Doreen Granpeesheh has spent the last year pruning out and grafting in strategies and plans at the Center for Autism & Related Disorders (CARD).
One thing for certain won’t be grafted back in: private equity.
Granpeesheh and her business partner acquired the company she founded in 1990 through a bankruptcy proceeding in August 2023. During a fireside chat at Behavioral Health Business’ INVEST 2024 conference, Granpeesheh told audience members that she would reinvest the company’s cash into new centers and avoid putting more debt on the company.
That strategy would be a return to form for CARD.
“I had no debt when I did the previous round of clinics,” Granpeesheh said. “I had built every clinic with our cash. … The company is stabilized; whatever it generates, we will put back into the company.”
She also noted that it’s not capital-intensive to open new clinics and that they often reach profitability in approximately six months to a year. Growing the company is a matter of strategic site selection and enabling centers to “support themselves,” she said.
Granpeesheh sold the company to the investment giant Blackstone in 2018 and stepped away from daily operations near the end of 2019. Following the onset of the COVID pandemic, the new ownership team struggled to get the company back on track, leading to bankruptcy proceedings in 2023. Previously, Granpeesheh told BHB that the company became too top-heavy all at once. It was then unable to meet its debt obligations.
Since taking over the company, Granpeesheh has focused on trimming down the company to make it more financially sustainable. In the future, she aims to continue simplifying the business and getting back on track to growth.
Trimming turns to growth for CARD
In the first few months, Granpeesheh set about cutting down expenses where she could. This included nixing vendor contracts where possible. Many, she said, were unnecessary.
She also set about thinning out and flattening the company’s corporate structure. She let go of all but one of the company’s top executives. “That in itself was a significant savings,” she said. Also, she and Pant are not taking salaries for their work at CARD.
This has allowed CARD to hit breakeven sooner than expected, at six months in. Granpeesheh anticipated it would take a year.
The last six months have been focused on growing the organization. On top of starting to open new sites, the company is looking to establish new patient and employee programs, including some that operated under Granpeesheh’s previous tenure. Today, CARD operates about 110 clinics.
The company also plans to open diagnostic centers that operate separately from its treatment centers. The collective autism therapy industry is struggling with a shortage of diagnostics, leading to many communities experiencing year-long wait lists.
Addressing workforce challenges
The trimming of the company’s corporate structure allows, if not requires, Granpeesheh to be involved in granular aspects of the business.
“I’m a very, very hands-on type of CEO,” Granpeesheh said. “I started to actually have weekly calls with all of our operations managers at the sites. … Then I really got involved with the supervisors — the BCBAs, we have about 300 of them — and really learned what their lives are like and what their problems and issues are.”
The process was illuminating for Granpeesheh and informed her strategy going forward.
“All of that came together for me recently and made me conclude that our focus in 2025 has to be making things easier for all of our folks,” Granpeesheh said.
At the frontlines of the company, this realization has translated to making clearer connections to the work of its registered behavior technicians (RBTs) and their career success. CARD has reestablished the incentive program, CARD Shops. Clinicians can generate points for billable sessions that can be used to purchase items, similar to credit card points. The company has also created a wage incentive program. RBTs get raises each time they complete 500 hours of care.
The hope is that these programs make it easier for RBTs to schedule additional available hours and hours during times that might not be convenient for them but are convenient for patients, such as evenings and weekends.
Taken together, these programs are meant to create clearer and better incentives for RBTs to be flexible and to help them feel empowered regarding their advancement. Offering appointments more frequently and at varied hours of the day is hoped to increase patient attendance.
At a more foundational level, Granpeesheh hopes employees will feel heard within the company. The CARD Shops program was a popular request during an early CEO-all-company meeting, for example.
“Nothing motivates people more than being heard,” Granpheesheh said. “If you can establish a system where there’s not a huge distance between the people who’ve just entered and the people running the organization, everyone’s going to feel heard.
“If people feel like someone cares, then they don’t quit because, whatever the problem is, they have a voice, and you can hear their voice, and you can try to fix things.”
Looking to the future
On the operations side of the business, CARD will lean into using AI and tech investments.
“AI is my No. 1 objective,” Granpheesheh said, noting that AI wasn’t at the forefront of business operations when she stepped away from daily operations. “I think investing in AI right now is absolutely the right thing to do for everyone. This is like investing in the internet 40 years ago. … You can’t reject that kind of technology.”
AI implementation is still in its early stages at CARD. The company completed a handful of pilot programs this year. Examples of AI use within the company include generating reports, capturing insights from conversations and analyzing the company’s historic clinical data.
On top of that, the company is going to use technology to bolster and expand its parent support and training programs. It also plans to develop games for use in treatment plans.
CARD will also flesh out partnerships with physical health care providers. Already, it has established partnerships with Cleveland Clinic and UCLA’s medical arm to stabilize patients’ physical needs before starting treatment with CARD. Patients can begin CARD’s treatment about 2 1/2 months after they are seen by physical care providers.
All of these efforts are also hoped to improve outcomes. In large part, trying to improve outcomes is an attempt to balance payers’ push to pay for fewer hours and the long-awaited, but yet-to-arrive, implementation of value-based care models across autism therapy.
While her early conversations with payers have been fruitful in terms of contracting, Granpeesheh says there is an elevated interest in tracking care outcomes in anticipation of value-based care contracting compared to when she stepped away from daily management of CARD in 2019.
These models often hold providers accountable for the results of the care provided. CARD is pushing itself to maximize outcomes with fewer covered hours.
“I am a little bit concerned about the field as a whole because the intensity of services has reduced,” Granpeesheh said. “The intensity of ABA is equivalent to a prescription. The intensity is the dosage. If you are supposed to be doing 30 hours a week and you’re doing 10, the result is going to be less. Is it just a given. … I’m really, really focused on trying to get the outcomes to be better before the payers require the outcomes to be better.”