The medical home is not yet well defined and means different things to different people, Isham said. One version of the medical home focuses on cultural and health literacy problems and faces the challenge of evaluating patient complexity at the point of care while also tailoring care to the patient. The use of payment models to catalyze development of this model should be explored.

Revisiting Somers’s point, Isham noted that infrastructure that facilitates integration of disparities reduction and health literacy improvement must be built for physicians in solo practices, given the many individuals who receive such care. Furthermore, clinician training, among other infrastructure needs of these delivery models, is needed.

Health literacy is the process of obtaining, processing, and understanding information important to health—information on which people must be empowered to act, Boat said. Self-management is an important concept of care organization. To facilitate self-care, patients should be educated to participate in care processes. Furthermore, it is the responsibility of clinicians to assess their patients’ level of confidence and to encourage patients to become involved in developing action plans for their own care. Additionally, mechanisms are needed to evaluate the ongoing success of these efforts.

Each chair suggested that continued collaboration among those in health literacy, disparities reduction, and quality improvement could lead to new and exciting opportunities to positively affect health care and improve health outcomes. Specific steps for progress include

• using data to drive action;

• teaching health literacy over the life course;

• focusing interventions on target populations;

• finding a balance between standardization and customization of health care; and

• enhancing organizational capability to address disparities, literacy, and quality.