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UrduThe company’s Medical Necessity Assessment (MNA) analytic provides an objective standard to help practitioners of ABA therapy as they build individualized treatment plans. ABA has been proven to be highly effective for children with autism and related developmental disorders. While ABA emerged as a promising treatment for autism in the late 1980’s, it is only within the past decade that health plans have been required to cover the cost of treatment. As a result, there are additional demands on practitioners to demonstrate a medical need for the treatment and prescribe a specific level of intervention. Until now, the Board Certified Behavior Analysts (BCBAs) who deliver this therapy have had few resources to provide guidance in deciding how many hours or sessions of ABA an individual patient should receive.
This lack of standardization may lead to under-or over-prescription of treatment hours, which can negatively impact outcomes for children. Standardizing the process for prescribing treatment hours can make health insurers more likely to approve treatment plans for reimbursement, and ensure that more patients are receiving a clinically appropriate level of care.
As a comprehensive electronic medical record and practice management platform solution to 600+ behavioral practice groups across the United States, Rethink became aware of the need for an evidence-based standard.
“There has never been a standard protocol available for determining how many hours of care should be delivered to a child based on their specific needs,” said Jamie Pagliaro, executive vice president and chief learning officer for Rethink Behavioral Health. “We designed an evidence-based assessment that may help reduce friction between providers and health plans, ensuring more children receive clinically appropriate levels of care.”
Developed with an expert panel and tested in more than 6,000 individual patient assessments with providers nationwide, the MNA solution allows a BCBA to plug in diagnostic factors for an individual patient, then synthesizes that input with supporting evidence and research, to produce a suggested dosage range of treatment hours based on evidence.
In tests, clinicians agreed with Rethink’s MNA solution recommendations 70% of the time. Most instances of disagreement were due to functional issues, such as scheduling or transportation availability for families.
“Our clinicians really do like it. It balances them and helps keep emotions and bias from affecting the amount of services we are prescribing to a client on initial and reassessment,” said Karin Torsiello, president of Behavior Basics, a Florida-based provider.
Insurers have indicated to Rethink that they are receptive to the MNA solution and are eager to continue to work with Rethink and providers to ensure children with autism are getting clinically appropriate levels of care.
About Rethink Behavioral Health
Rethink Behavioral Health offers all-in-one, technology-based solutions to behavioral health practitioners, including video-based RBT training, ABA data collection tools and practice management solutions to meet market demands. It is a division of Rethink First, a global health technology company providing cloud-based treatment tools, training and clinical support to schools, employers, behavioral health professionals and payers. Rethink serves thousands of clients globally, including more than 25 of the Fortune 100 and many of the country’s largest public school systems and health plans. Rethink’s SaaS solutions are powered by proprietary, clinically validated content and best practices overseen by a renowned Scientific Advisory Board and include more than 2,000 evidenced-based training modules, extensive Social and Emotional Learning content and ground-breaking neurodiversity and inclusion training and education tools. Rethink is owned by K1 Capital, one of the premier private equity firms focused on high-growth, enterprise software solutions.
