As the prevalence of autism spectrum disorder (ASD) continues to rise, parents of children with autism face significant challenges in obtaining high-quality and appropriate care and services. Delays in diagnosis, waitlists for treatment, shortage of available providers, high staff turnover, and a lack of standardized outcomes are prevalent across the country. When one or more of these barriers exist, long-term progress is negatively affected (CDC, 2021).
One approach to addressing these challenges is value-based care (VBC). VBC emphasizes quality care over quantity of care and encourages cost-effective care management. In this article, we explore: (a) what VBC means for parents of children with autism; (b) how VBC affects current providers; (c) how VBC improves service quality; and (d) how providers are measured based on outcomes.
What is Value-Based Care (VBC)?
In the current healthcare system, providers are often paid based on the number of services or service hours they provide, regardless of the quality of care they deliver. This fee-for-service model encourages high utilization because providers are financially incentivized to perform more procedures and services as more services translate into more revenue. This can lead to overuse of healthcare services, as providers may be motivated to perform unnecessary tests, procedures, or treatments, even if they are not beneficial for the patient. Fee-for-service systems are designed to incentivize overuse of healthcare services leading to higher than necessary costs. VBC, on the other hand, pays providers based on the quality of services they provide as tied to patient outcomes. Typically, this is determined through various measures around cost-effectiveness and key quality indicators. In short, the conversation focuses on outcomes, not hours. By shifting the focus from volume to value, health plans and providers can bridge gaps in the treatment quality of Applied Behavior Analysis (ABA) services for autism.
How Does VBC Affect My Current Services and Provider?
VBC will significantly impact the services you receive for the better! The goal of VBC is for your providers to be reimbursed based on how well they provide services and how much their clients improve. This allows providers to focus less on maximizing the hours they spend with clients and more on what they are doing with the hours they have.
Relatedly, over 60% of Board Certified Behavior Analysts (BCBA) and Board Certified Assistant Behavior Analysts (BCaBA) experience moderate to high levels of burnout due to exhaustion and loss of enthusiasm for work associated with the fee-for-service model (Plantiveau et al., 2018). By holding providers accountable to value, providers are better able to choose appropriate goals, tailor individual care, and observe measurable patient gains, giving them greater flexibility to deliver the right care at the right time (The Commonwealth Fund, 2023). As a result, providers can reconnect to their passion as healers, reclaim professional autonomy, and are empowered to maximize their clinical judgement (Tiesburg et al., 2020).
How Does VBC Affect the Quality of ABA Services?
Value-based care is applied in ABA therapy to increase access to care, reduce costs, and improve outcomes for children with autism. One way to apply VBC in ABA therapy is to prioritize early intervention. Research has shown that early intervention can significantly improve outcomes for children with ASD, reducing the need for more intensive interventions later in life. By prioritizing early intervention, ABA therapy can be used to improve adaptive behavior, IQ (intelligence quotient) scores, and language skills, reducing the need for costly interventions into adulthood (Cucinotta et al., 2022).
Furthermore, coordination of care across treatment professionals reduces duplication of care and improves monitoring of medication effectiveness and behavioral side effects. Many individuals with ASD receive services from speech-language pathologists, occupational therapists, physical therapists, medication managers, and behavioral health providers. Coordinating care allows treatment professionals to carryover skills and goals across different settings which improves treatment outcomes by aiding in skill generalization and maintenance (Fulceri et al., 2023).
Throughout the treatment journey, consistently measuring progress also allows treatment professionals to predict long-term outcomes based on how the individual is progressing across all areas of their life. In so doing, treatment professionals can intervene early with additional case management, referrals, and resources where needed as significant barriers arise. This approach allows for each individual’s overall healthcare to be managed according to their specific needs and with a focus on long-term outcomes.
How will VBC Affect Parents?
Improved outcomes: By providing parent training in ABA techniques, parents can learn how to help their children engage in positive behaviors and reduce challenging behaviors. Such continuity of care across the child’s day leads to improved communication skills, improved social skills, and fewer challenging behaviors as well as decreased rates of stress and depression in parents (Shoumitro et al., 2020).
Reduced costs: By providing parent training in ABA techniques, parents learn how to implement behavior modification techniques at home. This reduces the need for expensive in-person ABA therapy sessions and can lead to cost savings for families and the healthcare system while maintaining positive treatment outcomes.
Patient-centered care: Value-based care emphasizes the importance of patient-centered care, which involves empowering patients and their families to be active participants in their care. By receiving parent training utilizing ABA techniques, parents learn how to be active participants in their child’s therapy and can work collaboratively with healthcare providers to achieve the best possible outcomes for their child. Furthermore, VBC enables parents to obtain resources and advocacy such as for individualized education programs (IEPs), financial and public health resources, respite care, and other services. This holistic care approach has been demonstrated to improve care and outcomes for children, especially those in underserved and under-resourced communities.
What Will My Provider Be Measured On?
BCBAs who provide ABA services may be measured on several outcomes for value-based care contracts. These outcomes typically focus on improving patient outcomes while reducing costs.
Patient outcomes: Improvements in communication skills, social skills, and reductions in problem behaviors are measured using standardized assessment tools or through direct observation of the patient’s behavior as reported by the provider.
Cost savings: Reduction of healthcare costs associated with treating patients is achieved through interventions that reduce the need for costly medical interventions or improve the patient’s ability to function in their daily life.
Treatment adherence: Measuring the ability of BCBAs to adhere to evidence-based ABA treatment plans that have been shown to be effective in improving patient outcomes is achieved through regular monitoring of treatment progress and the BCBAs adjustment of treatment plans as needed.
Patient satisfaction: Patient and family surveys or direct feedback enable measurement of patient and family satisfaction with the ABA services, access to care and overall care experience.
VBC enables providers to focus more on delivering high quality treatment, improving outcomes, reducing care costs, and prioritizing empowerment of patients and families. With appropriate measures in place, VBC is the future model for payment of ABA services.
Dana D’Ambrosio, MS, BCBA, LBA, is Director of Clinical Development at RethinkFutures, a RethinkFirst Company.
References
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Centers for Disease Control and Prevention. (2021, February 25). Autism Spectrum Disorder (ASD). Retrieved from https://www.cdc.gov/ncbddd/autism/index.html
Cucinotta, F., Vetri, L., Ruta, L., Turriziani, L., Benedetto, L., Ingrassia, M., . . . Gagliano, A. (2022). Impact of three kinds of early interventions on developmental profile in toddlers with autism spectrum disorder. Journal of Clinical Medicine, 11(18), 5424. doi: https://doi.org/10.3390/jcm11185424
Fulceri, F., Gila, L., Caruso, A., Micai, M., Romano, G., & Scattoni, M. L. (2023). Building bricks of integrated care pathway for autism spectrum disorder: A systematic review. International Journal of Molecular Sciences, 24(7), 6222. doi: https://doi.org/10.3390/ijms24076222
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Shoumitro (Shoumi) Deb, Retzer, A., Roy, M., Acharya, R., Limbu, B., & Roy, A. (2020). The effectiveness of parent training for children with autism spectrum disorder: A systematic review and meta-analyses. BMC Psychiatry, 20, 1-24. doi: https://doi.org/10.1186/s12888-020-02973-7
The Commonwealth Fund. (2023, February). Value-Based Care: What It Is and Why It’s Needed. Retrieved from https://www.commonwealthfund.org/publications/explainer/2023/feb/value-based-care-what-it-is-why-its-needed
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