John A. Marcille
EDITOR'S MEMO

John A. Marcille

Solutions were to 1999 as new paradigms were to 1995. That year, new paradigms, it seems, were growing on trees, they were that common. Now, solutions are even more in evidence. You can't walk down the sidewalk without stepping in one. For instance, the following are all from news releases and other marketing and public relations efforts:

"McKessonHBOC Pioneers Physician Telephony Solution."

"Medical application solutions used by the physician at the point-of-care have long been considered to be the Holy Grail in the healthcare industry.... iMedica.com will offer Internet-enabled solutions."

"PeopleSoft eMarketplace To Deliver End-to-End E-Commerce Solution."

"U.S. Medical Network has developed an Internet-based solution to the claims- and referral-processing headache."

"There is a Netopia Virtual Office web site solution."

Solutions, of course, are where you find them, such as this one in a generally useful magazine: "... now may be a good time for practice managers to consider the alternative open source solution for their enterprise."

Years ago some sharp guy said you shouldn't sell products, you should sell solutions. But his advice has been ignored: Mostly, folks are just labeling their product a "solution," even when there is no problem to solve. It shows a clear lack of respect for your intelligence and mine. And it debases the value of "solution." It used to have power, that word; now it's a husk.

If you're advertising a "solution," you may be part of the problem.

So you can see why I'm hoping it has peaked, that '99 was the year of the solution. And 2000? Despite the problems we point out in our substantial disease management package, starting on Page 20, DM, unlike solution-mongering, is not all hype.

In fact, 2000 could be the beginning of the disease management decade.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.