It’s that time of the year to reflect on what was to prepare for what may be coming down the way.
Greater pressure for care quality, parental involvement, multidisciplinary services and ever-increasing pressure from regulators and payers made 2024 a year that shows how fast the industry is maturing and how far it still has to go.
I reached out to several of the field’s top leaders, asking the same set of questions. Their diverse answers illustrate several different facets of shared issues in autism therapy.
Given the youth of the industry and the interest that it holds from several powerful constituencies, e.g., payers and private equity investors, it is able to be much more responsive to the demands of the marketplace.
For example, throughout the following answers, executives recognize the need to ensure that care is enabling, respectful and of a level of quality for which that provider is willing to go to bat with critical examiners.
(The following answers have been edited for clarity, length and style.)
What defined the autism therapy space in 2024?
“In 2024, the field of ABA therapy for autistic individuals was defined by a significant shift to a more compassionate approach. This shift involves a deeper focus on understanding the unique needs and experiences of each individual, ensuring that therapy is not just effective but also respectful and empathetic.”
— Timothy Yeager, chief clinical officer of Centria Autism
“What we’re seeing in the industry … is a strong focus on early intervention, family-centered care, and the growing use of technology like AI and VR to personalize therapy and improve outcomes.
“Hybrid telehealth models expanded transition services for older clients, and greater inclusivity led by neurodiverse self-advocates are also emerging trends.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“In 2024, the autism therapy space can be summed up with two words: explosive growth. With most providers operating under the assumption that the prevalence of autism is actually much greater than the current statistic of “1 in 36 children” provided by the CDC, the industry was eager to build, expand, and effectuate quickly in an effort to meet this demand and get more clients into care. At ABA Centers, we stood up around 20 new brick and mortar clinics and began offering in-home services in even more areas.”
— Jason Barker, CEO of ABA Centers of America
How did payers approach autism therapy providers in 2024?
“Many autism therapy providers faced frustrating challenges with payers and their resistance to rate and process improvements, creating barriers to quality care for children with autism. Not a new theme, but a continuation of ongoing challenges with payer partnerships. More effort is needed to bring payers and providers together to create a system that works better for families and ensures children get the care they deserve. Value-based care models are still discussed across the industry, but it doesn’t appear that meaningful progress is being made here at this time, which is disappointing.”
— Krista Boe, chief clinical officer of Acorn Health
“While we have seen that regulatory challenges and complexities around reimbursements remain significant in 2024, emerging efforts to foster collaboration have become evident. Autism therapy providers, advocacy groups, payers, and government agencies are beginning to work more closely to develop strategies aimed at creating a more efficient and effective regulatory framework.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“There is a growing emphasis on collaborative relationships, where providers work closely with funders, whether private or public, to ensure that services meet the needs of clients while also aligning with funding requirements. This trend reflects a more integrated approach to care, focusing on long-term outcomes and overall value.
“This is part of a broader trend towards value-based care, where reimbursement is tied to the effectiveness and efficiency of services provided. Providers who can show strong clinical outcomes, patient satisfaction, and cost-effectiveness are more likely to secure partnerships and funding.”
— Timothy Yeager, chief clinical officer of Centria Autism
“The payer landscape has never been more challenging. Providers across the country are seeing more audits and regulatory challenges, some of which seemseems to be excessive. This puts an unfair operational cost and burden on providers already stretched by mediocre reimbursement rates. We have seen a general upward push on state Medicaid rates and commercial payers really digging their heels in oftentimes offering rates well below Medicaid and managed care rates.”
— Brett Blevins, the CEO of Commonwealth
How did expectations for existing patients/families change?
“For existing patients and families, expectations evolved to include client affirming care with greater participation in treatment decisions and continuity of services. Service offerings were further differentiated into Comprehensive, Focused, and Consultative models to meet individual client needs.”
— Jeff Skibitsky, president and founder of ABS Kids
“We are seeing more client families, pediatric clinicians and referral professionals in the ABA space transition to the idea of a child receiving all therapy services at one multidisciplinary therapy clinic. … [Providers] prefer one trusted clinic where their clients will receive everything they had recommended. … From a practical perspective, the family gets one bill, one scheduler, one place to drive to and can arrange all therapies back to back. From a clinical perspective, families can rest assured that the therapy team is collaborating behind the scenes at one company to carry over speech, behavioral, regulation, gross motor and fine motor activities across sessions for better outcomes.”
