The Center for Health Policy Evaluation in Long-Term Care

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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.


 

​Latest News

Featured: Payment Models

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Featured: COVID-19

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Featured: Workforce

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Topics

‭(Hidden)‬ COVID-19 (Coronavirus)

‭(Hidden)‬ Quality Improvement & Measurement
  • The Characteristics of Nursing Homes That Stop the Baldrige Journey and the Impact Stopping Has on Quality
    Kiran Sreenivas: Associate Center Director, MS, CPHQ – Presented at the 2019 AcademyHealth Annual Research Meeting | This study looks at the relationship between quality and a facility’s Baldrige journey. Those following the Baldrige journey may apply for recognition through a Baldrige-based Quality Award at AHCA/NCAL. The Quality Awards remains in active status for three years, after which reapplication is required to maintain status or move to the next level. Facilities that stop the Baldrige journey by allowing their award to lapse compared to those actively continuing on their journey by reapplying show worse performance on Five-Star, hospitalization, and staffing, despite other facility characteristics being similar.
  • CoreQ: Development of a Universal​ Satisfaction Score for SNF and AL Residents and Families
    Lindsay Schwartz: Senior Research Fellow, PhD, FGSA – Presented at the 2019 AcademyHealth Annual Research Meeting | This poster discusses the development of CoreQ, a set of 5 long-term care customer satisfaction measures for both residents and families, highlighting the importance of a standard, short customer satisfaction measures to allow providers to benchmark their performance, help residents and families in decision-making, and let states and others use the information for accountability.
  • Action Brief: Incorporating Information on Social Determinants Into Datasets Used to Measure Health Care Outcomes
    As a member of the National Quality Partners™ Social Determinants of Health Data Integration Action Team, Marsida Domi participated in generating this important action brief.

Payment Models
Skilled nursing facilities and assisted living communities work with many different payors and under different payment models. In skilled nursing, Traditional Medicare and Medicare Advantage plans cover post-acute stays following a hospitalization. Additionally, for residents that need longer-term care, private pay and state-based Medicaid programs (including Medicaid managed care plans) are the frequent payers. In assisted living communities, Medicaid Home and Community Based programs can cover a resident’s stay.

Each payor decides how to pay for the care and housing a person receives. Payment models often take into account the level of care a person needs. Newer models, like value-based payment (VBP) models, also offer payment based on outcomes achieved or measures of quality.

Publications
Reports
  • A Review of Nursing Home Medicaid Value-Based Payment Programs
    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.

Workforce
Nursing centers rely on a variety of types of staff to serve post-acute and long-term care residents. Numerous public programs and privately-initiated efforts aim to grow and develop the workforce of the future. Local, state, and federal policy can create opportunities and barriers to achieving a high-quality, stable workforce in long-term care.

Publications

Customer Satisfaction
Customer satisfaction is a key priority for post-acute and long term care providers. However, there are few sources of publicly-reported data on how providers can assess how residents and families feel about the care, environment, and quality of services available. Operators and government policymakers have several different options for measuring customer satisfaction and deciding what to do with customer satisfaction information.

Publications

Conference Presentations
  • CoreQ: Development of a Universal Satisfaction Score for SNF and AL Residents and Families
    Lindsay Schwartz: Senior Research Fellow, PhD, FGSA – Presented at the 2019 AcademyHealth Annual Research Meeting | This poster discusses the development of CoreQ, a set of 5 long-term care customer satisfaction measures for both residents and families, highlighting the importance of a standard, short customer satisfaction measures to allow providers to benchmark their performance, help residents and families in decision-making, and let states and others use the information for accountability.

Quality
Individuals and families seeking care and rehabilitation after a hospitalization or as a long term option for housing and support evaluate the quality of their options in different ways. However people define quality for themselves - whether a focus on clinical outcomes, amenities, or staffing – post-acute and long term care providers strive to meet and exceed expectations. There are different strategies to measure and achieve quality in long term care.

Publications

Conference Presentations
  • The Characteristics of Nursing Homes That Stop the Baldrige Journey and the Impact Stopping Has on Quality
    Kiran Sreenivas: Associate Center Director, MS, CPHQ – Presented at the 2019 AcademyHealth Annual Research Meeting | This study looks at the relationship between quality and a facility’s Baldrige journey. Those following the Baldrige journey may apply for recognition through a Baldrige-based Quality Award at AHCA/NCAL. The Quality Awards remains in active status for three years, after which reapplication is required to maintain status or move to the next level. Facilities that stop the Baldrige journey by allowing their award to lapse compared to those actively continuing on their journey by reapplying show worse performance on Five-Star, hospitalization, and staffing, despite other facility characteristics being similar.

COVID-19
In the COVID-19 pandemic, post-acute and long term care providers faced new challenges and innovated to use the skills and resources available to mitigate the spread of infection and promote the health and safety of residents and staff. The resources available here were produced at the height of the pandemic to inform providers and the public on the latest findings related to COVID-10 in this setting and what providers could do to address their challenges.

