According to the CDC, 1 in 54[1] children is diagnosed with autism spectrum disorder (ASD), with some states reporting 1 in 32[2] children receiving a diagnosis.1 One of the most common treatments for ASD is Applied Behavior Analysis (ABA), a therapeutic intervention that helps individuals with autism:

  • Improve communication, social, daily living and motor skills
  • Maintain positive behaviors
  • Transfer skills and behavior from one situation to another

Because ABA is a newer treatment than psychotherapy and other therapies, limited academic literature exists to support providers in effective decision-making for intensity and length of care. In addition, treatment plans are individualized and require extensive monitoring with heavy reliance on caregivers, nearly 50%[3] of whom need help managing emotional and physical stress. This makes it difficult for families to gauge treatment effectiveness and contributes to the rising costs of mandated ASD treatment. In fact, according to the CDC, in addition to medical costs, intensive behavioral interventions for children with autism cost $40,000 to $60,000 per child per year.[4]

A shift from fee-for-service models, in which ABA providers are compensated for each procedure, test, treatment, etc. performed, regardless of whether they lead to better outcomes for the patient, to value-based care models that link payments for the provision of services to the quality of services provided and reward providers for efficiency and effectiveness, can help address these challenges and deliver stronger clinical outcomes when the models:

  • Emphasize efficacy—Value-based ABA care models should define benchmarks that determine when the maximum benefit of ABA services has been achieved, measure progress against the benchmarks and empower providers in the decision-making process to ensure that intended outcomes are achieved during ABA treatment and beyond.
  • Improve member engagement—It is essential that providers and caregivers work together as a team. By participating in regular discussions with providers on progress trends barriers, and ongoing assessment, caregivers are empowered to understand the overall direction and impact of ABA services and how their active participation in their child’s treatment planning and delivery has a strong impact on outcomes.
  • Drive-data-informed decision-making—From the onset of ABA services, behavior analysts should set targets or specific behaviors selected for change based on skills assessments. Progress toward these targets should be monitored, analyzed for trends, and continuously discussed with caregivers. This high-engagement, data-informed process drives decisions on the next steps for ABA services, including whether to continue or slowly reduce the number of therapy hours, and enables providers and caregivers to select and use clinical services that will meet children’s needs.

Visit here to learn about Magellan Healthcare’s value-based collaboration with Invo Healthcare to define standards of care for children with ASD undergoing ABA treatment and improve ABA outcome