CARD, Magellan Health, Cortica Execs: the Challenge of Value-Based Care Is ‘Getting Everybody on the Same Page’

The autism therapy industry lacks consensus on measuring care quality, hindering value-based care efforts, according to industry insiders.

Despite the challenges, efforts by autism therapy providers such as Cortica, the Centers for Autism and Related Disorders (CARD), and health plan provider Magellan Health keep the nascent alternative payment model moving forward.

“The challenge with ABA is we don’t have an agreement on what outcomes would look like,” Yagnesh Vadgama, vice president of clinical care services for autism at Magellan Health, said during a panel discussion at the Behavioral Health Business event VALUE.

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The share of value-based care engagements between Magellan Health and autism therapy providers presently is “admittedly low,” Vadgama said. Magellan Health has a value-based care arrangement with a provider in Pennsylvania and one in California.

Vadgama, a board-certified behavior analyst (BCBA) with 19 years in the field, said the Pennsylvania engagement was used to pilot the model and help work out its mechanics. In California, that model continues to refine itself but also focuses on defining widely applicable care outcomes.

“That’s what we want to get to so we can get everybody on the same page,” Vadgama said of establishing care outcomes to use as a metric for value-based care models.

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One place to start building consensus on care quality and how to measure it could be long-established validated measures, Vadgama said.

In June 2021, Magellan Health announced a pilot with Doylestown, Pennsylvania-based Invo Healthcare to define standards of care for children with autism. In December 2022, Magellan Health announced it teamed up with Daly City, California-based Kyo Autism Therapy to develop outcome standards for autism therapies.

“What we want to be able to do is use that as a starting point,” Vadgama said. “And once we can get on a starting point, now we can start to build in other measures.”

Yagnesh Vadgama Neil Hattagandi at value-based care conversation in ABA at VALUE 2023 Behavioral Health Business
Yagnesh Vadgama of Magellan Health, left, and Neil Hattagandi of Cortica, right, speak at a VALUE 2023 panel.

He and other panelists emphasized that standardized assessments are incomplete care quality measures, but must be a necessary part of value-based care.

Apart from providers, autism therapies accreditation and quality standards group the Behavioral Health Center of Excellence announced collaborations with two major payers — Magellan Health’s corporate parent Centene Corp. (NYSE: CNC) and The Cigna Group’s services division Evernorth — to define and assess how to track the quality of care in 2022.

San Diego-based Cortica and Plano, Texas-based CARD have a small number of value-based care engagements.

Cortica CEO Neil Hattangadi said four of the company’s 30 or so payer arrangements are under an alternative to the typical fee-for-service arrangement. CARD Chief Revenue Officer Jeffrey Hulburt said about 10% of the company’s revenue comes from value-based care and other alternative arrangements.

Cortica hopes to see greater value-based care adoption to better support its all-in-one approach to pediatric autism care, he said. In addition to ABA, Cortica consolidates many other services pediatric autism patients need such as gastroenterology, neurophysiology, physical therapy and developmental pediatrics.

The challenge with ABA is we don’t have an agreement on what outcomes would look like.

Yagnesh Vadgama, vice president of clinical care services for autism at Magellan Health

Hattangadi said during the panel that other measures should include assessments of care beyond behavior and could include psychiatric, metabolic, sleep and other developmental assessments.

“The more we can get away from process metrics into outcomes metrics and let the providers decide how they’re going to achieve those outcomes, the better,” Hattangadi said.

Cortica and Point32Health, a diversified Massachusetts-based health plan, announced a value-based arrangement in September 2022.

 CARD relies on partnerships with other health care providers to ensure that its patients’ comorbidities not addressed by its services are treated. Hulburt said. The company has these partnerships in some, but not all, markets. 

“Why would we take on services that we don’t really know how to do,” Hulburt said. “I do believe we have to find a way to create those partnerships and our payer relationships should help us get there.”

Jeffrey Hulburt at value-based care conversation in ABA at VALUE 2023
Jeffrey Hulburt, chief revenue officer of the Center for Autism and Related Disorders, speaks with an attendee at VALUE 2023.

In some markets, CARD sees shortages of other pediatric specialties, limiting the number of potential partners, Hulburt said. This challenge limits the organization’s interest in prioritizing these partnerships. 

“We will interact when those things come forward, but we’re not proactively trying to solve them,” Hulburt said.

CARD has seen a lot of changes over the last few years. The company named a new CEO in February 2022. The same year, it moved to vacate 10 state markets. It is still among the largest ABA providers in the U.S. It lists 130 locations in 14 states on its website.

Vadgama said payers should lead in creating a global view of value in treating autism patients. Payers’ networks of providers should be able to flag other medical issues of autism patients that providers don’t address.

“That responsibility is on us right as the payer,” Vadgama said. “We have the network of providers that should be doing what else is needed. Does it benefit an ABA provider to start adding in LM FTS, LCSW, or maybe an MD? Yes. … But if you don’t have that, that’s where we would come into play.”

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