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By Monica E. Oss

There are significant opportunities and challenges for health care provider and payer organizations in the autism spectrum disorder (ASD) market, which is expected to reach a $2.23 billion valuation by 2022 (see U.S. Autism Treatment Market). First, consider that incidence rates continue to climb with one in 40 children ages 3 to 17 in the U.S. diagnosed with ASD (see The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children), whose care costs 4.1 to 6.2 times more than those without it. Estimates for children with the diagnosis range from $11.5 billion to $60.9 billion in 2011 (see Economic Burden of Childhood ASD and Annual Health Care Costs For Adults With Autism 55% Higher Than General Population for a perspective on adults).

Just last week, we saw the Autism Collaboration, Accountability, Research, Education and Support Act (see Another Boost in Autism Funding) signed into law with $1.8 billion allocated for treatment, which requires a customized approach for the entire family, say experts. Questions for executives in the field: What is the future of autism treatment and what are the emerging opportunities (and challenges) for specialty provider organizations? The answers, according to ASD treatment subject matter experts interviewed by our team, include:

  • Improve screening rates for early diagnosis
  • Deliver care in home and clinic settings to accommodate consumer and family needs
  • Leverage technology to expand access to care and training
  • Use evidence-based training and regular follow-ups to ensure consistency
  • Ensure the entire team understands the unique needs of ASD consumers and families

Improving screening rates to diagnose early: Currently experts estimate that only 50% of children are screened appropriately though the goal is 100% (see Screening of Young Children For Autism Spectrum Disorders: Results from a National Survey of Pediatricians) to diagnose early and improve outcomes. The Scott Center for Autism Treatment, The Scott Center developed a new screening tool – available at no charge – (https://www.screenourkids.org/about-the-evaluation/) to improve early detection and diagnosis, and uses advanced technology to expand patient access to care.

Delivering care in home and clinic settings to accommodate consumer and family needs: With increasing competition, home health options and flexible schedules are expected to become market differentiators. “Our work with caregivers and providers adds strength to the treatment package and helps families reach their goals,” says Katherine Wooten, LCSW, BCBA, Clinical Director of Corporate Programs of New Directions. “That willingness to partner with network providers and advocate for family/caregiver training and support in settings and times that best meet their needs “will be one of the key factors that we consider in building a value-based payment structure,” she adds.

Leveraging technology to expand access to care and training: Technology is also a new frontier. ASD provider organizations are using technology, such as telehealth, to shrink geographic distances and augmented reality to guide therapies (see Are You In A ‘Technology First’ State?) Lower-tech options, such as off-the-shelf tools that enable medical records to be integrated with patient portals and reminder systems, can also improve efficiencies in settings customized for consumers with ASD. “There is a lot of standard stuff that might not be used or accessed as much as it could be by smaller autism providers, who might not be aware of or think they don’t have capability to use them but some of these things are quite accessible these days,” says Boyd H. Mark, Director of Telehealth Services, The Scott Center for Autism Treatment.

Vik Shah, M.D., MBA, Lead Medical Director, Cigna, agrees and says the organization continues to investigate how technology can be used for parent training and additional ways BCBAs can support consumers.

Use evidence-based training and regular follow-ups to ensure consistency: Twenty-two percent of BCBAs have had certificates for less than two years, which is one reason why Ms. Wooten emphasizes the value of ongoing training that helps providers identify treatment barriers, effective interventions, medical necessity expectations, and build confidence. “Many BCBAs, particularly newer ones, often do not feel comfortable addressing environmental factors that influence treatment,” which is why education and technical support to address these issues is valuable, Ms. Wooten explains.

Devereux Advanced Behavioral Health is investigating multi-step interventions and follow up to achieve consistent outcomes, says Todd Harris, Ph.D., Executive Director of Autism Services for Devereux. The organization is creating tech-enabled, evidence-based Behavioral Skills Training systems based on empirical research for clinical professionals to ensure that team members understand interventions and model them appropriately to improve outcomes and lower avoidable cost.

“Interventions for consumers with autism are not always instinctual,” Mr. Harris explains. “We rely on staff to learn evidence-based interventions and practices to use with children or adults” and develop approaches that work.”

Ensure the entire team understands the unique needs of ASD consumers and families: One example of optimizing team members: Easterseals UCP North Carolina & Virginia is using behavioral analysts to consult with housing, employment and other service lines to meet a family’s needs. “We reshaped the service model to ensure we are looking at the entire family and not just the child in that moment,” said Bryant Edgerton, Vice President, IDD Services North Carolina, Easterseals UCP North Carolina & Virginia. “The team’s behavior experts inform everything we do, which allows us to get better and better at treating autism.”

For more on how to approach developing new service lines for the autism market, check out these resources from The OPEN MINDS Industry Library:

  1. Another Boost in Autism Funding
  2. Autism Rates & Costs: A Future View
  3. Are You In A ‘Technology First’ State?
  4. Opportunities In The Autism Market Shift With More Managed Care
  5. One in 40 United States Children Has Autism Spectrum Disorder
  6. New Opportunities Serving Adults With Autism
  7. Annual Health Care Costs For Adults With Autism 55% Higher Than General Population
  8. Prevalence Of Autism Spectrum Disorder In U.S. Stable In Recent Years
  9. Designing & Implementing Innovative Treatment Programs: An OPEN MINDS Executive Summit & Showcase
  10. Considering Cash-& Consumerism-In Service Line Planning

And for a deep dive on future opportunities and challenges in the autism market, join me on October 28 for the 2019 OPEN MINDS Children’s Services Executive Summit, which focuses on autism services. Our faculty includes:

  • Vik Shah, M.D., MBA, Lead Medical Director, Cigna
  • Yagnesh Vadgama, BCBA, Vice President, Clinical Care Services Autism, Magellan Health
  • Katherine Wooten, LCSW, BCBA, Clinical Director – Corporate Programs, New Directions
  • Sean Klutinoty, MBA, Senior Associate, OPEN MINDS
  • Richard G. Allen, Psy.D., BCBA-D, NCSP, Supervising Psychologist, Devereux Advanced Behavioral Health
  • Todd Harris, Ph.D., Executive Director of Autism Services, Devereux Advanced Behavioral Health
  • Boyd H. Mark, Director of Telehealth Services, The Scott Center for Autism Treatment
  • Daniel Openden, Ph.D., BCBA-D, President & Chief Executive Officer, Southwest Autism Research & Resource Center (SARRC)
  • Lecia M. Anzaldo, MPA, BCBA, Director of Autism Services, Easterseals UCP North Carolina & Virginia
  • Bryant Edgerton, Vice President, IDD Services North Carolina, Easterseals UCP North Carolina & Virginia
  • Shanun Kunnavatana, Ph.D., BCBA-D, Director of Clinical Development, Autism Services, Easterseals UCP North Carolina & Virginia

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