Autism Support Now has used a dogged approach to culture and advocacy to rapidly expand into one of the largest Medicaid-focused autism therapy providers in Missouri.

Headquartered in Independence, Missouri, the autism therapy operates nine clinics — eight in Missouri and another in Olathe, Kansas. It was initially founded in 2016 as an in-home applied behavior analysis (ABA) provider. It has since seen revenue increase by 50% over the past four years by embracing an unrelenting approach to engaging payer partners.

“I think you have to pursue something that has a greater good; I’m doing this for the people who don’t have a voice,” Michael Quinn, CEO and president of Autism Support Now, told Autism Business News.

That personal ethos of Quinn’s has led to a company culture grounded in kindness, collaboration, empowerment, and accountability — all essential aspects when it comes to working with “a clinical population of children who deserve the very best.” And Quinn’s ethos of being an unflagging advocate for deserving children is especially personal for him. His sister, who had a disability, died in relation to her condition. Whenever he advocates on behalf of his organization and his patients, he said he honors his company’s patients and his sister’s legacy.

In practice, this belief in advocacy and patient-centered thinking translates into tireless work, involving outreach and relationship-building with payers and other influential figures in the Autism Support Now markets.

“We were very persistent — when I say we, I mean primarily me,” Quinn said. “That means constant phone calls and emails, turning up at corporate offices, calling an executive’s administrative assistant immediately after concluding a call. “

The staunch approach has paid off. It has resulted in several payers increasing their rates, including one unnamed payer increasing its rate by 51%.

“If you look at the reimbursement rates, you have to do some analysis. If you’re providing services for one hour with an RBT and you’re paying, let’s say, $25 … and your reimbursement rate is, let’s say, $40 an hour. If you’re paying the hourly wage and you’re also paying for benefits, you’re underwater,” Quinn said.

If there is a delta between the cost of providing care and what they get paid, Autism Support Now will tell payers and use that to communicate the need for rate increases. The company also communicates how many plan members are in their care. In some cases, they will remind health plans, especially if they are part of larger conglomerates, that the plan is profitable. There also has to be a willingness to walk away from working with plans, putting them on notice of termination.

“You have got to be willing to just be a pitbull,” Quinn said.

Culture and strategy addresses turnover

The autism therapy industry struggles with retaining professionals, especially registered behavior technicians (RBTs) who execute the plans developed by board-certified behavior analysts (BCBA), masters-level educated clinicians. Both positions are certified positions overseen by entities like the Behavior Analyst Certification Board (BACB), Qualified Applied Behavior Analysis Credentialing Board (QABA) and Behavioral Intervention Certification Council (BICC).

Across autism and related disability treatment providers, providers of various sizes experienced turnover rates of 90% in 2024, according to a report by CentralReach, one of the largest software providers in the autism therapy space. 

Turnover is a perennial problem. It weaves with the interrelated issue of challenging payer rates to create the defining issue of the industry. While still challenging, some leading executives in the industry say the workforce is stabilizing.

“Autism Support Now is no different than other ABA providers in the sense that we have challenges recruiting and retaining RBTs,” Quinn said.

The approach to addressing this challenge is twofold: setting attractive rates relative to the specific markets of the company’s clinics and leaning into establishing an attractive culture specifically for RBTs. Rates for RBTs at Autism Support Now range from $20 to $28 per hour. The average RBT wage across the U.S. is $27.24, according to the workforce website ZipRecruiter.

While wages may get a potential employee to consider a job, culture and workforce investments keep an employee around.

“You can pay someone top dollar, but if your culture stinks, it doesn’t matter,” Quinn said.

The cultural focus around kindness, collaboration, empowerment, and accountability has led the organization to find ways to acknowledge good work. This includes the development of the Class Act Award by Brad Scott, director of strategic development and communications at Autism Support Now, to allow managers and front-line employees to be recognized by their peers for exhibiting the company’s cultural values.

Like other companies, Autism Support Now leans into training as a way to ensure continued support for RBTs once they join the company. This works to attract and retain employees, especially those that are new to the field. The organization is accredited by the BACB as a provider of continuing education.

Further, RBTs are given chances to advance that are akin to other organizations’ recognition of BCBAs. Autism Support Now will promote lead RBTs in every clinic to help create more of a career path. The organization also developed an RBT advisory council that provides insights that inform policy and practice development.

“We just treat them like professionals,” Scott said.