Managed care was created to bring affordable health coverage to a wide range of consumers. But it became apparent that cutting costs by limiting patient choice and treatment options; “fit for all” and "refer and forget", is not the solution. A simultaneous eclipse and expansion of the system evolved with the disintegration of the central vertical with a more horizontal integration scheme. Patient-specific data and feedback from different medical sources is required to engage the physician and patient in evaluating treatment options for disease management. For optimal results, this is being applied across the chain of primary and specialist care, which requires comprehensive data management.