CVS Health’s (NYSE: CVS) payer arm, Aetna, plans to create a preferred autism therapy provider network that may make a debut in 2026.
Aetna first announced plans to “steer” patients to providers with strong outcomes and appropriate billings in a Wall Street Journal article.
A representative of CVS Health (NYSE: CVS) confirmed the development of this preferred network to Behavioral Health Business.
“We would like to work with academic groups to establish industry standards of best practices around providing autism care, and we intend to curate a network of providers whose practices align with those standards,” the spokesperson said.
Providers that are able to demonstrate positive outcomes and high industry standards may be rewarded.
In the fee-for-services-dominated industry, organizations do not get a financial incentive to go beyond maximizing billable hours. Attempts to change financial incentives of the autism therapy industry have been few and far between. Some have turned to value-based care and similar models. About three years ago, Kyo Autism Therapy established a value-based care agreement with Magellan Health that included capitated payments and a directive to reduce hours when the patient shows improvements as assessed by standardized outcome measures.
The autism therapy industry is still fairly nascent. Payers are engaged with the federal government to potentially create some basic standards. The Association for Behavioral Health and Wellness (ABHW) has proposed to the federal government that it establish therapy-supervision ratios, a national credentialing standard and standardized clinical and quality standards.
“It may need to be a phased-in approach over a few years, because it’s possible that there could be certain geographies where too few providers currently meet whatever standards are ultimately established,” the CVS Health spokesperson said. “In cases like that, we will work with those providers to help them adopt these clinical best practices.”