Autism therapy organizations that adopt autism therapy models centered on holistic care are often caught in a difficult financial bind. These organizations, driven by a deep commitment to providing comprehensive and well-rounded care for their patients, often do so at their own financial detriment. Their goal is simple—to move the needle for the patients and families they serve. But the realities of the fee-for-service structure often fail to recognize or properly compensate the extensive, nonclinical work required to deliver a holistic approach to care.
The fee-for-service system that dominates much of healthcare—especially in the realm of autism therapy models—largely compensates providers based on direct clinical services. This system incentivizes the delivery of discrete treatments, often overlooking the broader, essential components that make up a holistic care model. For example, time spent on family education, care coordination with other providers, or addressing social and emotional aspects of care is rarely reimbursed, leaving providers in the position of delivering comprehensive services without being compensated for significant portions of the work. In short, these autism therapy models expect providers to improve the health and wellbeing of patients but often fail to pay for the services that would allow them to do so effectively.
This financial paradox was highlighted by Adam Hahs, Chief Science Officer at Hopebridge, an autism therapy provider based in Indianapolis, during a panel discussion at the Behavioral Health Business’ inaugural Autism & Addiction Treatment Forum in Chicago. Hahs discussed the struggles of his organization as they navigated these financial challenges. “Even if we have to work toward a prior authorization and not get paid for it for an extended period of time, we’re willing to do that because families need it,” Hahs said, underscoring the organization’s commitment to supporting families despite the financial obstacles they face.
Hopebridge, which offers Applied Behavior Analysis (ABA) at the core of its therapeutic services, also provides a variety of additional therapies, including occupational therapy, speech-language pathology, and other behavioral interventions. ABA has long been regarded as the “gold standard” for autism care, but Hopebridge recognizes that it is not a one-size-fits-all approach. Instead, they embrace a more nuanced, interdisciplinary model that takes into account a wide range of patient needs. The company offers a holistic view of autism treatment, one that incorporates multiple aspects of a child’s life and development. These are just some of the innovative approaches found in modern autism therapy models.
Hopebridge’s commitment to a multidisciplinary approach is evident in their data: approximately 67% of their patients receive a combination of therapies, and their data shows significant overall improvement compared to those who receive services added to their ABA treatment later on. This improvement is not just in clinical metrics but also in the long-term wellbeing of the family as a whole. But this expansive care approach comes at a price. The added services—while essential to the overall success of the therapy—often do not generate enough revenue to cover the costs, putting organizations like Hopebridge in a challenging position. These challenges are common in many autism therapy models today.
While Hopebridge provides all its therapies in-house, another major player in autism therapy models, Caravel Autism Health, based in Green Bay, Wisconsin, takes a slightly different approach. Caravel’s core focus is on ABA therapy, but the organization partners with other providers such as pediatricians and speech-language pathologists to offer a more holistic care model. “I think that is us trying to be really good at the core of what we do first,” said Mike Miller, CEO of Caravel Autism Health. He added that this approach has served them well, particularly during challenging times like the COVID-19 pandemic, when operational issues forced many to re-evaluate their care models.
Despite the benefits of offering comprehensive care, Miller also acknowledged the financial reality of this model: a significant portion of the work, especially coordination with other providers and engaging with families, is non-reimbursable under the traditional fee-for-service model. According to Miller, somewhere between 20% to 40% of a Board-Certified Behavior Analyst’s (BCBA) time is spent on tasks that are not reimbursed in traditional care settings. These tasks are critical to holistic care—activities like family training, care coordination with other specialists, and planning for long-term patient goals—but they go unrecognized by the existing reimbursement systems.
Caravel’s family training program is a good example of a non-reimbursable service that has proven to be highly beneficial for patients. Studies have shown that patients whose families engage in family training are twice as likely to make progress on important developmental measures, such as those assessed by the Vineland Adaptive Behavior Scales. The nonclinical time spent in this type of training is essential for ensuring that the progress achieved in therapy is supported at home. However, as Miller pointed out, this time isn’t reimbursed under current insurance models, which presents a significant challenge for providers trying to integrate holistic services into their care plans.
Despite these financial hurdles, Miller believes that the autism therapy models industry is slowly moving toward alternative reimbursement models. He described the industry’s progress as being in its “toddler stage,” acknowledging that while some strides have been made, the overall adoption of new models remains limited. According to Miller, progress has been more noticeable in nonprofit organizations that provide wide-ranging services and work closely with government agencies. These organizations, such as I Am Boundless in Worthington, Ohio, have been able to navigate the complexities of managed care and secure higher reimbursement rates by demonstrating the value of their outcomes.
I Am Boundless provides an example of how organizations can overcome the limitations of the fee-for-service model. Through years of engagement with managed care organizations, I Am Boundless has developed care management, case management, and delegated care contracts that allow them to offer higher reimbursement rates than those typically found in the fee schedules. “It didn’t automatically happen,” said Jennifer Riha, Chief Strategy Officer at I Am Boundless. “We had to spend a lot of time building that rapport and proving to them that we were what we said we were.” By leveraging their outcomes data and fostering strong relationships with payers, I Am Boundless has managed to secure the financial support needed to sustain their holistic care approach.
This story of persistence is one that other autism therapy organizations could learn from. In Hopebridge’s case, Adam Hahs is also committed to demonstrating the value of their holistic approach by gathering and presenting hard data that shows the benefits of such a model. “It’s time to put up the data and let data drive the decisions,” Hahs explained. “When we come to the table with that data, it all comes off a lot cleaner of a conversation.”
In the future, if autism therapy providers are to succeed in adopting more holistic care models, data will play a crucial role in convincing payers and regulators to recognize the full value of these approaches. By demonstrating the measurable benefits of integrated therapies and care coordination, providers can advocate for better reimbursement rates and more sustainable funding models that reflect the true costs of holistic care.
Ultimately, the financial struggles of autism therapy organizations offering holistic care models are a reflection of a broader issue within healthcare: the tension between the financial realities of reimbursement systems and the desire to provide the highest quality of care. While the fee-for-service structure rewards the delivery of direct clinical services, it fails to account for the holistic, interdisciplinary work that makes a real difference in the lives of families affected by autism. By proving the effectiveness of these comprehensive autism therapy models with solid data and engaging in strategic negotiations with payers, organizations like Hopebridge, Caravel Autism Health, and I Am Boundless are paving the way for a future where holistic care models can thrive—not just for the benefit of the patients, but also for the sustainability of the organizations that serve them.
As the industry continues to evolve, the hope is that we will see a shift in the way holistic care is valued, allowing autism therapy providers to continue offering comprehensive, family-centered care without the financial strain that often comes with it. The need for systemic change is clear, and with persistence, data, and collaboration, a more sustainable and compassionate model for autism therapy can emerge.
