April is Autism Awareness Month, a national observance to bring recognition and information about autism to the forefront.
At Beacon, we’re committed to changing the way people live with–and think about–autism. While there’s no known specific cause or cure for autism, with the right treatment, children with autism spectrum disorder (ASD) can make significant behavioral and functional improvements and thrive at school, home, and in their communities. Here’s how Beacon is helping kids do just that, and creating new opportunities for meaningful health care.
Autism’s prevalence and associated costs have made it a major concern for parents, educators, providers, employers, health plans, and legislators alike. Today, the CDC estimates that 1 in 68 U.S. children has an autism spectrum disorder (ASD).
In addition to the personal impact autism has on children and families, ASD can also take a significant economic toll, particularly on working families: for children with ASD, the greatest associated cost factors are special education services and loss of parental productivity. Mothers of children with ASD actually earn an average of 35% less than mothers of children with other health conditions, and 56% less than mothers of children with no health concerns. Health care costs associated with ASD are also $3,020 higher, while aggregate non-health care costs are $14,061 higher, including $8,610 higher school costs.
With its prevalence and associated costs, autism is becoming an increasing priority in health care: presently, 46 states and the District of Columbia mandate coverage for autism services, while Medicaid is now the single largest payer of health care for children with autism, covering up to 45% of U.S. children with ASD. More employers are also providing coverage for ASD; in fact, half of Beacon’s employer clients now offer autism benefits, along with seven of the top 10 Fortune 500 companies (you can explore a list of some of the many major employers that provide benefits here).
What Beacon is Doing
Care for Autism Spectrum Disorder
Beacon administers ASD services and benefits on behalf of health plans, employers and other purchasers of ASD services under a coordinated model of care. Research indicates that early and sustained intervention programs offer the best hope for achieving improvement in behaviors associated with ASD, and Applied Behavior Analysis (ABA) is widely recognized as the most effective behavioral intervention for children with autism. Delivered by qualified autism service professionals, ABA is a customized step-by-step approach that increases useful behaviors and reduce those that may cause harm or interfere with learning.
Beacon’s ABA management results in better outcomes for children with an ASD diagnosis. In California where we’ve managed autism benefits since 2012, Beacon conducted an in-depth clinical data analysis of our active cases across four commercially insured health plans, with group data analyzed by an independent medical statistician. The findings showed:
- Treatment time is usually shorter than generally expected. Our experience shows that children in active ABA treatment have an average episode length of 14 months.
- Care is often less costly than anticipated. The average cost per case across our California study was $19,000 to $20,000, compared to the CDC’s report that “intensive behavioral interventions for children with ASD cost $40,000 to $60,000 per child per year.”
- Treatment can be effective without being time-intensive. To achieve meaningful results, 15 to 40 hours of ABA services are typically required per week—the average service utilization in California was 14 hours per week.
- Kids with autism can get better. Kids showed significant improvements in 14 different skillsets, including language/communication, social skills, toileting, math, and routine schedule. They also showed significant reductions in seven critical types of maladaptive behaviors, including aggression, tantrum, self-injury, and non-compliance.
Care for Families
In addition to providing meaningful treatment for children with autism, families also require unique support. An autism diagnosis can be overwhelming, and parents and caregivers often experience a significant financial and emotional impact. According to the National Business Group on Health and the American Academy of Pediatrics:
- 50% of families report the need to stop or reduce work
- 33% experience financial burdens related to ASD health care costs
- 46% of parents need more help or information managing emotional and physical stress
- 40% need more help or information balancing work/family responsibilities
In response, Beacon created Autism Family Support–services that provide meaningful support and valuable resources to help families understand the ASD diagnosis and treatment options, and become better advocates on behalf of their child. Some of the specific features of the program include a telephonic assessment to evaluate the family’s short- and long-term needs; coping strategies based on the family’s unique dynamic; and connections to valuable resources and supports, including community programs and local events, support groups, educational information, and financial and legal resources. We also coordinate parent trainings with the child to teach new responses to targeted behaviors, as well as parent-only training to enhance learning and understanding of caretaker’s role in the treatment process.
Better Partnerships for Better Care
Strong provider and professional partnerships are a key component of what makes Beacon’s autism services so effective. In addition to direct services for the child, Beacon’s ABA model includes coordination with speech, occupational, and physical therapists, primary care providers, and mental health clinicians. We’re also continuing our aggressive network development and credentialing efforts to meet needs in local markets: in 2017, we doubled our ABA provider network capacity with more than 2,700 participating BCBAs, behavioral therapists, and other providers with ABA specialty.
Beacon also earned the prestigious designation of Approved Continuing Education Provider of Type 2 continuing education hours. Granted by the national Behavior Analyst Certification Board, this designation enables us to offer specialized clinical training and continuing education hours to both internal staff and contracted providers practicing ABA. Beacon is the only managed care organization to provide this important service to ABA professionals.
Why Cover Autism?
Providing meaningful autism treatment coverage goes a long way in helping children with ASD and their families–and it also makes good business sense. A comprehensive benefit portfolio also helps businesses stay competitive by retaining skilled workers and attracting new ones. With the peace of mind that treatment is covered, working parents can be more productive and limit costly work absences, while children who achieve a higher level of functioning typically have lower overall health care costs.
In addition to commercial autism services, there’s opportunity to deliver effective autism services within the unique delivery system of Medicaid, where many children with autism already receive their health care services. In Connecticut where Beacon administers services as part of the Connecticut Behavioral Health Partnership (CT BHP), we began managing ASD benefits for Medicaid beneficiaries in January 2015 following the state’s mandate for insurance coverage. You can learn more about our program and even watch a powerful video about our services in action.
Sources and Additional Resources:
Autism Spectrum Disorders – Center for Workplace Mental Health