How Behavioral Health Quality Performance Metrics Impact Patients with an Autism Diagnosis

In partnership with the Behavioral Health Center of Excellence, new standards of care provide peace of mind to patients with an autism diagnosis.
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According to the National Institute of Health, autism spectrum disorder (ASD) can be characterized by challenges communicating and interacting with others, as well as repetitive behaviors and restricted interests that may impact social engagement and relationships.

The Centers for Disease Control and Prevention (CDC) estimates that as many as 1 in 44 8-year-olds and an estimated 5 million adults have been diagnosed with autism spectrum disorder, which represents an increase of 18% in the last 2 years alone.

Each person with ASD presents unique experiences which can make finding effective care more difficult as it’s often personalized to an individual’s specific needs.

Understanding autism and the need for applied behavioral analysis

For individual’s with an autism diagnosis, finding the right care is important, but can be a challenge. Services dedicated to supporting autistic patients and their families is often highly specialized and the availability of professionals with the training and expertise required to assist the autism population may result in a gap in access to care. 

Applied Behavior Analysis (ABA) is the most well-researched and effective intervention that focuses on the unique experiences and challenges of individuals with ASD. Applied Behavior Analysis emphasizes interventions that are tailored to the individual strengths and needs of each person. Structured and personalized approaches assist in understanding and reducing interfering behaviors, and developing and promoting socially significant and beneficial behaviors in valuable areas such as social skills, motor skills, play skills, leisure skills, and communication skills. 

To meet the increasing need of those impacted by ASD, the number of Board Certified Behavior Analysts (BCBAs), who are professionals that have participated in education and training to achieve formal certification to provide ABA therapy, has increased over 500% from 2011 to 2021.

As the rise of ABA providers has expanded availability, the growth has also emphasized the need to ensure the identification of performance standards and the delivery of quality services.

That is why the Behavioral Health Center of Excellence (BHCOE), in partnership with Evernorth, is looking to develop the first-of-its-kind quality performance metrics for ABA therapy.

Establishing clear foundational metrics of quality and effectiveness for ABA services will help patients, caregivers, providers, and health plans better assess the overall standard of delivered care, increase access to providers with a focus on outcomes that align with evidenced-based practice and the national health care quality benchmarks in behavioral health, and more effectively and efficiently meet the needs of the autistic population.

How plan sponsors can use applied behavioral health analysis quality performance metrics

Creating quality standards of care can help individuals and families feel confident about the behavioral health provider they are working with, and the care that they are receiving, improving their overall satisfaction.

In addition to sound patient care, quality standards also give plan sponsors confidence about the in-network providers they are offering to their members.

An autism diagnosis brings many questions of the future. Through development of standards with trusted partners, plan sponsors and the health care industry can ensure that the quality of care an individual receives is never in question.

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Evernorth Behavioral Health
Evernorth’s data-informed approach to behavioral health provides personalized and customized care across the entire continuum for the populations we serve. These solutions predict emerging health needs, close gaps in care, and drive cost savings—all while empowering whole-person and whole family health.

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