The Center for Health Policy Evaluation in Long-Term Care


 Who We Are

The Center for Health Policy Evaluation in Long-Term Care is a collaborative research effort aimed at improving the quality of care for our nation’s elderly and disabled populations. Our multidisciplinary team has expertise in public health, medicine, nursing, epidemiology, policy, nutrition, economics, health services research, quality improvement, long-term care workforce, measure development, quality of life, dementia, customer satisfaction, program implementation, and healthcare administration, management, and leadership.

 What We Do

Our faculty leverage their range of skills, experiences, and partnerships to translate health policies and legislation into a real-world understanding of their impact on the lives of post-acute and long-term care residents and providers. Working across a range of stakeholders, we use this understanding and a systems-thinking approach to improve lives by providing solutions for quality care.



A Review of Nursing Home Medicaid Value-Based Payment Programs

February 2022

​Historically, state Medicaid programs have paid a single all-inclusive per-diem amount for every Medicaid beneficiary. Several services and treatments (i.e., medications, tests, procedures, treatments, and clinician fees) are excluded from this amount and are covered either by Medicare or Medicaid under varying arrangements, but most often in a fee-for-service arrangement. Because these per diem payments are distributed unrelated to the quality of care provided, they have been criticized for not incentivizing better quality. Value-based payments (VBP) have been used as an alternative payment model to incorporate quality to the payment to nursing facilities. Also known as pay for performance, these VBP programs link payments with the quality of care received by residents through varying arrangements thus promoting and incentivizing providers to focus on quality instead of volume of care.  



 COVID-19 (Coronavirus)

 Quality Improvement & Measurement

​Our Staff

 David Gifford: Center Director, MD, MPH

David Gifford, MD, MPH, serves as Director of the Center for Health Policy Evaluation in Long Term Care at the American Health Care Association, where he also serves as the Sr VP for Quality and Regulatory Affairs since 2011. He established the Center and the Quality Department at AHCA. His interests are in improving and measuring quality in LTC as well as how regulatory and payment policies impact quality. He has developed 8 new quality measures for nursing homes that all received NQF endorsement. 

He oversees a team of data analysis working with national MDS data, Medicare Claims, and Cost Reports to develop quality measures and conduct policy evaluations. Dr. Gifford also serves on the Board of the Advancing Excellence in America’s Nursing Homes campaign and the Baldrige Foundation Board and chairs the Department of Veterans Affairs Geriatric and Gerontology Advisory Committee. He serves on the NQF Measures Applications Partnership (MAP). 

He is a former Director of the Rhode Island State Department of Health, where he received the National Governor’s award for Distinguished Service Award for State Officials. He led efforts to expand public reporting of quality for home health and nursing homes and to make the nursing home survey process more person centered. Prior to that he served as Chief Medical Officer for Quality Partners of Rhode Island where he directed CMS’ national nursing home-based quality improvement effort. He also is on the Brown University faculty in the Schools of Medicine and Public Health as well as being a member of Brown’s Center for Quality and Innovation in LTC. He received his medical degree from Case Western Reserve University and conducted his geriatric fellowship at UCLA where he also earned his Master’s in Public Health while a Robert Wood Johnson Clinical Scholar.

 Kiran Sreenivas: Associate Center Director, MS, CPHQ

Kiran Sreenivas is a Research Director at American Health Care Association (AHCA) in Washington, DC. He supports AHCA’s Quality Initiative, LTC Trend Tracker, and other projects aimed at improving lives and delivering solutions for quality care. His passion is helping others use data to make informed decisions.

Prior to joining AHCA, he worked four years at America’s Essential Hospitals on a collaborative to reduce hospital readmissions and hospital-acquired conditions, such as pressure ulcers and surgical site infections. Kiran is currently working on earning a Doctor of Public Health at Johns Hopkins University. He received his master’s in health policy at George Washington University and his bachelor’s in biology at Northwestern University.

