Why ABA Provider Acorn Health Is Growing When Market Leaders Are Shrinking

Vicki Kroviak, CEO of Acorn Health, rejects the “dots-on-a-map strategy” for growing autism therapy businesses.

Under Kroviak’s direction, the Applied Behavior Analysis (ABA) provider has expanded its footprint by 47% since 2018.

At the same time, others in the space have had to downsize — laying off staff and even abandoning entire state markets.


Most recently, Acorn Health acquired seven sites from Maitland, Florida-based Breakthrough Behavior. The terms of the deal, closed on Sept. 19, were not disclosed.

Acorn Health offers in-office and at-home ABA services in 75 locations following the Breakthrough Behavior deal.

For Acorn Health, growing while others are shrinking comes from deep study of all options before taking a leap. It also helps to grow in areas the company already knows or even has existing infrastructure. Much of the company’s growth builds on work in its existing markets, Kroviak, who also serves as the company’s founder and company chair, told Behavioral Health Business.


“We do our homework before we go into a new market,” Kroviak said. “That’s a perfect example in Breakthrough Behavior. We understand what we’ve got.

“It’s highly unlikely we’re going to be surprised by what the labor market tells us in any of their facilities because we … already have an understanding of it.”

Strong local knowledge also gives insights into payer dynamics, allowing for even further planning, Kroviak said.

The autism space has seen two competing forces collide in 2022, precipitating hundreds of layoffs.

On one hand, private-equity-backed autism treatment companies have for years gobbled up smaller offices to gain market share and potential leverage with payers. This has accelerated in recent years, according to proprietary data sources.

On the other hand, COVID-driven wage pressures have prompted high rates of turnover in registered behavior technician (RBT) roles, the practitioners that most often work directly with patients. This, combined with limited reimbursement increases, drove some of the largest autism treatment providers to downsize to cope.

“I think there’s a lot of risks when you’re approaching your growth in a dots-on-the-map kind of way, particularly in the year that we’ve had where the labor challenges were so great,” Kroviak said.

Plano, Texas-based The for Autism and Related Disorders (CARD) is shutting down operations in 10 states, reducing its state market footprint to 14 states. Since December 2021, the company has cut its office footprint by 30%. Following the news of the closures, the company said it regularly reviews and evolves its operating footprint and evaluates its centers for capacity, staff and reimbursement rates.

Earlier in the year, CARD shuttered its Oregon office and 360 Behavioral Health closed 9 locations. At least 665 employees were impacted. It’s not yet known how many people will be impacted by CARD cutting its state footprint by nearly half.

Kroviak founded the company in Coral Gables, Florida in 2018 with the backing of private equity firm MBF Healthcare Partners. In 2021, MBF Healthcare Partners sold Acorn Health to the Ontario Teachers’ Pension Plan Board (OTPP). At that time, Acorn operated 51 locations across Michigan, Illinois, Virginia, Florida, Maryland, Pennsylvania and Tennessee.

The OTPP takes the long view of the ABA industry, said Kroviak. This allows Acorn to also strategically plan for the future. Similar to her company, Kroviak said OTPP understands the ins and outs of autism treatment and isn’t fazed by the recent workforce trends.

“That three- to five-year [holding period] in private equity pressure creates some impatience,” Kroviak said.

While terms of the deal were not released, the OTPP’s website lists Acorn Health with its “major investments” on its website. It defines major investments as those valued at $200 million or higher. The investment bank Brentwood Capital Advisors estimates the value of the deal to be $245 million.

One long-term strategy enabled by Acorn Health’s owners is paid maternity leave and other workforce development efforts. Other efforts include professional development and mentorship programs.

Paid maternity leave is especially important in the ABA space because women hold 85% of the BCBA, RBT and other ABA-related certificates, according to Behavioral Analyst Certification Board data.

The same data set shows about 64% of certificate holders are between the ages of 18 and 45.

“So it’s women and it’s younger women,” Kroviak said of the workforce. “We came to that decision by really doing the work to listen to our workforce.”

The company announced the new policy to the public last week.

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