Integrating different types of therapeutic services to support patients with autism and their families makes a lot of sense. For example, individuals with autism often receive applied behavior analysis (ABA), speech therapy and occupational therapy. However, several systemic issues challenge true integration and maximizing the benefit for all of health care’s stakeholders.

At the top of the list of challenges: Payers may get in the way of integrated autism therapy models. Some forbid providers from billing for multiple services for the same patient on the same day, potentially limiting the ease of a one-stop health care provider. Cultural and operational differences between provider types may challenge integration, preventing care from becoming something more than the sum of its parts and potentially driving up technology investment costs.

“Ego and inertia are both immovable forces,” Jessica Zawacki, director of research for ABA Centers of America, said during a panel discussion at the Autism Investor Summit. “You can put five different service providers all under one roof, but if they’ve got five different treatment plans, that’s not integration, that’s an invoice. Part of what we try to do is smooth that gap; we don’t just do co-location, it’s about integration.”

ABA Centers of America, a Fort Lauderdale, Florida-based multi-setting autism therapy provider, turns to developing clinical workflows and technology systems to get providers on the same page both in terms of planning and executing and tracking the implementation of that plan, Zawacki added. It’s the fastest-growing behavioral health company in the U.S., according to the Inc. 5000.

The case for multi-specialty, co-located and clinically integrated autism therapy services makes a lot of sense. It’s easier for patients and families to have a single point of contact for care. It simplifies the development and execution of holistic care plans that account for multiple aspects of a child or family’s needs. It also diversified revenue streams to mitigate the risks that come with each specialty.

“It all starts with the child,” Adnan Bhanpuri, owner of Chicago-based Treehouse Pediatric Therapy, said during the panel. “We realized a child with autism doesn’t just have behavioral challenges. There are so many more elements that they need to be addressed.”

Treehouse Pediatric Therapy provides physical therapy, occupational therapy, speech therapy, ABA and counseling led by licensed clinical social workers. Treehouse Pediatric Therapy didn’t start off specifically seeking to treat those with autism. Founded in 2012, The practice originally offered physical therapy and occupational therapy and added ABA in 2020.

Treehouse Pediatric Therapy’s biggest hurdle to integrating different types of care, Bhanpuri said, was more cultural than it was operational. The various clinicians had “preconceived notions” of what the others did and didn’t initially understand how their work could harmonize with each other. But reinforcing the common ground of improving the lives of their patients helped them find common ground. Zawacki echoed a similar sentiment.

Focusing on life improvement isn’t just a unifying credo; it can be one of the most useful proxies of the effectiveness of care. Doreen Samelson, chief clinical officer for The Catalight Foundation, said

“If we could agree on a global outcome measure, I think it’s quality of life or well-being,” Samelson said. “If everybody can say whatever [each provider type] is doing rolls up to that, that will help with integration too because we are all on the same page about what the ultimate goal is. … If you’re not measuring that in some way, it’s really hard to say if we’re going in the right direction.”

Samelson contended that these kinds of models have not been proven out in the autism therapy space. Until strong research validates and creates consensus on such models, it will be a struggle to get payers to treat them with special consideration.

She also posited that cost-effectiveness ought to be a key consideration for developing and measuring the effectiveness of integrated autism therapy models. ABA is among the most expensive and time-intensive behavioral health therapies on the market.

“If we cannot show cost-effectiveness, if we cannot show ways that we can get the same outcomes and improve well-being … then I think we’re going to be in trouble down the road,” Samelson said.

Bhanpuri pointed to actions by Indiana Medicaid as an example of payers reevaluating their costs related to autism therapy.