The benefits of connected home health care have advanced beyond physical and long-term personal care, with behavioral analysis services now being rolled out in states across the nation.
A panel moderated by Tellus’ SVP of Operations Michelle McCandless and presented by Matt Serel, EVP of Therapy Brands, and Vicki Ducworth, Senior Vice President of Government Operations, at eQHealth discussed the roll out and applications of Electronic Visit Verication (EVV) for behavioral analysis June 13 at Tellus’ 2nd annual EVV national forum.
“In the behavior analysis space, ABA is at least the most widely used clinical-proven service, and in the last ten years we went from having three or four states mandate coverage to 49 states,” said Serel.
Serel noted that what makes Applied Behavioral Analysis (ABA) different from other behavioral services such as psychotherapy is 20 to 40 hours of services are prescribed per week, rather than the typical one or two hours for a year or longer.
“Now, all of sudden, you have unbelievable access to care with these state [Cures Act] mandates,” Serel said. “We’ve gone from a field where no one was receiving care to where everyone is receiving care.”
Serel noted that’s resulted in a huge balloon in spending, and many new providers without experience in the field opening up businesses due to the demand. That’s created an environment of ambiguity and the potential for fraud and abuse in a space that hasn’t been regulated over time.
“We’re seeing people coming to us looking for what EVV offers,” said Serel, “often to ensure they can remain in compliance as they are facing more regulatory scrutiny.”
The adoption rate for large providers is in the 80 to 90 percent range, but these are individual EVV solutions, not state solutions with an aggregator. He’s also seeing a huge increase in providers starting their own businesses looking for practice management solutions that implement EVV “because they want to get started right.”
ABA is defined by the Autism Speaks website as a therapy based on the science of learning and behavior applied to real situations with positive reinforcement, with the goal to increase helpful behaviors and decrease those behaviors that are harmful or affect learning.
Therapists have used ABA to help children with autism and related developmental disorders since the 1960s, according to Autism Speaks.
Treatment programs can be performed in the home, as well as in schools or the community, fueling the popularity of EVV for ABA delivery.
eQHealth’s Ducworth, who has a child with autism, said she sees a lot of misinformation being communicated in the private community relative to EVV for ABA, particularly when it comes to monitoring,
“We have to get away from words like ‘Big Brother’ is watching,” she said.
There are two models for ABA treatment delivery: in home and clinic services, according to Serel, adding that EVV is more applicable in the in-home service since it’s similar to home care.
One of the challenges around behavioral therapy, besides the fact that it is broad-based, is that it’s a really expensive service, he added.
McCandless said Tellus is excited about the opportunity to work as the state-level aggregator for the state of Florida as one of the first programs to roll out EVV for behavioral analysis services starting in September. Colorado is not far behind, she noted.
All stakeholders, including technology providers need to be at the table to ensure the future of EVV and behavioral therapy, Serel opined.
“With proper communication, there can be common ground that’s found between all parties to make a successful roll-out that benefits everyone. I think EVV is a great thing for this field, it offers transparency that we don’t always have,” Serel said.
That transparency applies to both good actors and bad actors, he added, ensuring the most dollars are spent in the right place.
Ducworth suggested more CMS oversight related to ABA delivery with independent entity evaluation to bring relevant subject matter experts to the table and prevent miseducation about the highly charged subject matter.
“Behavioral health is too politicized,” she said.