Autism therapy providers with a strong working relationship with their payer partners are best positioned for success in 2026 and beyond. And those that don’t better start building fast.
Robust payer relations will become all the more vital as health plans reassess their management and spending on autism therapy benefits, especially Medicaid plans. While the tactics vary, industry insiders say the practice is time-intensive yet essential to having even the hope of meaningful engagement with health plans.
“You have to put yourself in a position to be in a position to negotiate,” Rick Loewenstein, CEO of TeamGame Advisors, said during a panel discussion at the Autism Investor Summit East conference. “If you don’t even put yourself in that position, you’re never going to have an opportunity.”
Loewenstein and the other panelists emphasized that establishing working relationships comes with the understanding that it will be hard, time-consuming and will require organizations to make compelling, data-based cases for why their organizations warrant additional consideration. It requires relentless engagement and conversations with several stakeholders within the organization.
It also requires providers to treat the engagement with the same kind of curiosity and empathy that serious personal relationships require. Michael Quinn, CEO and president of Independence, Missouri-based Autism Support Now, said during the panel that payer relations are akin to dating and marriage.
“It’s been a process for our organization over 18 months, where we’ve gone on multiple virtual and in-person dates,” Quinn said. “We’ve come to a point where we know what each party wants and needs. I think that’s the key to any successful relationship.”
Just as location is the most important part of real estate transactions, dialogue is the chief element of payer relations, Quinn said.
Behavioral Health BusinessMichael Quinn, CEO of Autism Support Now, discusses negotiation tactics with payers at the Autism Investor Summit East.
What actually moves the needs in talks?
Each panelist said it is essential to have two types of data about an autism therapy organization going into such conversations: business outputs and care outcomes.
The former includes measures of business success such as time to treatment, rate of parent training, approved hour utilization, patient/provider satisfaction scores, or turnover metrics. The latter assesses the impact of care on patients and the quality of the care provided.
The industry is still far from reaching a consensus on universal standards for assessing clinical outcomes across populations in autism therapy. Darren Sush, head of autism and psychology at Evernorth, said that the industry is still at the point where tracking operational and clinical data at all is hit-or-miss, let alone having that data accessible for negotiations or strategic planning.
“So just taking that information and putting it into a tangible, digestible format is already a leg up in entering those conversations when you’re trying to build a relationship with a funder,” Sush said.
It also helps to put data in front of the plan’s CEO, Loewenstein said.
Behavioral Health BusinessRick Loewenstein, CEO of TeamGame Advisors, discussing payer relations strategies in the autism therapy industry.
“It’s best to include them in these types of conversations because it becomes increasingly impactful when that occurs,” he added.
For Quinn, the essential data to bring to a conversation with a payer are the total cost to provide an hour of care, what that hour of care is reimbursed for, and statistically significant clinical outcome data. Outcomes data show that the service is worthwhile to plan members; the economic data highlights the viability and potential stakes of a continued relationship with the payer.
“We say to the payers, ‘Would you buy a home you can’t afford?’ And they’ll say, ‘Well, why are you asking that?’ Well, we’re asking that because we cannot continue to afford rendering services for your beneficiaries if the economics don’t work,” Quinn said.
When to walk away
Quinn highlighted using the prospect of ending payer contracts that don’t provide a satisfactory rate in payer negotiations, noting the unaffordable house comparison. But also tying this back to dating, such a serious development similarly requires a meaningful process to get to that point: “There has to be that conversation — that doesn’t happen on the first date. It happens when we’re dating for a period of time.”
Quinn noted, as he has previously, that the company has found success by putting contract cancellation on the table, even going so far as to issue a dated termination notice. According to Loewenstein, resorting to dramatic tactics should be the final option.
Behavioral Health BusinessDarren Sush, center, speaks during a panel chat at the Autism Investor Summit East about payer-provider relations.
“I would not do that until there is no other solution. There’s a lot of middle ground. It might be a little bit of a give and take on rates,” Loewenstein said. “You may not get an increase this year, but you’ll be in the primary position for next year.
“That’s a great place to be.”
Even if a payer is not actively assessing rates or its network, contacting with payers and networking with the health plan to identify potential internal advocates is a vital way to better understand what the health plans want from clinical network participants, Sush said.
“The main thing is developing and maintaining that relationship,” Sush added. “Find that point person … and continue the conversation, even if it’s just communicating all the great things from the last quarter.”