Publications

Reports
Journal Articles

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Related Links

LTC Trend Tracker


LTC Data Cooperative


LTC Stats, Data & Reports

LTC Fast Facts

David Gifford, MD, MPH: Center Director
​David Gifford, MD, MPH, is a geriatrician who currently serves as Chief Medical Officer at the American Health Care Association (AHCA). He helped create the Quality Department at AHCA, which assists providers in their quality improvement efforts and works with administration officials on regulations and policies impacting the profession. He also established the Center for Health Policy and evaluation in LTC at AHCA and currently oversees AHCA’s Long Term Care Data Cooperative, a National Institute of Aging funded initiative to link EMR data from nursing homes to help improve care. Dr. Gifford also serves on the Board of the Baldrige Foundation and chairs the U.S. Department of Veteran’s Affairs Geriatric and Gerontology Advisory Committee, a congressional chartered committee to advise the U.S. Secretary of Veteran’s Affairs on geriatric services for veterans.

He is a former Director of the Rhode Island State Department of Health from 2005 to 2011, where he received the National Governor’s Distinguished Service Award for State Officials for his management of the H1N1 influenza outbreak. Prior to that, he served as Chief Medical Officer for Quality Partners of Rhode Island, where he directed the CMS national nursing home-based quality improvement effort. He holds a faculty appointment at Brown University Medical School and School of Public Health and served as medical director in several nursing homes in Rhode Island. 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, MS, CPHQ: Associate Center Director

​Kiran Sreenivas is the Vice President of Research at the American Health Care Association (AHCA) in Washington, DC. He oversees providing internal and external stakeholders with data and analyses to support AHCA’s mission of improving lives and delivering solutions for quality care.

His passion is helping others use data to make informed decisions. Before joining AHCA in 2015, he worked for 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 received his master’s in health policy at George Washington University and his bachelor’s in biology at Northwestern University.

Stephanie M. Kissam, MPH: Associate Center Director
​Stephanie M. Kissam is a health services researcher with over 20 years of leadership in public health program development, research, and management. She started at AHCA in October 2023 after nearly 15 years at RTI International, where she led large national evaluation projects for the Center for Medicare and Medicaid Innovation and the Administration for Community Living.  Her areas of research include state health policy, health IT implementation, nursing home quality measure development and maintenance, and outcomes of value-based payment models. She received her Master’s in Public Health from the University of Michigan.

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

Terry Hawk, MS: Senior Research Analyst
Terry Hawk is the Senior Research Analyst at the American Health Care Association (AHCA) in Washington, DC. He oversees data and quality tracking for use in Research, AHCA/NCAL’s Clinically Integrated Networks, and the Long-Term Care Data Cooperative to support AHCA’s mission of improving lives and delivering solutions for quality care.

Terry has worked with a wide range of healthcare settings and their data including inpatient, hospice, home health, and most of all skilled nursing and assisted living facilities. His interest is helping translate data insights into actionable outcomes to inform data practices and regulations.

Terry received his master’s in public health nutrition at University of Washington - Seattle and his bachelor’s in biomedical studies at University of Oklahoma.

Valerie Williams, MHA: Research Associate
Valerie N. Williams is the Research Associate at the American Health Care Association (AHCA) in Washington, DC. She manages Battelle’s PQM endorsement of AHCA/NCAL’s CoreQ quality measures, helps maintain Power BI data reports, and share data and findings with constituent groups.

She enjoys working in the health care sector. Before joining AHCA, she worked at a freestanding emergency room for 4 years and a DC area SNF for 5 years both in the Business/Finance office assisting patients/residents/families navigate the financial processes.

Valerie received her Master’s Degree in Health Care Administration at University of Maryland Global Campus and her Bachelor’s Degree in Health Care Administration at University of Maryland -Baltimore County (UMBC).

Alex Deffer, MSW: Research Analyst
alexdeffer.pngAlex Deffer is a Research Analyst at the American Health Care Association (AHCA) in Washington, DC. She provides data and analyses to internal departments, state affiliates, and members to further AHCA/NCAL’s mission of improving lives and delivering solutions for quality care.

Alex has prior experience conducting program evaluations across the continuum of aging services and research on workforce solutions. She is passionate about using data, the voices of older adults, and the individuals working in long-term care to inform practical solutions to improve quality of care for older adults.

Alex received both her Master’s and Bachelor’s degrees in Social Work from George Mason University in Fairfax, VA.

KeShawn Franklin, MBA: Manager
Since 2015, KeShawn has worked with the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) providing her skills to the Quality, Regulatory, and Research Departments and members of the long-term care sector. In 2021, she expanded her role by joining the Research department as the Manager of LTC Trend Tracker and Quality.

In her current role, KeShawn supports the advancement of AHCA/NCAL’s mission of "Improving Lives by Delivering Solutions for Quality Care” through the day-to-day operations and management of the LTC Trend Tracker system, serving as the staff liaison of AHCA/NCAL’s Customer Experience Committee, and her involvement in various quality improvement & research efforts.

She obtained her Bachelor of Science degree in Psychology from Howard University and obtained her M.B.A. with a concentration in Project Management, from the University of Phoenix.

Lucille Xiang, MPH: Research Analyst
Lucille joined the AHCA/NCAL Research team this past July 2023 having recently graduated from Brown with her Master’s of Public Health (MPH). At Brown, she worked part-time at the Center for Gerontology and Healthcare Research doing research on a variety of long-term care topics.

In her current role, Lucille applies her practical and technical abilities to analyze data and communicate research findings into solutions to improve quality of care for AHCA/NCAL members and state affiliates.