Autism therapy organizations that  provide holistic care models often do so to their financial detriment, with the aim of moving the needle for the patients and families for which they care. 

The fee-for-service paradigm often fails to compensate — either at all or adequately — for the nonclinical aspects of providers’ and other employees’ time that seek to make providing a holistic care model of care more than the sum of its parts. This puts autism therapy providers in the thankless position of being expected to advance the health and wellbeing of patients without getting commensurate value.

“Even if we have to work toward a prior authorization and not get paid for it for an extended period of time, we’re willing to do that because families need it,” Adam Hahs, chief science officer for the Indianapolis-based autism therapy provider Hopebridge, said during a panel at Behavioral Health Business’ inaugural Autism & Addiction Treatment Forum in Chicago.

Hopebridge provides applied behavior analysis (ABA), which Hahs called the gold-standard of autism care, as well as occupational therapy, speech-language pathology and other behavioral interventions. Despite having ABA at the core, Hahs notes that it is “not the idiosyncratic lens through which you can look at care.”

“We have the fortune of having a number of different aspects through which we look at the impact on [the] interdisciplinary providers, their impact on ABA and the family’s wellbeing,” Hahs said. “In doing so, we can see to what extent those other services add additional launch or lift to the trajectory of overall gains for families.”

About 67% of Hopebridge patients receive a combination of therapies. The company’s data shows significant overall improvement compared to patients who get services added to ABA later.

Hopebridge provides added services internally, whereas Green Bay, Wisconsin-based Caravel Autism Health partners with other providers in its holistic care model. The company partners with pediatricians and speech language pathologists. ABA is the company’s core focus.

“I think that is us trying to be really good at the core of what we do first,” Caravel Autism Health CEO Mike Miller said during the panel. “I do think that has served us very well through difficult times, with COVID and other things in which operational things were more challenging.”

Caravel Autism Health does family training internally, a supplement that has a measurable impact on ABA therapy. Patients who have parents who engage in family training are twice as likely to make progress on measures assessed by the Vineland Adaptive Behavior Scales.

Miller approaches Caravel Autism Health’s holistic care model with the understanding that a significant portion of that work won’t generate revenue: Somewhere between 20% to 40% of board-certified behavior analysts’ (BCBAs) time is non-reimbursable in traditional care models. 

“In the context of whole-person care, it’s probably even less reimbursable because you’re starting to straddle outside — planning certain things, coordination with a pediatrician, is not likely going to be reimbursed, for example, but it’s critically important,” Miller said.

Miller assessed the autism therapy industry’s progress on alternatives to the fee-for-service model as being in its “toddler stage,” noting there has been some level of development in this area but not across the whole of the space. More progress has been made at nonprofit organizations with wide-ranging services that work closely with government agencies. I Am Boundless, a Worthington, Ohio-based behavioral health and intellectual/developmental (IDD) services provider, provides one example of this specific slice of the industry.

Through years of engaging with managed care organizations, I Am Boundless’ several programs have secured care management, case management, delegated care contracts and fee-for-services rates that are higher than published fee schedules based on its outcomes data, said Jennifer Riha, chief strategy officer at I Am Boundless.

“It didn’t automatically happen,” Riha said, adding that the company started its current relationship building with payers in 2018. “That initiative and the things that have grown out of all of that was what brought us to the place of being able to engage in these different kinds of contracts and being able to negotiate for enhanced rates.

“We had to spend a lot of time building that rapport and sort of proving to them that we were what we said we were.”

I Am Boundless offers primary care, dentistry, psychiatry, speech and occupational therapy and applied behavior analysis (ABA). It also provides several types of residential, community and integration services for individuals with IDDs.

Hopebridge is pointed in a similar direction, Hahs said. He also believes it’s incumbent on autism therapy providers to demonstrate to payers and others that they are providing value to the world.

“It’s time to put up the data and let data drive the decisions of the lift that those [holistic care models] provide,” Hahs said. “When we come to the table with that data, it all comes off a lot cleaner of a conversation. We’re not just talking and doing a dance but can dissect and present data in different ways than just having a subjective account.”