For years, autism therapy has forced healthcare purchasers into a false choice: expand access or control costs.
But as diagnoses in the U.S. have climbed to one in every 31 children, demand for care has outpaced the supply of Board Certified Behavior Analysts (BCBAs), the profession’s most highly trained clinicians. Providers are responding by prescribing more therapy hours delivered by larger teams of lesser-trained clinicians, while payors continue to reimburse them for every additional hour.
The spiral resulting from this fee-for-service-based system is unsustainable. State Medicaid spending on autism therapy has more than tripled—from roughly $660 million in 2019 to $2.2 billion in 2023—and purchasers are actively questioning whether higher utilization is producing better outcomes for children. Recent scrutiny of overbilling has only intensified those concerns.
Fortunately, new technology is opening the door to an alternative. Virtual care, artificial intelligence, and a growing body of published outcomes research are fundamentally changing what autism providers can deliver and what healthcare purchasers should reasonably expect in return. For the first time, technology has made outcomes-based autism care practical at scale.
Virtual Care Changes More Than Access
Virtual care is often minimized as a convenience for families. But in practice, it shifts the entire economics of autism therapy.
Historically, providers have had to recruit clinicians willing to live near centralized clinics while families traveled long distances to receive care. That approach makes little sense in a field where roughly half of U.S. counties have no BCBA.
Virtual delivery removes geography from both sides of the equation. Providers can recruit experienced clinicians wherever they live and then connect them directly with families regardless of location.
Instead of the traditional in-person model, which asks a limited number of Master’s- and PhD-trained BCBAs to supervise large teams of high school graduates with a certification, virtual organizations can now build models around direct clinical care delivered by the industry’s most experienced professionals.
Families gain faster access to BCBAs and greater flexibility. Providers can make better use of scarce clinical talent. Purchasers can unlock a model capable of both scaling access and improving efficiency.
Critically, emerging evidence increasingly supports this approach. Multiple published studies suggest clinical progress can be achieved with fewer therapy hours than have traditionally been prescribed. More recently, new peer-reviewed research evaluating a fully virtual, BCBA-led model found clinically meaningful improvements in adaptive functioning among participants receiving an average of just 2.6 hours of therapy per week.
That is an enormous change from traditional therapy, in which providers routinely rely on 30-40 hours of therapy per week. Virtual models make it difficult to argue that more hours produce inherently better care.
AI Makes Every Clinical Hour More Valuable
The conversation around AI in healthcare often centers on efficiency. While reducing administrative burdens is important, autism therapy presents an even more compelling opportunity for AI.
Every child learns differently. Effective therapy has always depended on meeting children where they are, adapting to their interests, and evolving as new skills develop. AI gives clinicians the ability to personalize therapy at a scale that is difficult to achieve manually.
That level of personalization makes every clinical hour more effective. Therapy plans can evolve in real time as children progress and caregiver coaching becomes more individualized. Teaching materials can be tailored to a child’s interests in seconds. For example, if a child loves Paw Patrol, AI can re-skin an entire session’s materials around that theme at the press of a button.
Of course, AI can also give clinicians even more time to work directly with children and coach families.
Automating documentation, streamlining treatment planning, and assisting with clinical workflows allow experienced clinicians to spend more of their hours where they create the greatest value.
Technology Makes Outcomes-Based Contracts Practical
This combination of virtual care, AI, and emerging outcomes research frees healthcare purchasers to move past traditional fee-for-service reimbursement models. By improving access to experienced clinicians, magnifying the impact of clinical hours, and facilitating measurement, it makes it possible to reward something much more meaningful: patient progress.
This opens the door for healthcare purchasers to change the type of care they will pay for.
Rather than rewarding therapy hours alone, the next generation of contracts can demand functional progress, reduced incidence of high-cost crisis services, stronger caregiver capability, and faster movement toward greater independence. The result of technology that enables measurable progress will be care that is both accessible and cost-efficient.
Markets always optimize around incentives. In autism care, this new system means the providers who thrive will be those who help children make the most progress.
About Jeff Beck
Jeff Beck, LCSW, is the co-founder and CEO of AnswersNow, a digital health platform that provides virtual applied behavior analysis (ABA) therapy and support for families of children on the autism spectrum.
