Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could be prevented, the thinking goes, with effective "disease management programs" using telephone support by non-physicians, mobile/remote technology, and patient-triggered treatment algorithms. Such programs have been modestly successful for diabetes, depression, congestive heart failure, and arthritis, and insurers are rolling many such programs out nationally to their members in an attempt to rein in costs.