The autism treatment field is at a pivotal moment. For decades, care has been fragmented, expensive, and difficult for families to navigate. Long wait times, disjointed treatment plans, and inconsistent quality measurement have left children and caregivers struggling for support. But now, a new partnership between Cortica Inc., a leading provider of integrated autism care, and Point32Health, a Massachusetts-based health insurer, may represent a turning point. By entering into a value-based autism care arrangement, Cortica and Point32Health are setting a precedent that could accelerate the adoption of outcome-focused models across the autism treatment landscape. This collaboration not only reimagines how autism care is delivered and paid for, but also lays the groundwork for what could become a new industry standard.
Why Value-Based Care Matters in Autism Treatment
The traditional fee-for-service healthcare model pays providers based on the number of services delivered rather than the quality or outcomes of care. For children with autism — whose treatment often spans multiple therapies and specialists — this system can create inefficiencies, redundancies, and higher costs without guaranteeing meaningful developmental progress.
Value-based autism care, on the other hand, aligns payment with outcomes. Instead of reimbursing for volume, insurers and providers agree on defined performance measures and quality benchmarks. Providers are rewarded for improving patient health, reducing wait times, and delivering care that makes a measurable difference in patients’ lives.
In the autism treatment space, this model is particularly important. Families often face:
- Long delays to access care: Waitlists for Applied Behavior Analysis (ABA) can stretch from three months to over a year.
- Fragmented care delivery: Parents must coordinate across neurologists, therapists, pediatricians, and educators, often with little communication between providers.
- Inconsistent standards: There is no uniform system for measuring autism treatment quality or developmental progress.
By addressing these challenges, value-based autism care offers the potential to transform not only how autism treatment is delivered, but also how families experience it.
Inside the Cortica–Point32Health Partnership
The new collaboration brings together Cortica’s all-in-one clinical model with Point32Health’s commitment to outcome-focused care. The agreement applies to members of Point32Health’s Massachusetts Medicaid (MassHealth) and commercial health plans.
Four Tracks of Care
The program is structured into four escalating tracks of care intensity, tailored to each child’s developmental needs. Families move into the track that best matches their child’s diagnosis and goals.
Key components include:
- Faster access: Families will receive a care plan assessment within 15 days of an autism diagnosis and begin treatment within 15 days of that assessment. This represents a dramatic improvement over the months-long delays common in the field.
- Whole-Child Scorecard: Each child’s development is measured every six months using standards set by the Behavioral Health Center of Excellence (BHCOE) and the International Consortium for Health Outcomes Measurement (ICHOM).
- Performance-Based Payments: Cortica is reimbursed through a monthly case rate, with bonuses tied to predefined outcome and process metrics.
Services Included
Cortica’s model integrates nearly all the services a child with autism might need under one roof, including:
- Applied Behavior Analysis (ABA)
- Neurology
- Developmental pediatrics
- Physical and occupational therapy
- Speech-language therapy
- Family counseling and support
This approach reduces the need for parents to manage multiple providers and ensures that treatment plans are aligned across specialties.
Why This Deal Is Groundbreaking
The Cortica–Point32Health partnership is not just another payer-provider agreement. It represents a proof of concept for value-based autism care at scale.
1. Addressing Wait Times
Research shows that early intervention is critical for children with autism. Yet, families often face months-long delays before treatment begins. By committing to 30-day total turnaround from diagnosis to treatment, this model directly tackles one of the most significant barriers in autism care.
2. Standardizing Outcomes
One of the biggest hurdles in value-based autism care is the lack of consensus on outcome measurement. Cortica’s use of a standardized “whole-child scorecard” rooted in BHCOE and ICHOM frameworks provides a model for how to evaluate progress consistently across providers.
3. Incentivizing Quality, Not Quantity
Instead of rewarding volume of therapy hours, this model incentivizes developmental progress, family satisfaction, and timely access to care. This could push the industry away from fee-for-service inefficiencies and toward more family-centered outcomes.
4. Easing Family Burden
By integrating multiple specialties into one coordinated system, Cortica relieves families from the stress of navigating disconnected care networks. As Jill Borrelli, Point32Health’s VP of Behavioral Health, explained:
“The family is already dealing with a very stressful situation. This is part of what makes the relationship with Cortica so special; all these types of services are in the same medical record, in the same case tracking, and managed holistically.”
The Bigger Picture: Autism Care and Value-Based Models
While many industries within healthcare have moved toward value-based care, autism treatment has lagged behind. Why?
Barriers to Adoption
- Lack of standardized measures: Providers, payers, and accrediting bodies disagree on what outcomes should be prioritized.
- Data collection challenges: Smaller ABA providers often lack the infrastructure to aggregate and report quality data.
- Fragmented delivery systems: Care is spread across multiple providers with little integration, making it difficult to track progress.
Momentum Is Building
Despite these barriers, industry leaders increasingly see value-based autism care as inevitable.
- Action Behavior Centers CEO Hersh Sanghavi has stated that “value-based arrangements are the future.”
- Hopebridge Inc., one of the largest autism treatment providers, recently reorganized leadership to emphasize outcomes and value-based strategies.
- Organizations like BHCOE are partnering with payers including Cigna’s Evernorth and Centene’s Peach State Health Plan to establish industry standards.
Implications Beyond Autism
The Cortica–Point32Health deal also reflects a broader trend in behavioral health integration. Point32Health has similar arrangements with other providers, such as Eleanor Health, an addiction treatment organization built around a value-based model.
Both autism and addiction care share challenges of fragmented services, inconsistent outcomes, and high costs. By demonstrating that outcome-based models can succeed in autism treatment, Cortica and Point32Health may inspire similar innovations across behavioral health.
Looking Ahead: What This Means for Families, Providers, and Payers
For Families
- Shorter wait times and earlier access to therapy
- Coordinated care under one roof, reducing stress and improving continuity
- Greater transparency into treatment goals and progress
For Providers
- Incentives aligned with quality, not just quantity of care
- Improved infrastructure for data collection and reporting
- Opportunities to scale outcome-based models across regions
For Payers
- More predictable costs through case-rate payments
- Demonstrable ROI by tying payments to outcomes
- Alignment with broader healthcare reform efforts toward population health and integrated care
Conclusion: A Turning Point for Autism Care
The Cortica–Point32Health value-based care arrangement is more than just a payer-provider contract. It’s a signal of where autism care is headed — toward a future where families get faster, more coordinated support; providers are rewarded for delivering measurable progress; and insurers can ensure dollars are tied to outcomes, not just hours billed.
As Dr. Suzanne Goh of Cortica put it:
“For our clinicians to be able to think about the quality of care above all else — and that’s what we are measuring — that’s what matters to the payer and the family.”
The autism treatment market is at an inflection point. With leaders like Cortica and Point32Health showing what’s possible, value-based autism care may finally become the model that balances quality, access, and accountability — improving lives for children and families nationwide.
