Chronic medical conditions such as asthma, diabetes, heart failure and hypertension affect large numbers of people, including patients, carers, families and friends. As the population in England ages, growing numbers of patients will need help with managing complex, multiple conditions over sustained periods. Apart from the burden of ill-health, treating these conditions is likely to cost the NHS far more than elective surgical procedures. This report offers an analysis of five managed care organisations across the United States and asks what lessons or transferable models might emerge for health care in England. It asks how the wider economic and social context affect how they work, examines the clinical processes they use to manage chronic disease, and puts forward recommendations for the future NHS. [SMD]