Why KKR, Altamont Have Launched a New Autism Platform Amid Industry Turmoil

With some major stumbles in the autism service industry still fresh in public memory, it may seem like an odd time for Gracent LLC to launch a new private equity-backed platform.

But Gracent’s leadership says now is the right time to get into the game after seeing where others went wrong. That includes keeping sustainability in mind as it grows and making board members and advisors to the company legitimate assets.

In terms of services, Gracent CEO Mark Shalvarjian sees the company eventually becoming a “pediatric therapy company” that acts as a one-stop-shop for the most important therapies related to autism.


“If we can provide those under one roof and provide significant coordination of care benefits to families, we think that’s the right way to do this,” Shalvarjian told Behavioral Health Business.

Shalvarjian acknowledges the company can’t be all things to all families. But providing several types of services with close internal coordination is vital to providing good care and distinguishing itself from competitors.

This includes the autism therapy mainstays of private equity-backed platform companies such as applied behavior analysis (ABA), speech therapy and occupational therapy at all its locations.


Gracent operates locally under two brands — North Shore Pediatric Therapy in the Chicagoland area and Pine Cone Therapies LLC in Texas. The company will eventually expand the physical therapy, mental health services and pediatric neuropsychiatry also offered at North Shore Pediatric Therapy to the Pine Cone locations.

The company has 12 centers in operation — nine in Illinois and three in Texas — and two in development, Shalvarjian said.

The autism therapy clinics were previously part of Sequel Youth & Family Services LLC, an at-risk youth services provider backed by the private equity firms Altamont Capital and KKR. Altatmont invested in Sequel in 2017. The firms held onto autism therapy assets after selling the rest of Sequel’s assets back to one of its founders relaunching them as Gracent in March 2022, and hired Shalvarjian in November 2021.

Today, Gracent has backing from Philadelphia-based FS KKR Capital Corp. (NYSE: FSK) and Altamont.

Who else is involved

Shalvarjian comes to the CEO role with decades of health care management experience, starting with DaVita in the late 1990s with a stint as the chief operating officer of Kadiant, another autism therapy provider, in 2020. 

Several notable board members and advisors back him up. Some of its independent board members include Molly Ola Pinney, the founder and CEO of the international ABA training nonprofit Global Autism Project, and Amy Kennedy, the co-founder of The Kennedy Forum.

Gracent also engages with the co-founders of Pine Cone Therapies and North Shore Pediatric Therapy. They attend the company’s board meetings, are key voices when it comes to evolving its services, and help establish and maintain local relationships for the company. These founders will also lead the development of regional advisory boards for Gracent even though they are “semi-retired” from business.

“These are perspectives that I think that most private equity-backed ABA providers do not have,” Shalvarjian said. “We’re always looking for opportunities to tap into knowledge and experience wherever we can to ensure that we’re doing all the right things, not just for the business, but for our clients and our team.”

What’s next?

Shalvarjian says that the market, especially the workforce environment, has improved, and gives it a slightly easier start. Over the last 18 months, Gracent and its backers have prioritized building out management teams and assessing what makes for an attractive workplace.

There is also a “clear” benefit to launching now in terms of debt financing, Shalvarjian said. Many incumbent platforms saw their debt payments skyrocket after rates from the Federal Reserve increased over the last few years. This was a fatal development for as was the fatal case of the Centers for Autism and Related Disorders (CARD) and other companies.

For the time being, the company is focused on generating revenue from working with commercial health plans. It is in the early stages of adding Medicaid to its business.

“I want to make sure that whatever we do is sustainable over the long term,” Shalvarjian said.

Hopebridge Inc., a large Indianapolis-based autism therapy company, shut down its Colorado ABA services and six-of-eight centers because of its large Medicaid census and stagnant Medicaid rates.

Gracent is exploring growth by compiling several market data sources to map out where it could go. But for the most part, the company will likely stay focused on de novo growth in its original state markets of Illinois and Texas. The data it’s exploring includes demographics, labor force trends and competitor information.

Shalvarjian didn’t dismiss M&A out of hand. But if it did so, it would likely be an introductory investment for further de novo and organic growth initiatives.

“We’ve definitely benefited from being able to observe what was going on, but also deal with it in our own way, without getting caught up in the frenzy of growth that was taking place,” Shalvarjian said. “I don’t think that you’ll see us writing a lot of big checks for existing providers to add to our network.”

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