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Fledgling autism therapy organizations face existential questions as they tackle the industry’s greatest challenge.

The paramount question for any autism therapy organization is this: What are you going to do about staffing? Staffing challenges mean challenges for service availability and quality. This, in turn, has the potential to damage, if not doom, a company.

“I have a lot of experience with handling employee turnover, and I find that a lot of companies didn’t take the time or make the space to let employees explain themselves and their wants and needs,” Ian Santus, co-founder and chief operating officer for Akoya Behavioral Health, told Behavioral Health Business. “We wanted to build a place where clinicians, especially RBTs, were attached to the mission and to the kids. That was easy to find. But what we found was that people are also attached to the people they work with. So, we made sure that feedback was open for them to express what they wanted to see in the world.”

Southfield, Michigan-based Akoya Behavioral Health was founded in 2023. It saw its first patient in November of that year. It now employs about 185 staffers and operates in two markets, the Grand Rapids and Detroit, Michigan, metros. Santus, who is a board-certified behavior analyst and autism therapy executive, founded the company with Yitz Miller, an entrepreneur in the outpatient mental health space.

The company offers in-clinic and in-home services. It operates two clinics.

Much of the company’s growth has come in the past four months as it opened its second clinic location.

“It really felt like we were hitting the mark in the summer of 2025,” Santus said.

Akoya Behavioral Health magnifies the staff experience and attachment to the organization through closely monitored training, especially for RBTs. With a higher commitment to training, Santus noted that this weeds out candidates who don’t align with the company’s efforts to create clinical quality. On top of industry-standard training offered by the vendor Hi Rasmus, the organization provides more than 20 hours of Akoya-specific training. This includes introducing new RBTs to the company, its story, its staff (Santus included), and the employees they will engage with.

“All of this is designed to build out higher expectations in terms of the care that they’re going to provide and also introduce them to a lot of the support and personnel that will be there to help them through those first few sessions,” Santus said.

The following Q&A has been edited for length, clarity and style. Santus will be joining the conversation at the Autism Investor Summit – East on Nov. 19.

BHB: In the company’s earliest days, how have you approached the question of payer reimbursement? 

Santus: For the first roughly year, we were commercial only. We worked to get contracted with as many of the major commercial insurance providers in the state as possible. About midway through 2024, we started working to get contracts with Medicaid. In Michigan, Medicaid is a challenge. You have to go county by county, more or less, to secure contracts and follow each of their individual rules and credentialing.

We decided to dip our toes into Medicaid contracting on the west side of the state, Grand Rapids, by securing a couple of small counties, learning the process and seeing how we can support these families. The west side of the state is pretty much 100% Medicaid. In the east side of the state, we then secured Macomb County and Wayne County contracts somewhere around February or March of 2025 after a year’s worth of work. Now we’re in a place where we’re about 60% Medicaid and about 40% commercial insurance.

As you look back at 2025, what would you say are the biggest accomplishments of the year? 

There are a handful of things.

I would say one of the biggest accomplishments of 2025 has been opening this Southfield office, our second clinic. It was a space that we were fortunate enough to find and a space that we were fortunate enough in the construction process to really drive to get open as quickly as possible. And it’s a beautiful facility. We went from finding this location to serving kids within a couple of months. This clinic, more or less, opened already at capacity. Those are huge celebrations for me. There are a lot of families that are looking for care, and we were able to meet that demand quickly.

Another big accomplishment for this year: summer is a crazy time, and fall can be a little bit quieter. We were able to plan for and account for a lot of the families that needed care come fall, to be able to support the families that were only looking for care in the summer to transition out of care, and continue to serve, more or less, at the same amount and intensity from summer to fall.

It’s been a long time coming for us to be a tech-forward company, a company that has deliberately gone out of its way to think a lot about the tech stack that we use here to make clinical programming and clinical progress monitoring very easy and efficient. We’ve built a lot of data infrastructure that has made operating this company a lot more transparent for us. I feel like, as we’ve scaled, the systems that we set up early allowed us to make the right decisions at the right time because we had all that access to data.

The question that I asked fairly early on was what was the best clinical platform for our BCBAs and RBTs to utilize to ensure maximum success for those clients; in other words, ignoring all of the other operational reasons why a certain software might be selected and just focusing purely on the clinical reasons from the get-go. I’m a clinician at heart, even though I function in both clinical and operations.

Do you have in mind what you want the company to accomplish before the end of 2026?

We’ve talked about opening at least a couple of other clinics. We’ve talked about potentially looking into expanding into other markets, be it Lansing or something like that. We’ve also talked about operating in other states. None of those things have been solidified for 2026 yet, but they’re all active discussions right now.