What’s Old Is New, But Only on the Surface

It seems that every year we publish at least one “what’s old is new” story. But really, why shouldn’t that be the case? When an old, discarded idea comes around again, maybe it means that it should not have been discarded in the first place.

The return of capitation was one such article; another was on renewed interest in delivering care at home. And this month, it is the return of the closed formulary. Let us be clear: The kernel ideas are old, but there is always some new spin on the implementation and sometimes even the rationale. They are never exactly the same — not the way Twinkies are, to take a frivolous example. At least I assume Twinkies are the same; I haven’t had any for at least 10 years and then it was only to find out if they were as good as when I was a boy. They weren’t, but I like to think that it is I who have changed, not the venerable Twinkie.

Not so with the closed formularies. To tell the truth, we may have stretched the truth a micron or two with our headline, because often these new closed formularies have escape hatches. That’s because we’ve learned a thing or two during the past 20 years. Our story by our former managing editor, Mike Dalzell, is very much about the present and the future. So don’t think of the old-is-new story as a “we’ve come full circle.” Think of it as a spiral, going around in circles in two dimensions, but making progress in the third and fourth.

Briefly, let me mention just two of the 15 feature articles and departments in this issue. Al Lewis, president of the Disease Management Purchasing Consortium, has written a fascinating and controversial book about the claims of some population management companies. We have a substantial excerpt that will amaze you. Amaze or dismay. And in the same issue we have my interview with Paul Terry, CEO of StayWell Health Management, one of the leading population health management companies and not one of Al’s targets.

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