Will autism services follow the trend to value-based care
Dr. Tracy Gayeski, Senior Vice President, Catalight Care Services
While more than half of all overall healthcare payments today are still based on fee-for-service1, the trend toward value-based care (VBC) has accelerated in recent years as legislators and the Centers for Medicare and Medicaid Services (CMS) have enacted VBC-driven programs and laws.2 Some models predict the number of patients treated under value-based care could roughly double in the next five years.3
Yet behavioral health is lagging behind. Physical healthcare is arguably easier to gauge in terms of outcomes: A lower HbA1C is a specific, quantifiable, evidenced-based indicator of diabetic disease improvement that measures the potential effectiveness of a given treatment program. Other quality metrics, such as 30-day hospital readmissions for chronic obstructive pulmonary disorder or heart failure, incentivize providers to deliver quality, coordinated care and to ensure the patient leaves the hospital with a clear plan for follow-up.
Value-based care in autism treatment today
Successful outcomes for behavioral health conditions like ASD are harder to measure. Some quality measures work across a variety of conditions – patient satisfaction, for example, but the right suite of metrics for behavioral health is still a work in progress.4
Assorted measures, such as the Aberrant Behavior Checklist, which scores symptoms such as stereotypic behavior,5 may ignore the fact that behaviors like hand-flapping can actually be self-soothing, and a reduction in this behavior doesn’t necessarily translate to an improved outcome or wellbeing.
Recently, the International Consortium for Health Outcomes Measurement developed an Autism Disorder Standard, suggesting a set of outcome measurements including quality of life, family functioning, anxiety and leisure, among others.6 The framework may not be the last word on appropriate ASD outcomes, but it’s a valuable step to further discussion and move the needle on VBC in autism.
Deepening the conversation in value-based care for behavioral health care
Catalight is one of the largest behavioral health networks in the U.S. delivering person-centered care to more than 12,000 individuals and families a day with three million service hours a year. Given Catalight’s scale, breadth of outcomes data, clinical and operational expertise in ASD and developmental disabilities treatment we have been partnering with payers and providers to further the conversation around value-based care for ASD.
It’s an important conversation at a time when the prevalence of ASD is rising, the costs of traditional applied behavioral analysis (ABA) are increasing, ABA workers are in short supply and experts are reexamining the idea of the up to 40-hours-a-week, in-home ABA as the gold standard of care.
Designing new flexible modalities of care has been a critical aspect of Catalight’s strategy. The traditional practitioner-mediated ABA where a paraprofessional delivers the direct care can be effective, but is not a one-size-fits-all and is costly and unsustainable for many families. This suggests that other modalities of care, which recognize differences in ASD severity, manifestation, and responsiveness to ABA, among other things, can be used to calibrate and tailor the intensity and course of treatment accordingly.
Recent research studies, including Catalight’s own data, indicate that children can make the same progress with fewer treatment hours. This is not only more cost effective, but better for the client and the entire family’s wellbeing.
About half of all families who come to Catalight for care choose a parent-mediated modality that empowers parents to help their child learn and grow. Catalight offers several parent-mediated modalities that fit the unique needs of families. Children in these modalities make good progress, and as a bonus, our measure of parent confidence shows that parents who choose this path for their family develop confidence in their ability to work with their child and make a real difference in their child’s future.
In addition to measuring the confidence parents have in working with their children and responding to their behavior, Catalight looks at family wellbeing, progress in adaptive skills, reduction in challenging and dangerous behaviors and parental stress. This comprehensive snapshot provides us with a picture of how the child and their family are doing.
Regardless of how effective current modalities of care are for ASD treatment, clients and their families deserve a measure of quality like commonly offered in primary and specialty care – an indicator of how well treatment is working, and what the investment in care is getting them.
Are you interested in learning more about VBC and trends in behavioral health? Please visit Catalight to join the conversation!
 Value-Based Payment As A Tool To Address Excess US Health Spending
 What are the value-based programs?
 Investing in the new era of value-based care
 Preparing for Value-Based Payment Models in Applied Behavior Analysis
 Autism spectrum disorders: a review of measures for clinical, health services and cost–effectiveness applications
 Toward a Value-Based Care Model for Children with Autism Spectrum Disorder