one influential model of disease management is the chronic care model ccm developed in the us by wagner austin et al a systematic review evaluated the impact of disease management programmes that contained two or more of those ccm components for diabetes depression heart failure and copd de bruin et al it found that of the studies that reported changes in healthcare costs out of showed a decrease in overall costs the overall costs varied between usd a system cost saving and usd an increase in the system cost per patient per year in prices