REDUCING HEALTH DISPARITIES IN THE ERA OF VALUE-BASED CARE

Abstract The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding “cherry-picking” healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.


CHARACTERIZING THE EFFECTS OF HOSTILE ARCHITECTURE ON THE HEALTH GOALS OF HOUSELESS ELDERS
Ian M. Johnson 1 , 1. University of Washington, Seattle, Washington, United States Over 12,000 residents of Seattle experienced houselessness in 2018-among them, 70% reported having health conditions, 17.5% were over 50, and over half do not access emergency housing services. Local governments increasingly use strategies aimed at deterring unhoused populations from using public space. This research aimed to characterize the effects of urban planning interventions on the health goals among older disabled adults experiencing houselessness. Agency-based focus groups were conducted with adults over 50 who self-identified as disabled and met the federal criteria for homelessness. Through participatory mapping methods, constituents identified places where opportunities and barriers toward achieving health goals were experienced. Findings indicate lived experiences of confinement, exclusion, and loss of autonomy as well as creative negotiation and reclamation of space. This research equips advocates and providers with spatial data to increase public awareness, enrich local advocacy efforts, and offer new methodologies for enhancing social work perspectives on place and aging.

COMMUNITY-BASED PARTICIPATORY RESEARCH FILMMAKING WITH FORMERLY HOMELESS OLDER ADULTS
Victoria F. Burns 1 , 1. University of Calgary, Calgary, Alberta, Canada This methodological paper discusses the process of co-creating a documentary film with seven formerly homeless older adults, highlighting some of the tensions carrying out community-based participatory research (CBPR). This paper is part of a larger study that explored 'finding home' through a series of individual and group audio and videorecorded interviews (including walk and drive alongs) with seven adults (aged 50+) with diverse homeless histories. In addition to the main findings, participants shared their experience of filmmaking and CBPR. Findings revealed four main tensions: 1) openness of sharing stories versus privacy and anonymity; 2) balancing participation/engagement and over-burdening; 3) negotiating interpersonal conflict and community building; and 4) ethical issues surrounding copyright and ownership of the film. Ultimately, we advocate for more CBPR film projects, as they not only provide a rich contextualized window into people's everyday lives but serve to advance the voices of marginalized populations beyond traditional academic circles. The US health care system is at a critical moment of transformation. The implementation of value-based models has made significant progress towards improving care quality and coordination, continuity of care and reducing cost. However, concerns have been raised regarding "cherrypicking" healthier people that may negatively impact patients with more complex needs and minority populations. Given that the US is becoming more diverse, there is a need for understanding the impact of social risk factors including ethnicity, immigration status, income and geography on health outcomes and issues of health care disparities. This panel brings together four studies that examine these phenomena in minority populations. These studies will provide novel insight regarding 1) healthcare utilization in Mexican-American Medicare beneficiaries and showing that social determinants of health are associated with a higher risk of hospitalization, emergency room admissions, and outpatient visits. 2) Mortality rates and predialysis care among Hispanics in the US, Hispanics in Puerto Rico, and Whites in the US demonstrating substantial disparities in access to recommended nephrology care for Hispanics in Puerto Rico; 3) Trends in age-adjusted mortality rates and supply of physicians in states with different nurse-practitioners regulation. 4) The impact of social risk factors on disenrollment from Fee-For-Service and enrollment in a Medicare Advantage plan in older Mexican-Americans. 5) Racial disparities in access to physician visits, prescription drugs, and healthcare spending among older adults with cognitive limitation. Studies in this panel will also discuss the effects of changes in care delivery and payment innovations in improving health equity.

ROLE OF SOCIAL DETERMINANTS IN ENROLLMENT AND DISENROLLMENT IN MEDICARE INSURANCE PLANS IN OLDER MEXICAN AMERICANS
Amit Kumar, 1 Maricruz Rivera-Hernandez, 2 Lin-Na Chou, 3 Amol Karmarkar, 3 Yong-Fang Kuo, 3 and Kenneth J. Ottenbacher 3 , 1. Northern Arizona University,Flagstaff,Arizona,United States,2. Brown University,Providence,Rhode Island,United States,3. University of Texas Medical Branch,Galveston,TX,Galveston,Texas,United States Objective: The objective of this study is to examine the association between social-medical risk factor with disenrollment from Medicare Fee-for-Service (FFS) and enrollment in a Medicare Advantage (MA) plan in Older Mexican Americans. Methods: The sample included older adults participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly linked with Medicare data. We used logistic regression to estimate odds ratios (OR) for the association of each sociodemographic and clinical factor with insurance plan switching. Results: FFS enrollees were more likely to speak Spanish, less educated, lower income, disability, and be dual eligible compared to MA enrollees. At 2-year follow up, older adults with social support had higher odds of switching from FFS to MA after controlling for all covariates (OR; 1.73, 95% CI: 1.11-2.69).
Conclusion: Having social support from family and the community was strongly associated with disenrollment from FFS and transition to an MA plan.

DIFFERENCES IN HOSPITALIZATIONS, ER ADMISSIONS, AND OUTPATIENT VISITS FOR MEXICAN-AMERICANS AGE 75 AND OLDER
Brian Downer, 1 Soham Al Snih, 2 Lin-Na Chou, 2 Yong-Fang Kuo, 2 Kyriakos Markides, 2 and Kenneth Ottenbacher 2 , 1. University of Texas Medical Branch,Galveston,TX,Galveston,Texas,United States,2. University of Texas Medical Branch,Galveston,Texas,United States Few studies have investigated the healthcare utilization of Mexican-American Medicare beneficiaries. We used data from 1,196 Hispanic-EPESE participants aged >75 years that has been linked with Medicare claims to describe the healthcare utilization of older Mexican-Americans and determine common reasons for hospitalizations. Participants were followed for two-years (eight-quarters). We estimated the probability of >1 hospitalization, emergency room (ER) admissions, and outpatient visits per quarter. The percentage of participants who had >1 hospitalizations, ER admissions, and outpatient visits for each quarter ranged from 10.6%-13.2%, 14.6%-19.5%, and 77.2%-80.5%, respectively. Twenty-three percent of hospitalizations were for circulatory conditions and 17% were for respiratory conditions. Older age (OR=1.26) and Spanish language (OR=1.51) were associated with hospitalizations. Women had higher odds than men to have an outpatient visit (OR=1.61). Greater education was associated with ER admissions (OR=0.72). Continued research is needed to identify social determinants and health characteristics associated with healthcare utilization among older Mexican-Americans.