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Month: December 2018

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Five Factors Investors Should Consider When Exploring Autism Services Companies

The field of autism services is experiencing considerable growth; a trend that looks to continue for some time. An increase in diagnostic prevalence, as well as an aging population of adults living with autism, will continue to increase the demand for services for the foreseeable future. As the demand for autism services continues to grow, the field has become even more attractive for investors. In my book, Autism Matters: Empowering Investors, Providers, and the Autism Community to Advance Autism Services, I discuss how investors can play a vital role in advancing the autism services industry.

But with so many providers, how do investors know which are strong investments? Through my diligence work with investors, I have determined five of the major factors investors should consider before investing in an autism services company:

#1. Payer Concentration/Diversity

Autism services providers are typically paid by third parties, whether they be insurance companies, governments, or school districts. Many providers, but mostly smaller providers, experience payer concentration lending risk to future growth and revenue prediction.  Just recently a prominent commercial payer handed down a significant rate cut to their ABA providers.

It’s also important to look at the state and federal laws surrounding funding. Is funding relatively secure or is it vulnerable to political change? If funding laws did change, how much funding could be at risk?

#2. Fraud and Legal Compliance

There are several things to consider in regard to compliance. Each area deserves due diligence when investing:

  • Is the company in compliance with payer contracting requirements? Every insurance company and government agency will have their own requirements regarding credentialing of staff, billing requirements, medical necessity criteria and service delivery, to name a few.
  • Is the company billing in a manner which prevents fraud? Fraud is prevalent in the autism services industry, occurring both intentionally, through billing and credentialing fraud, as well as unintentionally, due to lack of understanding of billing regulations and requirements.
  • Is the company compliant with state licensing laws, state psychology board regulations, and any other legal, operational requirements?
  • Is the company abiding by HIPAA and taking steps to protect consumer information?

#3. Revenue Model

Autism services are offered in different settings to serve different needs, and to meet varying funding compliance regulations. Some services are center-based, where individuals come into an office or facility. Other service providers offer in-home or in-school services models where the provider travels to the home or school for service delivery. And other companies offer hybrid approaches combining both in-home and center-based services. It serves investors well to understand what services a company offers and in what settings, so they may better understand the revenue model and the regulations that guide service delivery.

#4. Clinical Model and Outcomes

On a more personal and socially-focused level, in my book, I also stress the need for long-term, quality of life outcome measures in autism intervention therapy. The goal of intervention is to provide the skills necessary for successful adult lives and many programs fail to focus on this long-term outcome of service delivery.

#5. Workforce Classification

As the industry grows, some providers have taken to building staffs of independent contractors rather than hiring actual employees. While this provides lower overhead and prevents a provider from dealing with employee benefits, it also presents a risk to the investor on two levels. From a legal perspective, treating staff as independent contractors often violates the legal requirements for workforce classification. On a service delivery and clinical level, independent contractors are scrutinized less, undergo less training, and have no vested interest in the company they are contracted by. To ensure the integrity of service and quality outcomes, only the best suited should be employed, and companies should be accountable for training and quality assurance. While many contractors are skilled and knowledgeable, companies that rely on them to comprise their workforce are putting too much distance between themselves and their consumers.

While there are many important factors to look at, these five key areas will allow investors to quickly and critically assess some of the most vital aspects of an autism services company before committing to investing. For further information on these topics and others related to autism services, please read my book, Autism Matters: Empowering Investors, Providers, and the Autism Community to Advance Autism Services, and follow my blog for more news and insights.

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Public Awareness and Understanding Create Safer Environments for Individuals with Autism

Close up view of upset couple, guy holding hands of crying woman

Most of the intellectual, emotional, and physical energy devoted to people with autism spectrum disorders focuses on their behavior and their understanding of the world. There is another component.

Our behavior and our understanding of them.

Imagine you were just as intelligent as everyone around you but functioned differently. You lacked the ability to communicate, to read social cues, or relate to others. Imagine that commonplace noises caused you physical and emotional distress.

Now imagine that, instead of removing those noises, or allowing you to escape them; instead of treating you with compassion for your deficits and disabilities; instead of making an effort to help you communicate your needs, people ridiculed you, shunned you and forced you to endure what causes you pain.

For many people with autism, that is their daily life. In my book, Autism Matters, I tell the story of Jared, a young man tormented by schoolmates. He complained, “They said I had poor social skills, but what about the kids who were bullying me; don’t they have poor social skills?”

More than social skills, many mistakenly assume people with autism have intellectual deficiencies. Some do, just as some neurotypical people do, but many autistic people are extremely intelligent. They must contend with that stigma on top of the challenges of their condition. “I have to work 10 times as hard as you,” Jared noted, “to be taken seriously.”

There are many examples of eminent scholars who have autism spectrum disorders, the most famous of whom is Dr. Temple Grandin, a professor of animal science at Colorado State University and a renowned consultant to the livestock industry. Dr. Grandin has been the subject of books and movies, but she is hardly alone among people with autism in her intellectual accomplishments.

We need to look no further than the very first person diagnosed with autism to appreciate the power of a compassionate community. Don Triplett, now 86, had the good fortune to be born into a prominent family in a small town. As autism’s Case 1, Triplett attained some notoriety and the support of the townspeople of Forest, MS, where everyone is his friend, and more importantly, his protector.

Others of that generation who today function in mainstream society are beneficiaries, like Triplett, of parents who refused to institutionalize them and instead demanded that they are treated like people.

That kind of compassion and understanding can alter the life of a person with autism, but it requires that neurotypical people rise above their basest instincts and find the best of their own humanity.

We have come a long way in science and in the general public in our understanding of autism and we have a long way to go. On both fronts, we have a responsibility to improve our knowledge so that the next generation of Jareds don’t have to endure the outrages he suffered. For the autism services industry, increasing community understanding of autism will be a continuing challenge going forward.

There have been many examples of community members or public officials reacting to with ignorance to people with autism – whether to a meltdown or a lack of communication – with disastrous results, even as disastrous as death. These represent the glass half empty side of the equation.

On the glass half full side, I detail in my book the story of author Russell Lehman, whose emotional outburst in response to flight delays at an airport drew a sympathetic response from an American Airlines ticket agent. Witnessing Lehmann’s tantrum, the agent comforted him and helped him calm himself, board the plane and reach his destination.

I look forward to the day when that is the norm and not a remarkable story worthy of inclusion in a book.