal touches on each of these issues. I will provide my perspective on the issues of financial incentives/transparency in the next issue. Judith Hibbard adds to our understanding of the critical issues pertaining to patient empowerment. The article by Leif Solberg, together with a commentary by Eugene Nelson, analyzes, via an extensive study of group practices, the interplay of quality improvement with leadership/communication.

We then move on to case studies from the field. Ric Surpin, from Independence Care Systems, Inc, highlights a most innovative program that provides coordinated services to long-term-care disabled individuals. Of note is the fact that his not-for-profit company is worker owned. Richard Bernstein provides the perspective of his group, CareAdvantage, on case management. In the spirit of full disclosure, his group uses a technology for measuring the impact of care management that I helped developed. There are a number of tools that are available today that purport to measure the impact of care management efforts. I would very much like to highlight these different efforts. For myself, the issue is not standardization on a particular tool. Let the tools flower. What is key is transparency of the tool.

There are many international efforts to provide better-coordinated services. The next 2 articles highlight an Israeli and a Palestinian effort as it pertains to diabetes-the new chronic disease epidemic of our time.

Lastly we conclude with our regular humor column on challenges to our ever-changing healthcare system together with our human rights column.

Norbert Goldfield, MD

Editor