Association for Behavior Analysis International

Value-based healthcare or value-based care (VBC) represents a healthcare delivery model where providers receive payment based on outcomes. With VBC agreements, providers in the healthcare space are preferentially rewarded and compensated for helping clients improve their health, decrease the incidence and effects of chronic disease, and live healthier lives with evidence-based approaches. When applied to behavior analysis, VBC means providers in the behavioral healthcare space will be preferentially rewarded and compensated for helping clients improve their behavioral outcomes, decrease the incidence of chronic challenging behaviors, and live more productive lives with evidence-based approaches derived from the science of behavior. VBC has not yet arrived in behavior analysis but when it does, it will fundamentally shift the relationship between service provision and reimbursement. Providers will achieve greater efficiencies by spending more time on new, prevention-based services, thus leading to a reduction with time devoted mainly to chronic challenging behavior. The following symposium will offer different presentations each approaching VBC and how it can impact behavior analysis.

BCBAs, BCBA-Ds, clinical directors

Value-based healthcare (VBC) will change the way behavior analysts provide care. New delivery models will stress a team-oriented approach to client care and the sharing of data with an emphasis on coordinated care and easily measured outcomes. The present study builds VBC by examining whether Precision Teaching (PT) would enhance the quality of care already demonstrated by behavior analysis (BA). The study examined the following: (1) Pinpointing behavior - using a standard framework for precisely labeling target behaviors; (2) Element-compound analysis - analyzing constituent behavioral elements for a behavioral compound and applying the analysis to existing curricula and other data targets; (3) Dimensional measurement - applying universal and absolute metrics that quantify behavioral measures; and (4) Standard visual display - implementing a graph that quantifies behavior change, maintains visual consistency from analyst to analyst, reduces interpretative errors, facilitates pattern recognition, and offers the most accurate model for present data. Decision making data comparing the two groups indicated a marked increase in decisions made in the BA + PT group. Furthermore, when examined outcome measures for the BA + PT, the Vineland and Autism Treatment Evaluation Checklist showed substantial gains. Also, social validity scores also point to satisfaction with the experimental procedures of PT added to BA.

Value Based Healthcare (VBH) has been a model within the medical field for the past decade. Due to the complexities of measuring behavioral health outcomes, however, VBH is only now moving into the behavioral health field. Health Resource Services Administration is starting to connect behavioral health providers reimbursements to their ability to deliver quality services through an efficient treatment model. ABA providers will need to overcome idiosyncratic approaches to measuring outcomes in order to qualify for preferred reimbursement within the expanding VBH model. This paper will review outcome data from an ABA treatment model using a precision measurement system aimed at accelerate client outcomes. This model includes training RBTs to make data-based decisions, teaching foundational skills to fluency to ensure skills are retained and generalized, and by implementing an instructional curriculum that allows for new skills to be learned without direct training. Finally, discussion will include how insurance companies have responded to our approach to solve the VBH application to ABA services for children with ASD.

As downward payor pressure affecting reimbursement rates and hours continues to build, behavior analysts must precisely and objectively quantify value delivered as a function of time invested. Behavior analysts have at their disposal varying degrees and dimensions of clinical data with which to describe value. These include but are not limited to the number of learning opportunities, goals attained, decisions made, percent growth per pinpointed skill or percent reduction in targeted maladaptive behaviors, change in variance over time, a projected time window of when goals may be met, percent of skills that return to maintenance or intervention post mastery, and how well skills have generalized into the home, school, and community environments. Access to and inclusion of the aforementioned methods of describing value per function of time varies based on three facets of clinical service delivery: 1) the sophistication of the clinical service delivery model including supervisorial rigor; 2) the tooling deployed to assist the clinician in the collection and analysis of data; and 3) the educational and experiential histories of the clinician and supporting care team. This presentation will explore how present day and near-term future technologies may assist in each of the three facets to automate, standardize, and reliably document, analyze, and communicate value in a multidimensional quantitative model.