Evolution, not revolution, has characterised the development of managed care in the US, said Jerome Ashford of Ashford Miller Moore in Glendale, California, US, at an IIR conference on Implementing Disease Management [Auckland, New Zealand; November 1996]. Knowledge of the development of managed care and disease management in the US, and how this has been driven by changing customers and customer expectations, can be applied in other countries to short-cut the development process, according to Mr Ashford.