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Advances in clinical science and operational practices are allowing patients with chronic conditions to live longer and healthier lives. However, this progress comes with a dilemma - chronic health conditions increasingly drive health care resource use and underlie much of the rising cost of health care. Kaiser Permanente (KP) has implemented comprehensive care and disease management programs to guide and support clinicians and patients. These programs build on and leverage Kaiser Permanente foundation of integrated organizational oversight and decision making involving the payer, delivery system and clinicians. Care delivery is based on evidence based medicine and the Chronic Care Model, …