If the NND analysis ultimately shows that a program may not be able to show a financial return on investment based on a reduction of short-term acute utilization, disease management programs may have to consider alternative measures of economic effectiveness. These include (i) cost-effectiveness analysis in which program effectiveness is measured in quality-adjusted life years gained;[16] (ii) period-over-period changes in health status as measured by the Short-Form 12 (SF-12), which has been shown to predict medical expenditures;[17] and (iii) changes in patient self efficacy, which has been shown to correlate with healthcare utilization (office visits, emergency department visits, and number and length of hospital stays).[18] As illustrated in this paper, the structure of the NND design is intended to provide an estimate for the first program year only. We would expect that each additional program period will decrease acute admissions beyond that established in the first year, and thus the cumulative effect will be heightened. The NND analysis can easily be expanded to include future periods; however, estimates will most likely be less precise.