How The Business of ABA Changed in 2023

Updated on October 12, 2023

Within the dynamic world of healthcare, the landscape of Applied Behavioral Analysis (ABA) therapy and comprehensive autism care is undertaking a transformative journey. A mix of supply and demand inequality, market evolutions, and overarching shifts in healthcare accelerated this change. 

The sector has been busy with telehealth emerging as a dominant force and intense discussions around Medicaid reimbursements. Even industry giants like Invo Healthcare and CARD have faced recent unfavorable hurdles, and it’s evident that care for those with autism spectrum disorder (ASD) is undergoing a significant reshaping. 

Ground Zero: The Clinicians

Amidst these macro changes, it’s imperative to recognize the individual challenges those at the heart of the industry face. The clinician’s role, while rewarding, isn’t devoid of hardships. A staggering 72% of ABA clinicians have voiced their experience with burnout

This statistic is a stark reminder of their multi-layered pressures, from coping with varying patient outcomes and circumnavigating communication barriers to managing the often overwhelming administrative responsibilities. 

The rapid integration of telehealth, driven by necessity during the pandemic, rising autism diagnoses, and now by industry momentum, has further restructured clinicians’ interactions with patients.

Rising Demand for Services

Autism services are grappling with an unparalleled surge in demand, with ASD diagnosis rates escalating from 1 in 69 children in 2012 to 1 in 36 by 2023. This increase has unearthed a pronounced staffing crisis; as of 2019, most states (49 out of 50) fell short of maintaining the requisite number of certified Applied Behavior Analysis (ABA) providers. 

This shortage is predominantly rooted in two interconnected issues. First, there is an evident scarcity of qualified clinicians in the field, compelling companies to invest in extensive internal training programs. Second, the rapid expansion drives led by the private equity sector, seeking to harness this growing demand, ran into stumbling blocks, including local employment market realities and restrictive reimbursements.

The Growth of Telehealth Provisions

The meteoric rise of telehealth, accelerated by the pandemic’s needs, has revolutionized our understanding of healthcare. Instead of imagining a future with virtual check-ups and remote diagnostics, we’re living it. 

Technological advancements, like virtual reality, are being eyed as potential solutions to scale services, and companies are unveiling initiatives, such as educational reimbursements, to bolster workforce retention. However, as these shifts occur, ABA, the primary autism treatment, is undergoing rigorous scrutiny

Detractors argue some ABA methods might be coercive and may not fully respect neurodiversity, highlighting an urgent call for more ethical, inclusive service delivery. In light of these challenges, industry experts anticipate a collaborative phase ahead, with stakeholders ranging from providers to regulators working as a team. 

There’s a collective vision of innovative care models, a sharper focus on comprehensive patient outcomes, and the adoption of value-based payment models.

While technologically advanced approaches to autism care bring the promise of accessibility and flexibility, it also introduces a set of unique challenges. Clinicians must maintain the same level of engagement and trust through a digital screen, adapting their techniques to this format. 

Moreover, the administrative side of telehealth, especially with the critical need for accurate medical coding in this virtual realm, adds another layer of responsibility to their role.

Ensuring Precision Telehealth’s Medical Billing

While offering unprecedented conveniences, the digital shift to telehealth also beckons new complexities, especially in the intricate medical billing and coding world.

In the good old days of traditional healthcare, things were relatively straightforward. A face-to-face consultation, a physical examination, perhaps some tests — and then a bill that largely followed familiar protocols. But now, with telehealth, we’re navigating uncharted waters.

Missteps in digital billing aren’t just about a mismatched number on an invoice. They could lead to legal complications, reputational damage, and a dent in the ever-so-important patient-provider trust relationship. In an environment where telehealth is keen to solidify its reputation as a reliable and efficient healthcare medium, there’s a pressing need to get things right, especially behind the scenes.

Billing entities have quickly become key players in telehealth delivery. They’ve recognized the unique challenges telehealth brings and are laser-focused on ensuring billing accuracy that mirrors the exact nature of the services rendered and bolstering the integrity of the telehealth ecosystem. 

