Centria Autism reposted this
Chief Clinical Officer @ Centria Healthcare | I foster an environment of clinical excellence through leadership and systems development
Every BCBA knows that when it comes to delivering quality care, hours alone don’t equal impact. To have the best possible impact, organizations need to go beyond simply logging hours with their clients and instead focus on the clear and measurable outcomes they’re achieving across the course of treatment and within each session. To do that, our industry needs to pivot away from hours-based insurance payouts to milestone-based insurance payouts. Currently, ABA providers get paid a fee for every hour of service provided to a client. By shifting to a value-based payment program, providers could get paid that fee plus an at risk incentive when they achieve certain positive outcomes with their clients. The challenge, no one can agree on what those outcomes are. Some insurance companies are continuing to talk about progress metrics as part of the program, and fail to get to clearly defined functional outcomes for clients. And, I’m concerned that if we don’t get this right, it will lead to a further fragmented industry. At Centria Autism, we’re in the process of shifting toward this kind of value-based program. To support that effort, we’ve developed a tool called the “Emerging Independence Index,” which identifies a range of milestones across 4 sectors: communication, socialization, adaptive living skills, and interfering behavior. We are in the beginning stages of rolling this out organization-wide. This index measures our clients’ trajectory on a scale of increasing autonomy and independence as it relates to quality of life. It helps us routinely measure our clients’ progress across these 4 sectors and ensure that, month over month, our patients move toward increased independence and overall enjoyment of life. It’s going to allow us plant our flag in key objectives we want all of our clients to functionally achieve. Rather than focusing on hours spent with clients, our BCBAs will instead hold the quality of care against this scale as their main objective - and Centria itself will benefit based on how well we meet these objectives. Our ultimate goal is to make sure all of our clients’ progress towards autonomy and independence. By focusing on impact as opposed to hours, we can do a better job of achieving that outcome and maximizing our clients’ continued progress over time.
Controversial opinion here, but I feel that my clients' progress is put under microscope at each reauth. Every graph is looked at, all regressions must be explained, everything needs to justified. This post/comments make it sound like we get our hours and do whatever we want. We collect data for a reason - to keep track of progress/ and make changes within an appropriate time frame. Sometimes it seems like admin feels the need to put down bcbas work to justify their existence and give them a job to do of "correcting us". In no other field are clinicians required to provide as much justification and data as we do. Also,creating progress metrics assumes that all children can progress at the same pace which is just not the case. Clients with dual diagnosis, clients who are profoundly autistic vs HFA....this opens the door to unfair expectations and comparisons which don't really feel necessary as a clinician. We go into the field every day, we do our jobs in good faith and try our best. When will everyone start trusting us and stop minimizing our own ability to be ethical and competent.
Metrics and fee for accomplishing them are SO needed in our industry for sure.
Agreed! Glad to hear insurance companies are looking at impact. ABA has for many years got away with little accountability. I think we need to also separate ABA from hours that look more like respite. Many clients and their families need daily, trained, care, but it's more like respite than ABA. This needs to be acknowledged and addressed. It could greatly reduce cost, and put more focus on the ABA portion of care.
Axioms....an axiomatic not a dogmatic business....Skinner gave us the words radical behaviourism and selection by consequences...he wasn't a 'wasp'...he was friends with nature loving 'frost' the man had anamnesis just not the best way with 'para(ver)bles'. Your post describes a wonderful idea...i think it needs to be adopted by ALL professionals who work with intellectual disability/disabilities etc...and peace and joy are worth measuring.
Impact vs hours, love that
Just a question, that may have been asked already but I didn’t read all the comments first so I apologize if it’s a repeat. How does this translate to keeping programs and goals individualized and not just teaching skills to a test. We want to keep people away from writing PEAK specific goals or VB MAPP specific goals and teach a skill. I can see where many goals become these target points and does that really translate to a learned skill/behavior etc?
I cannot agree with this more, children’s outcomes and hours attended are not the same at all, and should never be used as a sole measure of success! I am very interested in the index you are developing, will you and Hilary be in Utica in a couple of weeks?
Logan Rice
1w
We are MORE than a billable hour!
Accelerating Results Through the Performance of People
1wIf we apply Skinner’s behavior science, and what he considered his most important contribution, rate of response, or behavior, frequency, then we can objectively define for virtually any skill what it means to be competent or skilled. Precision teaching uses such ranges of behavior frequency in short timed intervals, as is used in progress, monitoring,to define aims, and works to enable students to achieve those competent levels of performance. It’s hard to move a whole organization towards standard, natural science measurement. But in the end, following Johnston and Pennypacker’s strategies and tactics book, I think the field will need to adopt rate of response if we want objective, scientifically determined measures of capability.