Over the past year, Doreen Granpeesheh, the founder of the Center for Autism & Related Disorders (CARD), has been hard at work revitalizing the company she founded in 1990. Taking a fresh approach, Granpeesheh has been pruning outdated strategies and grafting in new, more sustainable plans aimed at ensuring CARD’s future autism therapy growth and stability. After acquiring the company through bankruptcy proceedings in August 2023, Granpeesheh has led a dramatic overhaul focused on financial sustainability, the creation of a robust workforce, and an innovative use of technology.
One thing is certain: the approach of private equity is not part of the plan moving forward.
A Return to Simplicity and Sustainability
In a fireside chat at the Behavioral Health Business INVEST 2024 conference, Granpeesheh shared her vision for the future of CARD, which hinges on reinvesting profits into new centers while avoiding adding any more debt to the company. For Granpeesheh, this marks a return to the foundational values that initially led to CARD’s success.
“I had no debt when I did the previous round of clinics,” Granpeesheh said. “I had built every clinic with our cash… The company is stabilized; whatever it generates, we will put back into the company.”
The decision to avoid adding debt is part of Granpeesheh’s broader goal of creating a self-sustaining business model. She’s keen to replicate the approach that made CARD successful in the past. In the past, Granpeesheh built every clinic with cash on hand, and her philosophy is rooted in growth through profits, not external funding.
Unlike many companies in the behavioral health space, Granpeesheh doesn’t see opening new clinics as capital-intensive. In fact, she believes that these new centers can quickly become profitable—usually within six months to a year—if the right sites are selected and the right operational structure is in place. This model also allows CARD to grow strategically, one clinic at a time, with a focus on sustainability and long-term autism therapy growth rather than rapid expansion at the cost of financial stability.
Cutting Costs and Restructuring for Efficiency
The first few months under Granpeesheh’s leadership were focused on getting the company back on track. Her first priority was cutting unnecessary costs and restructuring the business to ensure it was running as efficiently as possible. For Granpeesheh, this meant eliminating unnecessary vendor contracts and scaling down the company’s corporate structure. By reducing the number of high-level executives, Granpeesheh and her business partner, Pant, were able to save significant amounts of money—money that could be reinvested directly into the business.
Granpeesheh and Pant also made the decision to forgo salaries for their leadership roles, emphasizing their commitment to CARD’s mission and long-term viability. This commitment to reinvestment in the business allowed CARD to break even much sooner than expected. Where Granpeesheh had initially predicted it would take a year to reach breakeven, the company managed to do so within just six months, a sign that their efforts were already paying off.
With the company’s financial foundation secured, Granpeesheh’s focus has shifted to growth. As of today, CARD operates approximately 110 clinics. However, this is just the beginning. Granpeesheh has ambitious plans to expand CARD’s footprint, both geographically and in terms of services offered. One key part of this plan includes opening new diagnostic centers, which will operate separately from CARD’s treatment centers. This move is in direct response to a growing shortage of diagnostic services in the autism therapy industry. Many communities are currently facing year-long wait lists for autism diagnoses, and Granpeesheh sees this as an opportunity to help meet the demand for timely care.
Empowering the Workforce: A Key Focus for 2025
One of the most significant changes Granpeesheh has brought to CARD is a renewed focus on employee engagement and retention. As a highly hands-on CEO, Granpeesheh has worked directly with the company’s operations managers and behavior analysts (BCBAs) to understand the challenges they face. Granpeesheh is deeply invested in improving the work environment for the frontline staff at CARD, particularly the registered behavior technicians (RBTs) who are responsible for providing care to patients.
“I’m a very, very hands-on type of CEO,” Granpeesheh said, explaining her strategy for better understanding the day-to-day realities of the staff who work directly with patients. “I started to actually have weekly calls with all of our operations managers at the sites. … Then I really got involved with the supervisors—the BCBAs, we have about 300 of them—and really learned what their lives are like and what their problems and issues are.”
