“There are a lot of opinions about what autism is, and how it should and shouldn’t be treated. We need to understand the comorbidities that are common with autism and have a network in place to support them.”
— Katherine Wooten, LCSW, BCBA, CCM, Senior Director of Lucet’s Autism Resource Program
The increase in autism diagnoses has led to a higher-than-ever demand for Applied Behavior Analysis (ABA) and other autism-related care amidst a constantly shifting reimbursement landscape. To help health plan decision-makers make sense of it all, Katherine Wooten, senior director of Lucet’s Autism Resource Program (ARP), recently presented a webinar outlining the key components required to build an industry-leading, clinically excellent autism program.
Clinical, business & legal trends
The prevalence of autism in the U.S. is skyrocketing, affecting 1 in 36 eight-year-olds and 1 in 45 adults. Despite the growing numbers, the science behind autism hasn’t caught up entirely, leaving many questions unanswered regarding its causes and treatments. One of the major challenges is the lack of consensus on effective interventions and treatment modalities. With autism insurance reform preceding comprehensive research, there remains uncertainty about the most suitable interventions, appropriate settings and caregiver involvement.
“There are a lot of opinions about what autism is, and how it should and shouldn’t be treated. Autism is an interesting case where we put the cart before the horse — that is, we’ve gotten autism insurance reform before we even have a whole lot of research telling us how to be good stewards of that benefit,” Katherine noted.
Currently, ABA is the gold standard for autism treatment, but many of the practitioners are relatively inexperienced, having obtained their certification in the last five years. Health plans and parents need to look carefully at their provider networks to ensure that they are getting quality care from experienced practitioners.
One significant business trend that has emerged in the last decade is private equity firms investing in autism. This development has led to some real concerns about unequal access, decreased quality and increased costs of treatment. While there are significant benefits that private equity brings to the table, it’s important to keep these concerns in mind when considering a private equity-backed provider to ensure they are delivering quality care.
“It’s incumbent upon both payers and providers to make sure we’re reviewing treatment plans through the lens of each child, and tailoring interventions that are specific to that child.”
Katherine Wooten, LCSW, BCBA, CCM – Senior Director, Autism Resource Program
Key components of an Autism Resource Program (ARP)
Early intervention
Early intervention is an essential element of successful autism care programs. It’s crucial to educate health plan members to recognize the early signs of autism and seek help immediately to ensure the best outcomes.
Customized care
Autism presents differently in each person, so it’s important to consider each individual child’s unique strengths, challenges, developmental milestones and preferences when designing their treatment.
“It’s incumbent upon both payers and providers to make sure we’re reviewing treatment plans through the lens of each child, and tailoring interventions that are specific to that child,” Katherine explained.
Coordinated treatment
Katherine stressed the importance of coordinating services like communication between health care providers, therapists, educators and others to ensure that care is integrated. That involves behavioral health and medical providers working closely together. “We need to understand the comorbidities that are common with autism and have a network in place to support them,” she said.
What makes Lucet’s autism program stand out?
Lucet’s ARP encompasses the key components of a successful autism program by ensuring that our clinical teams comprise highly experienced board-certified behavior analysts and board-certified child, adolescent and adult psychiatrists and social workers who provide personalized care. We offer access to holistic treatment modalities, along with concierge-level support and community engagement to benefit the whole family. Our emphasis is on coordinated care management across behavioral health and medical teams. By prioritizing early intervention and comprehensive support, we improve outcomes and enhance the quality of life for individuals with autism and their families.
For more autism resources, access our toolkit and Autism Resource Center.
Katherine Wooten, LCSW, BCBA, CCM, is senior director of the Autism Resource Program and Rachel Jenkins is a senior marketing specialist at Lucet, The Behavioral Health Optimization Company.
