ABA Centers of America is bootstrapping its way to national expansion, adding four new state markets to its footprint.

The Fort Lauderdale, Florida-based autism diagnostics and therapy company is expanding into Texas, Tennessee, Georgia and the Washington D.C. area. The center already operates in Florida, Massachusetts, New Hampshire and New Jersey. It is also working through the final stages of licensing for locations in Pennsylvania.

So far, ABA Centers of America has not engaged with a private equity firm or similar backer to grow, CEO and founder Chris Barnett told Behavioral Health Business. Barnett is a serial entrepreneur who owns and operates several ventures through the holding company, ICBD Holdings. The private equity industry has been behind the rise of the national autism platform companies that top the industry in terms of size and reach.

“We’ve found a model that makes sense, and … the market is responding to it,” Barnett said. “It’s our goal to treat as many kiddos as we can … I’m painfully aware that there are kiddos all over the country that are languishing on somebody’s waiting list waiting for me to enter the market.”

Being the father of a child with autism influences his motivations as a business owner and leader, he added.

Specifically, ABA Centers of America is opening locations in the following markets:

— Austin, Houston and Dallas, Texas

— Nashville, Tennessee

— Washington D.C.

— Alexandria, Virginia

— Buckhead and Alpharetta, Georgia

The company is also in the process of building three centers in the Philadelphia area. ABA Centers of America offers center-based, in-home and in-school services. By the end of the year, the company will effectively double its footprint. The company was launched in 2020.

Today, ABA Centers of America cares for over 700 children and has been growing its census consistently at about 12% each month, according to Barnett. It also offers diagnostic services with the goal of getting clients to an assessment in 14 days and delivering a diagnostic report within a week.

The diagnostics are available to all regardless of payer status or if the patient will go on to get care at ABA Centers of America.

“I can give them a diagnosis, and I can get them on somebody else’s waiting list, potentially two years quicker,” Barnett said. “And that’s really important to me.”

ABA Centers of America’s approach to growth with payers

Working with commercial payers on an out-of-network basis or through single-case agreements has enabled its approach to care, staff and footprint expansion. ABA Centers of America is also credentialed with Medicaid programs in most of the states where it operates. 

Barnett declined to discuss specifics. But he offered that “well over 20%” of ABA Centers of America’s clients get access to care through single case agreements and that “we do treat a lot of our clients out of network.”

“We’re solving a pain point for the payers,” Barnett said. “They’re federally and sometimes state [mandated] to provide providers in their network, and there just aren’t enough providers to meet the demand.”

Often, out-of-network and single-case agreement rates are higher on average than in-network rates. Single-case agreements allow patients to use their in-network benefits without a care provider establishing an in-network contract with a payer. However, single-case agreements may be difficult to obtain and administer en masse.

For that, ABA Centers of America turns to proprietary outcomes tracking and business intelligence software to use data to negotiate with payers.

Barnett also owns a technology company called ABATECH that builds software — including an electronic health record (EHR) and clinician-level data collection systems — that is “incubating” alongside ABA Centers of America. ABATECH doesn’t presently work with any other organizations.

The approach to care and staff

The company’s outcomes-focused approach enables it to center care on improving clinical progress, titrating it down until the patient can be considered a “graduate” of ABA Centers of America’s treatment.

“It’s our goal to get our clients out of care where possible, when possible,” Barnett said. “It’s our goal to put ourselves out of business with that client.”

While its interventions were standardized early on, board-certified behavior analysts (BCBAs) customized treatment plans. The company’s average hours per week are less than 25; contrast that with other organizations that push for 40 hours per week. This, too, is a winning point with payers, according to Barnett.

The company also takes patients of all types and ages, including teens and adults.

ABA Centers of America can do this and find the staff it needs to grow with the higher rates it has secured.

“The [single-contract agreement] rates are very important to us; we’re getting sustainable wages in order to build and grow a business and treat the population like they need to be treated,” Barnett said. “We’re using that model to allow us to take care of BCBAs.”

On top of competitive wages, ABA Centers of America offers the ABA Academy of Excellence to train both BCBAs and its registered behavior technicians (RBTs), the frontline workers in most applied behavior analysis (ABA) programs. The company pays new employees while they are trained.

These internal training programs are geared toward supporting and attracting younger BCBAs. The Behavior Analyst Certification Board (BACB) says that 65% of the RBTs and BCBAs it has certified are aged 18 to 34. 

Typical BCBA caseloads at ABA Centers of America are about 10 clients.

“A lot of BCBAs are newly graduated, and sometimes they don’t feel confident and ready to take on a caseload. But they enter the market, and they might be told they have to take 25 clients and get very little support,” Barnett said. “Clinical excellence is important to me because, to be honest with you, my daughter deserves that.”