— Adnan Bhanpuri, an owner of Treehouse Pediatric Therapy
“In 2024, patient and family expectations have evolved, with a stronger focus on measurable outcomes, transparency, and culturally responsive care. Families now expect providers to offer comprehensive support, including collaboration with specialists. … Our locations offer unique programs designed to reflect the needs of their communities, including family guidance for support at home and in the community, in-school assistance, and integrated care that fits into daily life.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“In 2024, there’s a noticeable shift with families seeking ABA providers who prioritize their child’s unique needs, respect their dignity, and involve the family in the therapy process. There’s also a greater demand for transparency in methods, treatment goals, and outcomes.
Overall, families in 2024 are more informed and engaged, seeking ABA therapy that aligns with their values and expectations for compassionate, effective care.”
— Timothy Yeager, chief clinical officer of Centria Autism
What about for prospective patients/families?
“Parents seeking ABA services are more empowered and proactive in their approach. Many are relying not just on service provider reputations and practices, but also turning to online communities, social media, and forums to share experiences, ask questions, and gather advice from other parents. This shift allows families to make well-informed decisions about their child’s care. As a result, they’re evaluating multiple providers, with a strong preference for those who communicate openly about their treatment models and progress tracking. Shorter waitlists and comprehensive care are also increasingly important considerations.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“Prospective families are choosing to make sure that they don’t just do ABA only. One element has to do with the negative press on how ABA used to be practiced. Another element has to do with the practicality of bringing a child to multiple locations and dealing with multiple bills and authorizations.”
— Adnan Bhanpuri, an owner of Treehouse Pediatric Therapy
“Prospective families more and more are going to the web and googling ABA, and finding negative stories about the science. Which obviously creates hesitation. Providers have to be aware of this when speaking to parents and prepared to explain the science in layman’s terms and also talk about the great work that we do.”
— Brett Blevins, the CEO of Commonwealth
“Families want flexibility in scheduling options, including after-school availability, as well as multiple therapy settings like center-based, in-home, in-school services where permitted, and telehealth. These scheduling accommodations help meet the unique needs of each family and ensure clients fulfill their prescribed therapy hours. Providers may prefer a different approach for their business model, but, rightfully so, parents and families need and want options in the approach to therapy for their children. For new clients, there is also often an unmet expectation of a quick movement from diagnosis to treatment. We are proud of the fact Acorn Health is able to meet this expectation – within four weeks on average – despite the challenges with payers and credentialing. We’ve put processes in place to move kids into care quickly for their assessments and treatment, which is what our families expect and need for this medically necessary treatment.”
— Krista Boe, chief clinical officer of Acorn Health
Overall, how did the industry improve?
“Personally, I was encouraged by a renewed focus on quality of treatment and outside investment being more thoughtful around the space and providing value outside of purely financial motives.”
— Brett Blevins, the CEO of Commonwealth
“Providers focused on expanding center-based care to ensure stable hours and consistent quality. The growing neurodiversity movement shaped the industry’s approach to care. Treatment plans were focused on the goals and priorities of the families along with the developmental milestones needed to achieve each step. Investments in quality and outcomes were prioritized, with organizations benchmarking clinical effectiveness, auditing implementation and measuring quality-of-life impacts to enhance care delivery.”
— Jeff Skibitsky, president and founder of ABS Kids
“As a field, we are still adolescents in a pivotal growth phase. While this will continue for years, there is a significant focus on professionalizing and standardizing our service delivery model to ensure high-quality care that effectively scales. A combination of developing rigorous standards and best practices that elevate our services while addressing significant access barriers.”
— Timothy Yeager, chief clinical officer of Centria Autism
“At BlueSprig, we’ve been proud to lead the charge by opening and expanding centers in underserved communities, increasing availability, and working to reduce barriers to care. Advocacy efforts within our organization and across the industry have also led to improved insurance coverage and funding, helping more families access the life-changing services their children need. We’ve also focused on equity, delivering culturally responsive care and ensuring every child and family feels supported.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“We are excited to be part of a trend of more industry collaboration, particularly in Florida, Michigan, and Tennessee. Providers are coming together – in consortia, partnering with others – to improve the industry and access to care. We believe partnership through industry round tables, consortia and cross-collaboration on outcomes data is critical for our young industry.”
