Hopebridge Autism Therapy Centers, which is already one of the country’s largest autism treatment providers, is expanding its footprint even more in 2020.

Indianapolis-based Hopebridge is a completely center-based provider of applied behavior analysis (ABA), diagnostics, occupational therapy and speech therapy. It serves children as young as 18 months and as old as 12 but mainly focuses on early learners.

The company — which is backed by Arsenal Capital Partners, a private equity firm based in New York City — recently announced it will add more than 20 new locations across two new states, Colorado and Minnesota, in the next 12 to 18 months.

While those locations are new, the company’s aggressive growth strategy is not. In fact, in the past three years alone, Hopebridge has more than tripled the number of centers it operates.

Today, the provider has planted its flag in six different states and has no plans of stopping there, according to founder and Chief Clinical Officer Kim Strunk.   

Behavioral Health Business recently connected with Strunk to learn more about Hopebridge’s need-driven growth “algorithm,” which is bolstered by its PE-backing and the company’s unique “grow-your-own” staffing model.

You can find that conversation below, edited for length and clarity.

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Just how many facilities do you have these days? I know you had 14 centers at the end of 2017, then that number jumped to about 40 last May. What are you up to now?

That number is changing every week. We will have at least 51 within the next two weeks.

How do you decide where to open new locations? For example, you recently announced as many as 12 new clinics in Colorado and 10 in Minnesota, two states that you hadn’t previously operated in.

There’s really kind of an algorithm.

In the early days, we didn’t have quite the level of sophistication in determining which areas we went to. Today there is a process, and we have a team that really evaluates which is our next state to go into.

Demand is not ever really an issue. I’ve not encountered a state that has enough providers to meet the demand that is out there.

But every state is a little bit different. While we all have mandates now to provide insurance, they’re all funded and administered slightly differently. Making sure that we really understand the scope of the funding and how each state can provide resources for those families is really important.

One of the other aspects of Hopebridge that is really core to our mission is serving children on the Medicaid population. That’s been a part of our culture and mission from the beginning, but that’s often challenging because each state administers their Medicaid policies differently.

Making sure that we understand how we become providers and operate within the constraints of their system is really important.

We also take into account the demographics and the ability to hire staff. Right now, BCBAs are in high demand and there’s a shortage to meet those needs. In rural communities, for example, it’s really hard to get staff there. While I can put a clinic there, if I can’t staff it, I really can’t do any good for the families.

Staffing shortages are a problem for everyone in the behavioral health industry right now. How do you combat those problems?

We strive to be the very best place to work.

We find that we’re an attractive employer based on the support that we provide our clinical teams, the development opportunities and the structure that we offer.

The other thing that we do is we’re very invested and committed to fostering individuals who would like to go into the field. We provide opportunities to assist and support them when they’re working through their master’s in behavior analysis by giving them some of [the] experience hours that they need by providing mentorship.

We have established a program. We call it the Behavior Analyst Fellowship Program, which is akin to an internship clinical fellowship experience. Students are working alongside our team members and learning how to become behavioral analysts.

It’s kind of a grow-your-own model that we’ve implemented and have been very successful with. We currently have well over 150 people that are employed by us and are working toward their master’s [degrees].

I’m sure your PE-backing can’t hurt either. It probably helps finance more competitive wages.

Sure.

Do you have any turnover numbers you can share?

It’s a pretty variable number.

I think we’re probably fairly in line with industry averages from a behavior technician standpoint.

I don’t have the specific numbers, but we do have indication that our BCBA turnover is significantly less than industry average.

Again, I think that goes to the fact that we invest a lot into our clinical team in terms of development opportunities for them, continuing education, support and our model structure.

Got it. Back to your PE-backing. Walk me through your history with that.

We started in 2005, and the PE-backing came in 2011.

At the time the initial investors came about, it was [about] operational opportunities for us.

In the early years when we first started, the [autism] prevalence rates were not even close to what they are today. In addition, at the time we started, there were no mandates requiring insurance companies to pay for services. We weren’t seeing autism diagnosed nearly at the age of diagnosis today.

Around 2011, Indiana put the mandate in place [requiring insurance companies to pay for ASD services]. That’s really when we started seeing a lot of significant demand increases for our services.

It was really just an opportunity to be able to capitalize the organization in order to meet the demand that we were experiencing.

Since that point, we have seen, as an industry, the prevalence rates continue to increase and skyrocket. Families are still trying to obtain access to intervention services.

There’s not been enough providers in the space from the very beginning. Because of that, there continues to be a great demand for our services. If you’re going to continue to grow and increase access for these families, it requires capital.

Therefore, that was the attractive thing for us — to partner with a PE firm that would allow us the opportunity to finance growth so that we could continue to reach more families and children.

Can you talk about how PE has helped you explode and discuss your growth trajectory?

Identifying children early and providing intervention early is really pivotal in determining how a child responds to the intervention and their ultimate outcome.

Ultimately, what we’re trying to do is help these children transition into a school environment — because that would be a typical environment for this age group — and to do so successfully and with minimal support.

Our growth plan is a very aggressive growth plan, but that’s really driven by the fact that these families are out there that need the services. Our strategy has never been to go into a state or a community and just open one center — because you only have certain capacity in that one center.

While our centers are large — they typically are 10,000 to 15,000 square feet and can serve up to 60 children — that’s only 60 children. The population needs are so much greater.

Our model has been to aggressively go in and become a partner with those communities and a solution in those states. That’s why when we go into a state, we’re opening eight, nine or 10 clinics, and we’re doing it fairly quickly.

Again, our goal is to try to be a solution for those families. So there’s nothing worse on the provider side than to take a phone call from a family and not have the ability to serve them.

You guys have changed PE-backing in the past few years, but generally how do you go about finding the right PE partner? Did you guys seek firms out or did they come to you?

It started just through some network connections that we had.

Then, as probably any other provider reading this article can tell you, right now, PE firms are reaching out to multiple ABA providers.

We continue to get pinged by different PE firms that are interested in our services, but we were very careful in our selection of our partner. We chose somebody that aligned with our vision and our values and was really focused on making sure that we could increase access to these families.

That was the most important thing. As we chose a partner, that’s what we were looking for.

What advice would you have for autism treatment providers who maybe aren’t PE-backed yet but are looking for a PE partner?

Just to choose carefully.

Finding a partner that aligns with your vision is really important. The advice I would have is just to make sure you get to know the group that is interested in you and make sure that you align on the core values of your business.