PROJECT SUMMARY / ABSTRACT Candidate: Renuka Tipirneni, MD, MSc is a general internist and junior health services researcher focused on improving the health care system for prematurely aging low socioeconomic status (SES) adults approaching retirement age. Dr. Tipirneni's long-term career objective is to become an independent mixed methods investigator integrating large-scale clinical and economic data with in-depth qualitative data to inform the design and evaluation of policies and programs to improve the health of low-SES aging adults. Research Context: Low-SES Americans approaching retirement face a crisis of poor health and markedly increasing mortality. Between 2001 and 2014, disparities in life expectancy between low- and high-SES adults near retirement have widened and this may have accounted for 500,000 excess deaths. Yet the drivers of this crisis are poorly understood. The Affordable Care Act (ACA) should improve access to care through insurance expansions and care delivery innovations and help this group manage chronic conditions and improve their health. However, it is not clear how low-SES aging adults are specifically benefitting from ACA policies, which groups should be principally targeted for new care delivery programs encouraged under the ACA, and what factors are associated with successful health improvement and decreased costs for at-risk aging Americans. Specific Aims: 1) Determine changes in coverage, access, utilization, health and financial stress for low-SES 55-64-year-olds before and after the ACA Medicaid expansion; 2) Classify sub-groups of low-SES 55-64-year- olds at highest risk of poor health and characterize heterogeneity of changes in access, utilization, health and costs in identified high-risk sub-groups; 3) Identify facilitators of and barriers to improvements in health outcomes and health care utilization among high-risk low-SES aging adults in an ACA care delivery program. Research Plan: To accomplish these aims, Dr. Tipirneni will perform quasi-experimental analyses with the Health and Retirement Study to assess health and health care changes before and after the ACA. She will then identify sub-groups of low-SES near retirement adults at high risk of poor health trajectories. Lastly, she will conduct qualitiatve interviews with low-SES near retirement adults in an ACA care delivery program to identify facilitators of and barriers to health improvement and decreased high-cost utilization. Career Development Plan: Dr. Tipirneni will develop expertise in 1) analysis of large-scale longitudinal survey and administrative data; 2) application of quasi-experimental approaches to evaluate programs; 3) mixed methods research; and 4) programmatic research focused on aging adults. Dr. Tipirneni's career development goals will be supported by close mentorship from an interdisciplinary team; advanced didactic coursework; participation in research and career development meetings/seminars; and ongoing guidance in her rese...