Hear hear. Providers paid on outcomes will serve the purposes described here. Effective patient education is key. I know this first hand as an employee of a patient education company that whose increasing success is being fueled by just the realizations you outline here-greater understanding that education improves outcomes coupled with less provider:patient time = need for more creative education tools served directly to the patient. As Christiansen says in his book (Healthcare Rx, I paraphrase here) 'bring the solution closer to the user'. Informed, motivated individual leads to better health outcomes. This of course raises the question of motivation, another discussion entirely.

I have yet to see a proposal for a consumer based incentive program to properly reward good behavoir and punish bad.  This should start at the employer level and at least should be part of the discusssion.  Propose punishing an overweight diabetic by pounds over normal and see what kind of reaction you get in the town hall meetings but why should tax payers join in to pay for healthcare of those not taking care of themselves.  This discussion and the anticipated outrage needs to be a part of the debate.

I see it on a daily basis in my line of work. A patient is discharged from the hospital after a two week stay for congestive heart failure. The discharge instructions and advice have been reiterated by numerous healthcare professionals. Then the home caregivers go out for an assessment and they find the patient reverting back to old habits. Foods high in sodium, noncompliance towards meds, and a general negativity toward their providers. These types of scenarios are abundant and they become vicious cycles that contribute to out rising healthcare costs. Noncompliance and total disregard among patients lead to wasteful spending and inefficiency within our healthcare system. More responsibility needs to be place upon the individual who in the end must be cognitive of the changes they need to make to help eliminate and prevent chronic disease.