Aligning Payer, Accreditation and Provider Goals to Achieve the Triple Aim

This session explores how the State Compensation Insurance Fund's (SCIF) efficient treatment approval process and outcome metrics were scaled and monitored across a broader network of care, allowing for meaningful insights into long-term patient recovery trajectories and resource utilization and aligned with the attainment of Commission on Accreditation of Rehabilitation Facilities' (CARF) accreditation, to catalyze data-driven, patient-centered transformation within Pain & Rehabilitative Consultants Medical Group (PRCMG). The integration of standardized performance indicators and patient-reported outcomes enabled all teams to strategically align care delivery with value-based goals. By aligning clinical and business practices with CARF standards, PRCMG established a rigorous framework for continuous quality improvement, outcome measurement and individualized care planning. Leveraging comprehensive data analytics, PRCMG demonstrated significant improvements in functional outcomes, patient satisfaction and operational efficiency.

This collaborative model successfully achieved the Triple Aim: enhancing patient experience, improving the health of the injured worker population and reducing the cost of care. This session offers actionable insights into how healthcare leaders can align payor goals with accreditation standards to build a culture of accountability, support transparent data reporting and sustain measurable improvements in rehabilitation outcomes. You will understand how provider-payer partnerships and accreditation play essential roles in aligning stakeholder incentives, enabling population-level impact and positioning organizations for success in value-driven healthcare.

You will learn to implement and track patient-centered outcome measures that align with both clinical goals and payer expectations, as well as recognize how accreditation serves as a framework for quality improvement, compliance and operational excellence in rehabilitation settings. You also will be introduced to strategies for collaborating with state-level payers like SCIF to scale and monitor value-based care initiatives. Be prepared to align your organization’s clinical and financial practices with value-based care principles, enhancing competitiveness and payer partnerships and empowered to use insights from rehabilitation outcomes to inform broader strategies that improve population health while reducing cost and variation in care.