provider side. It requires ongoing observation of patient understanding and perception. It is a difficult but important thing to research because it affects outcomes.

Partida reflected on the importance of maintaining a balance between health literacy research aimed at understanding the needs of and developing interventions for individual patients on the one hand and research on health system complexity needs for health literacy on the other. Health systems are driven by policy, funding, and licensing requirements. Managing such an organization while being responsive to individual patients can be a daunting task. Health literacy must be simultaneously addressed from both the patient perspective and the delivery system perspective while also recognizing diversity at each of those levels, Partida said.

Linda Harris, roundtable member at the Department of Health and Human Services (HHS), reminded the group that health literacy is an underlying theme of many of the Healthy People 2020 objectives that have to do with health communications and health information technology. The Healthy People 2020 document has been completed and is in the review and clearance process at the HHS.

Ratzan highlighted the need for increased transdisciplinary research. The idea of behavioral economics is also important, he said, and suggested that the book Nudge may have some lessons for health care reform (Thaler et al., 2008). There are approaches to adding behavioral incentives for everything from organ donations to choices in Medicare and Medicaid. There are clearly activities where health literacy can be integrated in CMS activities. Furthermore, health literacy is important to health care reform in many ways. These efforts can lead to better patient outcomes and public health outcomes and play into cost effective delivery of care in the 21st century, Ratzan said.

Isham closed the session by thanking all the participants for their thoughts and contributions.

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