Value Based Healthcare is Coming – Are you Ready?

There has been much talk over the last few years of ABA moving toward a value-based care model…

…and now it seems to be in motion. And it’s about time! For many years I’ve heard in many ways a version of “one person with autism is one person with autism and we can’t compare one to another.” “Chi Square doesn’t allow for large database comparisons.“ “It’s a spectrum and not possible to conduct program evaluation…”

It’s 2023 and time for us to look at the aggregated data that has and continues to be collected to ultimately define what the best practices are that result in better outcomes for the patients served. I personally feel strongly that this is the right direction for the industry to go in assuming the “right” metrics are the basis for evaluation. Why? Because it ensures that John, Joey and Jane are able to reach their full potential and it may result in an equal playing field for companies large and small.

So, what is value-based care and how is it going to impact ABA practices? For those who may not be familiar with this concept, value-based healthcare is a delivery model that has been implemented in primary care in more than a dozen states. Rather than fee for service, it’s a reimbursement model based on patient outcomes. This approach will most likely drastically impact the way autism services are provided in the future. With the focus shifting towards measured outcomes, autism services providers will need to ensure that their interventions – for both skill-building and behavior reduction – yield positive outcomes for their patients. The transition from fee for service to value-based reimbursement model will incentivize positive and socially significant outcomes. On the other hand, providers that fail to demonstrate such outcomes may be penalized and may need to reevaluate the effectiveness of their services. Overall, value-based healthcare has the potential to improve the quality of therapeutic interventions for individuals with autism by promoting evidence-based practices and incentivizing providers to focus on positive patient outcomes.

Personally, I believe this is a positive movement for ABA because I have consulted with companies large and small and can say that they are not all equal. I’ve worked with agencies where a nail technician is hired on a Thursday and working with clients on Monday with limited to no training provided. I have also had the good fortune of working with agencies that implement known best practices from providing face-to-face BCBA led quality training for new hires, providing ongoing support and development for their employees, monitoring the data and make programmatic changes based on the data to name just a few.

Personally, I want to see an equal playing field for companies large and small. One where reimbursement rates are based on the implementation of best practices and the demonstration of clinical outcomes expected based on a comparable dataset.

At the 2023 CASP conference held in April, I attended a panel moderated by Spectrum AI with panelists from Aetna, Elevance and Evernorth and the President of Learn Behavioral Health. It was an interesting high-level discussion of what the current goals are:


  • Gathering and analyzing the data
  • Determining what to incentivize
  • Piloting with large agencies like Learn Behavioral Health to work out the kinks before rolling it out widely

It’s an exciting time in that we are finally at a point where after decades, we have evidence-based data to show what works and actually makes a difference. We are still in our infancy with respect to program evaluation for ABA but, there is data to leverage that will soon enable companies of all sizes to implement practices that will result in the best quality of care for the patients they are privileged to serve. It’s definitely a few years away but it is no doubt on the horizon.

So what can you do to best prepare for this transition? Implement know best practices today.

  • Training – establish a new hire training that is of the highest quality. Our new RBT Curriculum is now available for purchase
  • Develop a recruiting engine to enable you to hire, train and speedily get clients through the intake process to direct treatment initiation (this was a metric discussed at the CASP panel as one that will be incentivized)
  • Start aggregating data today. Consider assessment measures at intake and 6-month follow-ups. What progress are clients making, as individuals, groups, and wholistically?
  • Quality Assurance
  • Client satisfaction
  • Staff satisfaction
  • Ensure your infrastructure is strong both operationally and clinically
  • Ensure your billing process is tight and results in clean claims

Need assistance with ensuring your agency is functioning well? Not sure if there are areas within your agency that would benefit from some tweaking? We are here to help!

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