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How Consumer Demand Is Transforming Autism Care

Blog | 
Consumerism | 
Innovation | 

Autism Spectrum Disorder (ASD) is the fastest growing, lifelong developmental disorder in the country. ASD affects 1 in 59 children, and boys are five times more likely than girls to have ASD.[1] It is a whole-body lifelong condition that affects people emotionally, physically and socially. Although more than half of people with ASD demonstrate above average intellectual ability, they struggle with communication and social interaction.

ASD care is typically fragmented and costly and requires residential care, special education, supportive services and intensive therapies. During childhood, annual care costs average $60,000 per child. Lifetime care costs exceed $2.3 million per child, which is largely funded by public programs. This places a public prerogative to reduce costs and improve ASD care and intervention. ASD is the fourth-most expensive condition in the U.S. and is projected to reach $461 billion by 2025.[2]

Effective and early therapeutic interventions for people with autism will change their current trajectory and help them live longer, healthier lives while reducing costs. As demand for better ASD care increases, innovative companies have the opportunity to serve people with enhanced technologies that deliver better outcomes. According to a 2013 study in The Economist, this demand has created coverage gaps that providers are seeking to fill with new services.[3]

People living with ASD may require constant attention and 25-40 hours of therapy each week. Many people with autism have difficulty with feeding, sleeping and eating. They are more likely to experience gastrointestinal disorders, seizures, ADHD, anxiety, depression, bipolar disorder and schizophrenia. Their emotional, physical and social limitations can even cut their life expectancy by half. People with autism and their families need affordable access to coordinated, holistic and affordable care.

Although the biological causes of ASD are uncertain, the earlier ASD is diagnosed and intervened produce better outcomes. Detecting autism in young children improves lifelong learning, communication and social skills. Diagnosing ASD is an objective test, but Applied Behavioral Analysis (ABA) has become the gold standard of autism therapy. It helps people with autism amplify positive behavior and reduce negative behavior. Board Certified Behavioral Analysts (BCBAs) oversee ABA therapy and are supported by Registered Behavioral Technicians (RBTs) and other therapists. These therapists are hard to find as demand increases.

In response to demand, autism healthcare services as scaling rapidly. Commercial payers are expanding their funding and seeking measurable outcomes, skill development, best practices and cost reduction. Providers with domain expertise, high-quality therapists and scalable capabilities are preferred within their networks. ASD therapy offered in clinics/centers, at home and in schools offer individualized support and expansive services for people. Each setting requires different business models, and one-size does not fit each person. Here are the different types of ASD care providers:

  • Center-Based Providers
  • Home-Based Providers
  • Center-Based and Home-Based Providers
  • Diversified Community Settings
  • School-Based Therapy Providers 

There are opportunities to provide individualized care in home settings, or more expansive care in facilities that reach more people with autism. All models are thriving, but they each share these similar principles that deliver superior care:

  1. Providing convenient patient care.
  2. Offering access to BCBAs and other high-quality therapists.
  3. Create continuity between the schools and their communities.
  4. Establishing referral networks and payer relationships.
  5. Focusing on measurable outcomes.
  6. Raising local, regional and national brand awareness.
  7. Integrating holistic care delivery platforms in new providers.
  8. Providing clinical and organizational leadership for the sector.

Now is the time to scale ASD services to create longer, healthier lives. As consumers and payers are demanding convenient, high-quality and consolidated care, those who deliver quality outcomes will win. For innovative examples of autism care providers in the marketplace, please read the full Market Corner Commentary here.

Sources

  1. https://www.autismspeaks.org/science-news/cdc-increases-estimate-autisms-prevalence-15-percent-1-59-children
  2. https://www.autismspeaks.org/autism-facts-and-figures
  3. https://www.economist.com/leaders/2016/04/16/beautiful-minds-wasted
About the 4sight Health Author
David W. Johnson CEO

David Johnson is the CEO of 4sight Health, a thought leadership and advisory company working at the intersection of strategy, economics, innovation and capital formation. Dave wakes up every morning trying to fix America’s broken healthcare system. Prior to founding 4sight Health in 2014, Dave had a long and successful career in healthcare investment banking. He is a graduate of Colgate University and earned a Masters in Public Policy from Harvard Kennedy School.

Employing his knowledge and experience in health policy, economics, statistics, behavioral finance, disruptive innovation, organizational change and complexity theory, Dave writes and speaks on pro-market healthcare reform. His first book Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare, and his second book, The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care for All (McGraw-Hill 2019), are available for purchase on www.4sighthealth.com.