The pressure is on in the autism therapy industry to standardize care akin to other, more well-established sectors of health care.

The industry must come to a consensus on care quality, how to measure it, and how to communicate it with payers and other major constituencies. With spending on autism therapies by payers and funding from private investors at historic highs, many in and around the industry are beginning to ask a common question. 

“The question that not only health plans are asking, but state regulators are asking, and they’re starting to really poke at it and to say, ‘What are we really doing here? What are we getting out of this?’” Yagnesh Vadgama, vice president of clinical care for autism at Magellan Health, said during a panel discussion at the Autism Investor Summit 2025. 

Magellan Health is a managed behavioral health care organization that works with other health plans to manage behavioral health-related benefits. It was acquired by Centene Corp. (NYSE: CNC) in 2021.

Vadgama and other panelists said the lack of standardized clinical measures and means of accumulating those outcomes represents a serious challenge for the industry. It prevents the industry from proving its case to those that fund its activities, limits consumers’ ability to discern high-quality providers and places the industry in the position of losing control over its own clinical expertise.

“If we don’t figure it out, somebody’s going to figure it out for us,” Jason Barker, CEO of ABA Centers of America, said during the panel. “It may not be what we’re looking for.”

Several entities in recent months have moved to cut back spending on autism therapy. Indiana’s Medicaid program has moved to cap the number of hours the program will cover in a year and over a child’s lifetime. Optum’s Medicaid business is also moving to haul in spending on autism therapy but across several states. Each cites a steep increase in autism therapy spending in recent years.

An investment perspective

From a different side of investing in autism therapy, private equity firms and other investors are more and more skeptical of companies seeking their capital. This has made the dealmaking process in autism therapy much longer and more difficult.

Still, the autism therapy industry has been a favorite of investors for years and has weathered the post-COVID slowdown in dealmaking and investment in the behavioral health industry. 

The frustration around a lack of standardized care outcomes and measurement processes also impacts payment innovation in the autism therapy space. The evolution of value-based care models, or any other payment models that incentivize specific outcomes rather than volume of services, is rooted in mutual understanding of care quality at best or of business process measures at least.

David Harbour, the CEO of Centria Autism, recalled previous experiences in pediatric home care and primary care: Those industries have several standardized care and outcome metrics that are part of the payer-provider discourse.

“If you go talk to payers, whenever they talk about quality metrics, they’re talking to you about utilization; they’re talking to you about how many hours of supervision, parent engagement, or whatever it may be,” Harbour said. “And those metrics are fine, but that’s not truly a quality metric.”

The lack of progress on value-based care and other alternative payment models leaves health plans and provider organizations in clinical and bureaucratic tiffs over the appropriate levels of care and reimbursement for said services. This is a huge drain on time and capital resources for provider organizations, Barker said.

“I would love to not have to spend and have my people spend the majority of their time arguing with health plans for treatment hours as if we’re in a third-world flea market,” Barker said. “If you don’t want to provide us the hours, just give us a case rate, or put us at risk, or give us the resource so we can just do what we know is right and is going to provide the best possible outcomes.”

The lack of standardized outcome measures gives latitude to lawmakers, regulators, or health plans that are looking to reduce health care spending. Harbor said that conversations with these constituencies often have to fall back on the effectiveness of the industry’s core therapy, applied behavior analysis (ABA). And those conversations will continue to orbit around justifying ABA at large until care quality measures show differentiation at the organization level.

“Until we get to standardized outcomes, which is extremely challenging in this industry, I think it’s going to continue to be a challenge,” Harbour said. “Those are going to be some of the discussions that are going to continue to come up over and over again with payers and Medicaid directors and politicians that we have to talk to about the services we provide.”

Building consensus and authority with the autism therapy industry

Molly Ola Pinney, founder of Global Autism Project and of ABA Business Coach, assessed the U.S. autism therapy industry’s average care quality at a C+ or B- grade with few outliers in either direction. At the organization level, Pinney said that autism therapy organizations need to address different questions about care quality depending on their size.

“Some of the larger organizations have grown so quickly that they’ve lost track of quality along the way and standardizing would help in a big way,” Pinney said. “Then, we see clinician-owners who are prioritizing quality, which is great, but sometimes at the expense of running a sustainable business and organization.”

Barker, who oversees one of the fastest-growing behavioral health organizations in the U.S., said that being “data-driven” has been a key strategy to ensure clinical quality as the company scales. “We literally capture every bit of data,” Barker said.

To make consensus building effective, Harbour said that some centralized organization with gravitas to capture provider and payer attention needs to push consensus-established standardized outcomes.

There have been notable attempts to establish care quality outcomes and measurement tools. A coalition of autism therapy providers and other experts worked with the The International Consortium for Health Outcomes Measurement (ICHOM) to establish two different tracks of potential industry-wide care outcomes standardization. The group ultimately failed to make a splash.

At least some payers would be willing to accept such consensus-based standards.

“I’m a behavior analyst. I’ve been in the game for 21 years. I happily carry the torch for us when I’m having these conversations,” Vadgama said. “But there’s no concise way of looking at outcomes for me to say, ‘This is how the field is getting better.’ … We’re grabbing and we’re pulling to try to find what we can get out there to support our beautiful science. But it’s challenging.”