Nailing an all-in-one autism therapy model would be a huge boon for patients and provider organizations, but it’s not the norm.

Several other segments of health care have consolidated different specialties into holistic systems that, at their best, do more than the specialties could do independently. At the very least, providers can then keep patients when health care needs change or new ones arise.

Several systemic and longtime challenges prevent the proliferation of all-in-one autism therapy models. Still, some organizations have established these models, attempting to make their own market or to make the market accept their innovation. Still, pushing forward all-in-one models may somewhat miss the mark for what the collective autism therapy system is asking providers to produce.

“It’s really, really hard pulling together a comprehensive team and optimizing a care plan for a child with complex needs, and doing that at scale,” Ellen Herlacher, a partner with the venture capital firm LRVHealth, said during a Behavioral Health Business webinar. “Sometimes I have to remind myself from the venture seat that it’s a pretty new model … Even though, from the venture seat, things move so quickly and you see a model emerge, and you see evidence of efficacy, and wonder why there aren’t fast followers —we’re still pretty early days.”

It’s expensive to invest in the technology and administrative system to make these models work, let alone scale. LRVHealth is a backer of San Diego, California-based Cortica, a company that consolidates several care specialties for children with autism and other neurodivergent conditions, the biggest exception being general pediatrics. The company has raised $175 million since its founding in 2014, according to Crunchbase. 

On top of the challenge of building an all-in-one autism therapy model, there is no guarantee that the market will appreciate the value it delivers. Payers, stuck in the fee-for-service model, balk at value-based care models and are more eager to seek greater access to care, rather than reimbursement innovation.

Still, there is a movement toward value-based care in the autism therapy industry. Cortica provides one example. Payers such as Magellan Health and Kyo Autism Therapy have worked for years to wire together a “skeleton” reimbursement model for value-based care to ease continued conversations on the topic.

There is also not yet an industry-wide consensus on what metrics should be used to measure value and applied across the industry. In the meantime, Behavior Frontiers CEO and co-founder Helen Mader says there should be greater efforts made to increase fee-for-service rates that have historically been stagnant. She adds that she has seen some improvement in recent years.

“I think in our industry we still need to focus on increasing the rates for fee-for-service — many of those rates remain too low,” Mader said during the webinar, referring to the advancement of value-based care. “We shouldn’t lose sight [of] that when those rates are not sustainable. So that, oftentimes, does still need to be the first step.”

Behavior Frontiers, founded in 2004, has focused on providing applied behavior analysis (ABA) as its core offering, the norm for autism therapy providers in the U.S. Still, the company has sought to simplify the lives of patients and families by also providing speech therapy, occupational therapy and diagnostic services. It is based in El Segundo, California.

And over the course of Behavior Frontier’s 20 years of operation, patients and their families have continued to push the organization for more and higher quality center-based therapies that are based on ABA. Simply “perfecting ABA is a challenge,” Mader added.

Even without consolidating additional services, Behavior Frontiers has invested heavily in building its operational capacity by investing in data tracking. For example, the company has built its own tracking software, PrioraCare. It enables electronic data collection, automates reporting, and, in 2023, has the added capacity of clinical outcome reporting across the company’s clinical census.

“It seems that most ABA companies do not have a way to view their data or present it in aggregate on either their operations or clinical progress,” Mader said. “So I think that value-based care arrangements will not be realistic in the near future for many providers.”

Behavior Frontiers does not yet have value-based care contracts but is in talks with payers.

Regardless of approach, the ever-increasing demand for autism therapy services from patients and investors puts significant pressure on organizations to reach ever-higher levels of sophistication. As challenges in the industry continue to evolve, autism therapy therapy will have to continue to mature.

“What we learned [in 2023] is that we are starting to see a bifurcation in the market where sophisticated providers are going to excel and continue to excel,” Mader said. “But unsophisticated providers may start falling by the wayside.”