 Holly Harmon: Senior Clinical Fellow, RN, MBA, LNHA, FACHCA

Holly Harmon, RN, MBA, LNHA, FACHCA brings both passion and a wealth of practical, real-world, clinical and operational experience to her role as Associate Vice President, Quality & Clinical Affairs at AHCA. Her extensive service in a wide array of settings including post-acute care, long term care, residential care, assisted living, independent living, a psychiatric hospital and occupational health have provided her with insights, knowledge, skills and innovative ideas which she exuberantly shares with others.
In addition to her vast clinical experience, Ms. Harmon has put her dynamic energy into leading the statewide Maine Culture Change Coalition/LANE as President, the Maine Partnership to Improve Dementia Care in Nursing Homes as Co-Chair, Vice-President of American College of Health Care Administrators, Maine Chapter and the Maine LANE Co-Convener for the national Advancing Excellence in America’s Nursing Homes Campaign. She also served as the Director of Quality Improvement & Regulatory Affairs at the Maine Health Care Association.
She puts her boundless energy and warm and energetic personality into training, education and presenting both, nationally and locally. She has made simplifying the complex world of long term and post-acute care policy and practice an art.

 Lindsay Schwartz: Senior Research Fellow, PhD

As Associate Vice President of Workforce and Quality Improvement for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), Dr. Schwartz develops and implements quality improvement initiatives, including quality measurement development and data collection and oversees workforce initiatives. She is a nationally recognized expert on quality in assisted living and workforce issues in long-term care. 

Dr. Schwartz was part of the development team for the CoreQ, a customer satisfaction measure for long term care settings. She led the process for National Quality Forum (NQF) endorsement for the assisted living CoreQ measures, the first AL-specific measures to be endorsed by NQF. Dr. Schwartz earned her Ph.D. from the Johns Hopkins University Bloomberg School of Public Health in the Department of Health Policy and Management. During graduate school she worked as a research assistant for the National Health and Aging Trends Study (NHATS) and completed a Health Fellowship in the U.S. Senate Health, Education, Labor, and Pensions Subcommittee on Aging and Retirement. Prior to attending graduate school, Dr. Schwartz worked in home and community-based services in different roles including as direct care staff and as a case manager for an Area Agency on Aging. 

She serves as current Chair of the Center for Excellence in Assisted Living (CEAL) Board of Directors, Co-Convener for the Gerontological Society of America’s (GSA) Assisted Living Interest Group, and as a mentor for the Robert Wood Johnson Foundation’s Health Policy Research Scholars program. In 2019, she was awarded fellow status through the Gerontological Society of America (GSA) in the Social Research, Policy, and Practice Section. This is the highest class of membership in GSA and an acknowledgement of outstanding contributions to the field of aging. Dr. Schwartz earned her B.S. in Psychology and a minor in Business from Indiana University.   

 Marsida Domi: Researcher, MPH

Marsida Domi is a senior research analyst at the American Health Care Association (AHCA) in Washington, D.C. Marsida is passionate about leveraging data and robust methods to address disparities in the quality of care patients receive. She leads AHCA’s measurement development and NQF endorsement efforts, achieving NQF endorsement for 7 measures including five customer satisfaction measures for nursing homes and assisted living facilities, as well as discharge to community and hospitalization measures. She led AHCA’s efforts on the NQF SES Trial Period, testing the impact of including socioeconomic factors in quality measures. She also oversees evaluations of the impact of Medicaid policies on quality as well as AHCA’s design and support to states implementing Medicaid Value-Based Purchasing programs. She has served on Batelle’s “Quality Measure Development: Supporting Efficiency and Innovation in the Process of Developing CMS Quality Measurement” Technical Expert Panel.
Prior to joining AHCA, she has worked with various organizations conducting clinical trials in leukemia and lymphoma, designing and implementing studies in breast and gynecologic cancers, and conducting economic evaluations in lung cancer clinical trials. 
Marsida received her Master’s in Public Health (MPH) from the Mailman School of Public Health at Columbia University in Comparative Effectiveness and Outcomes Research and her bachelor’s in Economics from Brown University.

 Michael Leitson: Senior Data Manager

ahca_mleitson.jpgMichael Leitson is a Senior Data Manager at the American Health Care Association in Washington, D.C. He supports the acquisition, construction, standardization, security, automation and management of data used in research. His interests include streamlining data processes to easily obtain data to improve the quality of care and designing data warehouses to improve retrieval of data.
Prior to joining AHCA, Michael worked as a business analyst of various capacities for a hospital and a nursing home organization, as well as institutions of higher education. He received his master’s in Applied Statistics and bachelor’s in Mathematics, both from Kennesaw State University.