Granpeesheh’s engagement with the staff has informed several key changes at CARD. The company has re-established its incentive program, CARD Shops, which allows clinicians to earn points for billable sessions that can be redeemed for items, similar to how credit card rewards work. In addition, CARD has implemented a wage incentive program where RBTs receive raises after completing every 500 hours of care. These programs are designed to encourage more flexible scheduling and to motivate clinicians to take on additional hours during evenings or weekends—times that are often more convenient for patients but less convenient for staff.
In Granpeesheh’s view, fostering a culture where employees feel heard and valued is essential for long-term retention. “Nothing motivates people more than being heard,” she said. By implementing programs like CARD Shops and wage incentives, Granpeesheh is ensuring that RBTs feel empowered in their careers and are motivated to provide the best possible care to patients.
Granpeesheh is also focused on creating clearer paths for career growth within the company. She believes that by listening to employees and acting on their feedback, CARD will build a more engaged and committed workforce—one that is aligned with the company’s goals and vision for the future. This approach is key to ensuring that autism therapy growth at CARD is driven not only by the expansion of services but also by a dedicated, well-supported team of professionals.
Leveraging Technology and AI for Growth
Another key component of Granpeesheh’s vision for CARD’s future is the integration of technology, particularly artificial intelligence (AI), into the company’s operations. While AI was not at the forefront of business operations when Granpeesheh stepped away from daily management in 2019, she now sees it as crucial to CARD’s continued success. In fact, she views investing in AI as akin to investing in the internet 40 years ago—an opportunity that is too important to ignore.
“AI is my No. 1 objective,” Granpeesheh said, emphasizing the importance of staying ahead of technological trends.
In its early stages, CARD has already started experimenting with AI in several areas. Some pilot programs are focused on using AI to generate reports, analyze clinical data, and capture insights from conversations. Granpeesheh also sees AI as a valuable tool for expanding and improving CARD’s parent support and training programs. One exciting development in this area is the creation of new games designed to enhance treatment plans. These games are aimed at improving patient engagement and providing additional tools for clinicians to use in therapy sessions.
In addition to its focus on AI, CARD is also investing in partnerships with physical healthcare providers, including the Cleveland Clinic and UCLA’s medical arm. These partnerships are designed to address patients’ physical health needs before they begin treatment with CARD. Granpeesheh believes this approach will help stabilize patients before they start their therapy programs, ensuring that they are in the best possible health to benefit from treatment.
Navigating the Shift Toward Value-Based Care
A significant challenge facing CARD and the broader autism therapy industry is the transition to value-based care models. These models hold providers accountable for the outcomes of the care they provide, and as a result, they have created an increased focus on tracking patient progress and improving care outcomes. Granpeesheh has been actively engaging with payers to prepare for this shift and to ensure that CARD is well-positioned to succeed in this evolving landscape.
“There’s a concern about the intensity of services being reduced,” Granpeesheh said. “The intensity of ABA therapy is like a prescription—the dosage matters.” Granpeesheh is focused on maximizing the impact of CARD’s therapies, even within the constraints of reduced coverage hours. By improving care outcomes before the industry is fully required to meet value-based care standards, she hopes CARD can stay ahead of the curve and continue to deliver the highest-quality care to its patients.
A Bright Future for CARD
Doreen Granpeesheh’s return to CARD has marked the beginning of a new era for the company. Through careful pruning, reinvestment in the workforce, and the strategic adoption of new technologies, Granpeesheh is positioning CARD for sustainable autism therapy growth and success. With a focus on employee empowerment, operational efficiency, and patient outcomes, CARD is poised to thrive in an increasingly competitive healthcare landscape.
As Granpeesheh continues to lead CARD into the future, she remains committed to the company’s core values of providing exceptional care while building a financially stable, innovative, and growth-oriented organization. With her hands-on leadership and a clear vision for the future, CARD’s path forward looks brighter than ever, ensuring continued autism therapy growth for both the company and the individuals they serve.