— Krista Boe, chief clinical officer of Acorn Health
Overall, how did the industry degrade or regress?
“Despite progress in the autism industry, challenges remain that limit service accessibility. Long waitlists for diagnostic evaluations delay early intervention, and the demand for qualified providers often exceeds supply, especially in rural areas. Navigating insurance requirements adds stress and financial strain for families and increases the timeline to start treatment. These issues emphasize the need for systemic improvements, including streamlined insurance processes, expanded diagnostic resources, and increased workforce development to meet growing demand.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“Not surprising, but some markets in the U.S. continue to be very challenging for ABA therapy operations through combinations of low payer rates, BCBA scarcity and RBT turnover. Some are just not viable financially, and we saw the result of that in 2024 with providers closing up shop. This degrading of networks only exacerbates the problems of access to care for children with ASD and there is a need to continue to advocate for and overcome these obstacles for clients and their care.”
— Krista Boe, chief clinical officer of Acorn Health
“The industry made strides in improving operational efficiency, leveraging data analytics and EHR integration to manage key performance indicators and optimize care delivery. The use of automation and data analytics has streamlined decision making and empowered clinical teams to have oversight over the work they manage. These efforts ensured more consistent and client-centered care across diverse settings. However, challenges remained in expanding access to care for rural populations and adolescents/young adults, highlighting gaps that require ongoing attention.”
— Jeff Skibitsky, president and founder of ABS Kids
“I think the movement to less hours recommended per child will be a game changer. The days of recommending 25+ ABA hours in isolation is giving way to less recommended ABA hours supported by the related therapies of PT/OT/SLP/Feeding therapists.”
— Adnan Bhanpuri, an owner of Treehouse Pediatric Therapy
How did investment (fundraising, M&A, etc.) evolve in 2024?
“The core fundamentals of early ABA intervention remain attractive to investors: supply/demand issues, solid unit economics, and lifetime value of an end consumer. The first round of investment saw quite a few big winners but also quite a few major losers. 2024 has kickstarted phase 2 of investment in the space. The Behavioral Innovations sale and exit multiple reinvigorated investment interest in the space after it had started to dwindle. With an improving economic environment and historically elevated amounts of what investors call “dry powder” on the sidelines, the space should anticipate increased activity in 2025. There is a lot of value that can be created with the right partnerships.”
— Brett Blevins, the CEO of Commonwealth
“This explosive growth combined with a greater focus on clinical excellence did not go unnoticed by the dealmakers. In 2024, investment activity in the autism therapy space showcased resilience and strategic evolution. Mergers and acquisitions remained a defining feature and private equity continued to penetrate the autism care industry, with attention directed at both platform investments and the expansion of established players.”
— Jason Barker, CEO of ABA Centers of America
“In health care overall, not just in the autism and behavioral spaces, M&A activity is on the rise again after postpandemic lulls in activity. At Acorn Health, our focus is on responsible, sustainable de novo growth in key markets, but we are encouraged by what we see across the industry and in the behavioral health sector.”
— Krista Boe, chief clinical officer of Acorn Health
“Private equity has made the industry tough to operate in. The fundamental elements of a therapy clinic being operated by investor folks from a remote location with no connection to the local families has made this tough on families. Also, private equity has disrupted pay through their deeper pockets and makes competing for employees harder. “
— Adnan Bhanpuri, an owner of Treehouse Pediatric Therapy
How did government regulations change, if at all?
“Regulatory developments like the reauthorization of the Autism CARES Act marked a crucial step forward for autism care, ensuring funding through 2029 for critical initiatives such as autism research, early detection programs, and the training of much-needed developmental specialists. These measures address long-standing challenges in the industry, including the shortage of diagnostic resources and barriers to accessing care. While progress has been made, issues like lengthy diagnostic waitlists and insurance complexities remain significant hurdles for families.”
— Ania Labno, chief transition officer of BlueSprig Pediatrics
“Government regulations increased oversight through audits and strengthened recognition of Mental Health Parity Laws, improving access to services. We appreciate the federal government’s continued support of our autism community across the country. Their collaboration and assistance will only empower our community to continue to treat children with autism spectrum disorder and help them grow to be productive adults.”
— Jeff Skibitsky, president and founder of ABS Kids
“There was less notable change from a regulatory standpoint this year, but we do expect that regulatory standards may change more in 2025 with cost-control measures and policy changes with a new administration.”
