BUPA-owned Health Dialog's regional programme to help French diabetics looks set to go national. Meanwhile, German insurers are waiting with bated breath to see whether US player Healthways has delivered the goods for DAK. And in the UK, private hospital chain Nuffield says its move into gyms has worked well.

Managing chronic and preventive healthcare programmes could become big business for private providers in Europe.

It could potentially contain costs. Academics report that the cost of chronic illness accounts for three-quarters of US healthcare expenditure. Costs will balloon as the population ages and more patients live longer.

Chronic programmes typically seek to empower the patient and provide coaching, information and treatment services around the condition. The aim is to help patients change bad life-styles and conform to treatment guidelines and to provide continuous care, as opposed to a series of drastic acute interventions.

Money may dry up during the recession for new programmes, but experts, such as Accenture partner Dr Daniel Schlegel, says that programmes are already in place in France, the UK, Germany, the Netherlands, Denmark and Sweden. In Germany krankenkasse insurers now have a duty to provide such programmes.

If chronic programmes deliver real savings, then that message will quickly be picked up by policymakers and politicians in Europe. But it is too early to say how effective the schemes will be says Schlegel: "The UK schemes have been running for three years, the German for 18 months."

Dr. Cornelius Erbe, at DAK, says that it made sense to use US operator, Healthways, on a project to monitor 40,000 chronic patients, because Healthways could quickly build scale and had transferrable expertise from the USA.

The same reasoning applied to Health Dialog's win in February 2008 of a pilot programme for 136,000 diabetics with the Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés, the primary health insurer in France. Senior management sources at BUPA, which owns Health Dialog, say they expect the project to go nationwide soon.

And private healthcare operators are beginning to look beyond the hospital; last year Nuffield in the UK sold off nine of its hospitals and bought a chain of 155 gyms.

Employers will soon be offered a programme which includes preventive healthcare - exercise, regular tests - as well as acute medicine. Meanwhile, a new generation of 20 and 30 somethings are imbibing the Nuffield brand on their jogging machines. Physiotherapy and healthchecks will be moved into the gyms, which are normally close to the workplace.

But questions remain. Erbe at DAK says measuring the results of these programmes is very difficult. He is working towards a report this autumn on cost savings and health outcomes. Erbe won't be drawn on numbers, but savings on intervention could be between 5% and 15%. 

And the medical establishment, particularly doctors, can be very resistant.

In Bavaria, DAK faced a backlash, as doctors told patients that DAK was working with American raiders and investment banks. It even became an issue in local elections as political parties vied to win the doctors' vote.

Equally, private hospital groups in Europe are slow to grab the opportunity. Erbe says: "This is a chance for the big hospital chains to extend beyond inpatient, to reach new markets. But they are quite conservative."

Take-up rates also vary.

One consultant said that, typically, only 40% of chronic patients take up and run with the programmes. The motivated, prosperous and well-educated sign up; the chaotic poor do not.

Even 40% sounds impressive, but, if it is only reaching the natural winners, it looks less so. But others argue that remote programmes run over the web, by phone, email and text can achieve far higher response rates.

Jacqueline Baardman at the Federation of Patient and Consumer Organisations in The Netherlands simply says: "You have to adapt the programme and the tools to the patient. Yesterday I saw a patient with dementia self-treating. There is a world to win."

Our Analysis: We agree with Baardman: there is a world to win.

It calls for a change in culture, a deployment of healthcare resources around the patient, a new respect for the patient and recognition that it is the patient who is the real manager and expert.

The most important person for a newly diagnosed patient is often the person who was diagnosed a year ago. 

This approach also calls for direct marketing expertise. You have to learn how to reach 'difficult' groups – the poor, the uneducated, the chaotic.

It calls for the deployment of a whole range of technologies, from home devices to texting. For example, GE has just invested $250m in a joint venture with Intel to develop a home monitoring device for elderly and chronic patients.

Yes, there is a world to win.