Decades of evidence has found that despite the very high cost of health care in the US, older Americans routinely receive care that is suboptimal. While there have been enormous efforts to reform health care delivery through policy and payment reform to optimize the cost-quality tradeoff, relatively little is known about whether these changes have achieved the goal of improving care for older Americans and, if not, how to improve them so that they do. My current research makes innovative use of national datasets to conduct rigorous evaluations of the impact of these policies on the care provided to older adults. In addition to its methodological rigor, my research takes a real-world approach, evaluating outcomes that matter to both patients and providers. To date, I have conducted high-impact research examining the effect of health care policies on older adults, focusing in particular on improving quality measurement, evaluating whether policies and incentives aimed at improving quality and value are effective, and assessing which aspects of these measures and incentives work versus don't work. This research has provided practical lessons on ways to improve quality improvement initiatives and has helped inform the planning and implementation of new innovative delivery systems designed to improve patient care. It has also had a significant impact on clinical practice and policy for older adults. I am to continue conducting this research. Looking forward, I aim to expand my research program to examine the impact of health care policies and payment reform on older adults with dementia, a group that is particularly vulnerable and may experience numerous unintended consequences from payment reform; and to use my research program to train and mentor new investigators in the field of improving health care delivery for older adults. Thus, the specific aims of this proposal are: (1) To conduct high-quality research examining the impact of health care policies and delivery systems on quality of care for older adults with chronic and complex illness, with the goal of expanding this research to examining these effects in person with Alzheimer's disease and related dementias; and (2) To use my research as a platform to mentor new investigators in improving health care delivery for older adults, to help them become independent investigators and support the expansion of the field with well-trained patient-oriented researchers in aging. My overall objective is to improve the quality of care for older adults with chronic and complex diseases. Ultimately, my ongoing and proposed research, coupled with my mentorship program to train outstanding investigators in the field, will help address the critical need to reform the health care delivery system to efficiently improve quality for the millions of aging Americans who are in need of better care.