Hi Joan, thank you for dropping by and for the feedback. I totally agree with your premise that, even without outcomes-related evidence, patient self-management is probably a "Good Thing". That was the argument I was making in the debate: that the evidence doesn't really exist (yet) but if we set our expecations on improved patient experience (like the airline industry found with digitization from paper) then patients may find navigating the healthcare system easier even if we can directly tie patient outcomes and cost savings to self-management. It's all about managing expecations -- for example, if we (in a predictive manner) tell patients that they will lose 50 pounds or signficantly lower their cholesteral then we'll be in trouble; however, if we tell them in a retrospective manner that they have lost weight or improved some other parts of their overall health then we'll be in the clear.
You are, of course, quite correct that reimbursements will drive all sorts of behavior but I think the government (writ large) understands that and things may actually get better in the future.