Caring for those with autism often fails to account for the totality of the person, let alone their health.

But an increasing number of behavioral health organizations are recognizing the clinical need — and the business opportunity — for whole-person care models in various settings.

Indeed, leading clinicians and executives in the field maintain that a diversity of services is the only way to create true depth within a business that serves those with autism.

“To me, the whole concept of whole-person care is a reflection that people are more than one thing,” Patrick Maynard, CEO of the Worthington, Ohio-based I Am Boundless, said during a panel at the Behavioral Health Business INVEST 2024 conference. “It’s a disservice if we’re only going to do one line of service; we need to do all of them.”

I Am Boundless is one of the largest nonprofit social services providers in Ohio by revenue. It generates $170 million in annual revenue, Maynard said. Services include autism therapy, integrated behavioral health, psychiatry, housing and housing support, specialized treatment models, primary care, dentistry and pharmacy services.

The development of this wide array of services was rooted in I Am Boundless’ long-term strategic goal of becoming financially sustainable.

“There’s no mission without money,” as Maynard put it.

This focus was vital given the low rates paid by the Ohio Medicaid program for autism services. The organization, in brief, has partnered with numerous government entities and managed care organizations to weave a web of services that not only allows the organization to have standing with these entities but also helps make up for services with thin margins.

One such service is contracting with government entities to care for what are called “multi-system youth,” or young people who are interacting with multiple government or social systems. Maynard described it as a “high-margin service for us.”

“So the key to this whole thing was, as we integrated services and created more services, we created scale and capacity and margins, which is the big thing,” Maynard said. “If you can increase your margins, then, obviously, you have more resources to put towards your mission goals.”

Similarly, applied behavior analysis (ABA) services provided by the San Diego-based multi-specialty autism therapy provider Cortica tend to generate a stronger margin, LRVHealth Partner Ellen Herlacher said during the panel. LRVHealth is an investor in Cortica.

Some of Cortica’s other services include developmental therapies such as speech-language, occupational and physical therapy, and medical services such as developmental pediatrics and gastroenterology.

The all-in-one approach has won over investors and payers for Cortica. In 2023, the company raised $115 million across two rounds. It is also one of the few autism therapy providers that can command alternative payment models that can be considered value-based care arrangements.

Herlacher said that adding diverse services is not the same thing as diversifying within the context of creating whole-person care models. Rather, adding new parts deepens the specialization of an organization’s capabilities around a common condition. In the case of Cortica, that includes autism spectrum disorders and other developmental and neurological conditions.

“What we’re able to do is understand the multiple factors that are at play when you’re talking about a particular child and then specialize around what the right mix of care is,” Herlacher said.

LRVHealth’s investment strategy includes assessing the impacts of a business on all of the many constituencies impacted by an issue. In considering investing in the autism therapy space, Herlacher said she and her team considered the impact of caring for those with autism on families (parents of autistic children divorce at twice the rate of other parents), the increased spending on these patients payers face, and the desire but hurdles of clinicians across specialties to coordinate care for those with autism.

A whole-person care model helps to ameliorate the issues each of these constituencies face.

The increased diagnosis of autism naturally leads to its co-occurrence with psychiatric conditions such as eating disorders and OCD.

Dr. Wendy Oliver-Pyatt, founder and chief medical officer of Galen Hope and CEO of Within Health, said this necessitates the invention of new models of care. Often this requires providing care that doesn’t fit into traditional models, as those with autism are frequently not accepted to programs that treat psychiatric conditions.

“Good autism care is good clinical care,” Oliver-Pyatt said. “We need to figure out a way to integrate care and make it work for our patients, not just fit some preconceived model of what care should be. I think good care really is attuned care: It’s about looking at the person in front of you and what they need.”

At the root, Oliver-Pyatt said, good care for those with autism and co-occurring conditions is based on the biopsychosocial model, an assumption that care will account for the patient’s biological, psychological and social needs.

Serious considerations for attuned care extend to all aspects of a behavioral health business. It even influences what the office looks like, ways to incorporate the likes of the patient and thoughtfully include technology.

For Within Health, a virtual eating disorder treatment company, technology allows for the patient’s multidisciplinary team to be more attentive to needs, allow for more immediate support when needed, and gather and track patient data. The latter item includes remote patient monitoring. It also includes a community “living room” function to help with off-hours distress.

“Without the app, we can’t extend our reach and work with this type of acuity,” Oliver-Pyatt said.