Making value-based care a reality in autism therapy requires meta, if not somewhat circular, functions.
Change management, operational compliance and fraud prevention require autism therapy providers to set up monitoring systems to track their data collection processes. In other words, provider organizations need to set up a process to ensure that their clinical and operational data systems are being used and working according to plan.
“This shouldn’t have been a surprise, but it was anyway,” Krista Boe, chief clinical and compliance officer at Acorn Health, said during a panel discussion at Autism Investor Summit 2025. “I know better as a clinician than to think that we don’t have to measure clinician behavior in terms of how they’re doing against this collection system and goal. … This is not just looking at how client behavior is changing relative to treatment over time. But in order to get there, we’ve had to focus on [making] sure this data gets collected at the appropriate intervals.”
Acorn Health, a Coral Gables, Florida-based autism therapy provider with 73 locations in seven states, has established data dashboards to track employees’ data collection behavior, Boe said.
To some degree, the autism therapy industry is already predisposed to data collection and reporting, a defining function in value-based care in the wider context of behavioral health. This comes from data collection processes that are a part of the industry’s cornerstone therapy, applied behavior analysis (ABA). However, value-based care contracting, which seeks to align payment with clinical outcomes, often requires putting together that data collection, plus other or new reporting, in new ways that may be unusual to employees.
This is tied to a perennial challenge in the autism therapy industry: the lack of a consensus-built or authority-figure-defined battery of clinical outcomes and measurement tools to start as a common ground for value-based care discourse.
Ensuring quality at scale
Boe further notes that developing incentives for an organization to act a certain way within the context of a value-based care contract will spill down to new incentives for employees who live out the contract details. This may lead employees to “modify contingencies” to achieve those incentives. For example, it drives providers to only accept early-intervention patients.
“You combat that culturally and philosophically as an organization with rigorous compliance structures and programs,” Boe said. “I don’t think you can safely grow these types of concepts without having really good checks and balances in place from an auditing perspective.”
Rigorous compliance, quality and auditing structures can be a limiting factor when scaling value-based care arrangements across large populations of patients. However, advances in technology, especially automated large language model-trained AI tools, could help make global assessments of internal quality more reasonable.
“We all know you get what you measure, basically, so you have to be very careful about what you’re doing,” Chris Sullens, the CEO of autism- and intellectual/development disorder-focused software developer CentralReach, said during the panel discussion. “With LLMs and other things, you can start to do these things at a scale that you just couldn’t do with humans.”
Sullens said that the “amount of auditing scaffolding” that autism therapy providers need to build to bring about value-based care was an unexpected challenge.
One way to lessen the burden and complexity of value-based care contracting is to start with the simplest measures possible to get both payers and providers in the mode of operating outside of the fee-for-services paradigm.
“In our experience in working with payers, we take, like, 19 steps back and [suggest] parent satisfaction,” Jeff Beck, founder of digital ABA provider AnswersNow, said during the panel. “Our BCBAs are wringing their hands because that’s not ABA. We totally agree, but we have to do something to move forward so that we have a quality measure that we and the payer can align on, that’s not going to be convoluted by which assessment tool you’re using.”
It’s easy to find consensus on something like a parent satisfaction survey and what it indicates. This and other tangentially related measures, like emergency room utilization, with which payers are very familiar, have helped AnswersNow establish two different value-based care arrangements, Beck said.
While measures like those above are the basis of accountability for AnswersNow, the company still tracks and reports outcomes from the Vineland Adaptive Behavior Scales, more often referred to as the Vineland, to payers, Beck added.
