The disease management sector has been evolving rapidly since the concept was introduced in the mid 1990's. The initial focus was to treat chronic conditions in the most cost efficient way in the hope of reducing the spending associated with chronic diseases, which are estimated to drive approximately 75 percent of the nation's total health care spending. The initial response was that of skepticism. While many players have attempted to demonstrate their respective disease management program returns on investment, no standardization was established to measure the amount of cost savings and the quality of outcomes as a result of their programs.