The collaboration between telehealth platforms and specialized billing solution providers is anticipated to grow stronger as time progresses.

Investment Trends in Autism Therapy

When discussing the ever-evolving realm of autism therapy, notably Applied Behavioral Analysis (ABA), it’s impossible to overlook the increasing investor interest. Drawing parallels from historical growth patterns akin to those witnessed in areas like home health, it’s evident that the ABA sector is on an upward trajectory. 

Recent insights from The Braff Group echo this sentiment, hinting at a bright future. However, this expanding market presents its own unique difficulties for businesses to overcome.

Tracing back through this industry’s journey, the early years of this century marked significant milestones in the coverage of autism services. Tireless grassroots campaigns eventually led to the inclusion of autism services in health insurance policies. This shift was monumental but also came with its share of complexities. The increased funding and the resulting attention it garnered meant that the sector, which was once predominantly focused on care, began witnessing a rush of profit-driven endeavors, especially from the corridors of Wall Street.

While promising on paper, the influx of investment into the ABA sector brings with it the pressures of scalability and efficiency. Clinicians often find themselves in rapidly growing environments, and with growth comes the challenge of maintaining service quality. Investors and private equity firms, with their eyes on returns, might push for operational efficiencies that inadvertently increase the workload on clinicians, demanding more of their time and emotional resources.

Furthermore, the emphasis on value-based care and accurate medical coding signifies that clinicians’ services are now evaluated and billed based on outcomes rather than just consultations. While beneficial in driving quality, this outcome-based approach also places the onus on clinicians to ensure that their interventions yield measurable results. In essence, their performance directly impacts the organization’s bottom line.

Invo Healthcare and CARD: The Experience of Industry Heavyweights 

The intricate dance of the ABA industry in recent times has been profoundly shaped by the journeys of two notable entities: Invo Healthcare, one of the country’s leading behavioral health service providers, and CARD, an autism research, advocacy, training, and services organization. 

The ups and downs they’ve encountered over the previous 12 months illuminate the industry’s barometers as a whole.

Invo Healthcare

Invo Healthcare’s decision to close multiple ABA subsidiaries emerged from an intricate blend of market challenges and a vision for the future. Subsidiaries like Autism Home Support Services, ABA2Day Behavior Services, and Xcite Steps found themselves at the heart of this change, significantly impacting over 983 professionals. Behind this decision were layers of complexities – from mastering the rapidly evolving world of telehealth to ensuring accurate medical billing.  By zeroing in on school-based behavioral health services, including ABA, they’re returning to their roots. 


The year was a rollercoaster for CARD. After being acquired by Blackstone, their challenge was balancing swift expansion with quality care. The pressures of limited pay for therapists and the pandemic put CARD on uncertain terrain, leading to financial strategies like borrowing and shutting down centers. However, 2023 marked a turning point. Faced with a Chapter 11 bankruptcy, CARD’s founder, Doreen Granpeesheh, joined by Sangam Pant, showcased a resolute aim to revitalize the organization and bring it back to its core values.

Both Invo and CARD’s experiences underline a pivotal lesson in the ABA sector: marrying business aspirations with consistent quality care is vital. Their journeys highlight the transformation within the ABA world, emphasizing the need for growth that genuinely makes a difference.

The move towards value-based care in autism therapy marks a significant stride forward, albeit with its unique challenges. Amidst the vast transformations the ABA industry has experienced, remember that the heart of this sector – the clinicians and patients – remains its driving force. 

As technology evolves with the rapid integration of telehealth and investment interests peak, the bedrock of quality care, accurate medical coding, and clinician well-being must remain paramount. 

The challenges are evident, but so is the collective dedication of the community. This dedication, coupled with innovative strategies and unwavering commitment, will shape the future of autism care.

Vladimir Kogan
Vladimir Kogan
Vladimir Kogan is the CEO of Nevada Autism Center.