The LBJ Hospital in American Samoa is establishing a new programme which follows up with patients who don't keep appointments or take their medication.
Its chief executive, Michael Gerstenberger, says the epidemic of non communicable disease in the territory is getting worse.
He says the new programme is an effort to help patients manage their health so it doesn't get to the stage where treatment is ineffective.
"We feel got to make some dramatic intervention on the island in order to turn those numbers around because they are all moving in the wrong direction."
Michael Gerstenberger says some of the reasons patients stop taking care of themselves can include low levels of education, a lack of money for medication, transportation or child care.
