One Behavioral Provider’s Decision to Co-Develop Technology
The Philadelphia-based Acclaim Autism is a provider organization that works with families impacted by autism, helping individuals on the autism spectrum to live their best lives. As the organization’s website explains it, “Acclaim Autism provides high-quality, scientifically-driven, evidence-based at-home applied behavioral analysis (ABA) therapy services for autism to children impacted by Autism Spectrum Disorder (ASD) and their families. Hyperfocus on a positive outcome for kids is central to everything we do. We only hire the best therapists and provide industry-leading training. With a strong employee focus on training and development, we consistently provide the best therapy. Our area of expertise is kids up to age 21. Family training and support is also offered. Services are provided in patients’ homes, schools, and community settings.”
But, like all behavioral care providers, Acclaim Autism has faced technological and operational challenges, among them an overly complex landscape around patient and family intake. Per that, Acclaim Autism’s leaders were able to announce a breakthrough on Oct. 24. A press release published on that date by Acclaim Autism technology partner, the McLean, Va.-based Appian, began thus: “Appian today announced Acclaim Autism, a leading multi-state behavioral healthcare company based in Philadelphia, is using Appian’s private AI capabilities to simplify and accelerate its patient onboarding process. Acclaim Autism specializes in providing evidence-based therapy services to children with Autism Spectrum Disorder (ASD), offering care in homes, schools, and community settings. Acclaim Autism is committed to improving operational efficiency, particularly in its patient intake process. Appian and Appian's systems integration partner, Ignyte, are proud to support Acclaim Autism in this mission. The behavioral health industry faces unique challenges, including limited funding and complex patient intake processes. These obstacles often lead to long wait lists, with families experiencing delays of three to six months before receiving care. Acclaim Autism’s leadership recognized the need for an innovative solution to expedite their intake process, while ensuring compliance with strict data privacy policies and HIPAA regulations. This led them to partner with Appian and Ignyte to safely and compliantly implement generative AI in their existing document processing workflow.”
The leaders of Acclaim Autism, in a blogpost published to their website on Oct. 22, wrote that “Long wait times are a major challenge in autism care. According to a 2023 study by Kraft et al., nearly two-thirds of U.S. autism diagnostic centers have wait times longer than four months, with over 15 percent facing wait times of more than a year. While these wait times have improved over time, this creates significant delays in accessing early intervention, a critical period for maximizing developmental outcomes. Recognizing these issues, Acclaim Autism decided to innovate by leveraging technology to reduce wait times while ensuring the highest standards of accuracy and data security,” they wrote. “We partnered with Appian and systems integrator Ignyte to integrate Appian’s private AI into our onboarding process. Our goal was to simplify and accelerate the intake process while maintaining HIPAA compliance and safeguarding sensitive patient data. Appian’s AI solution automates the extraction of unstructured data from medical documents—such as autism diagnosis reports, DSM-5 codes, doctor’s notes, and more. This step is critical as it allows our team to process key patient information, including birth dates, diagnoses, and other details, without the manual burden of sifting through large amounts of text.”
Furthermore, the Acclaim Autism leaders noted the following improvements brought about by AI-enhanced onboarding:
Ø Accuracy: Achieving 95% accuracy in data extraction in early testing, the AI pulls out essential information like diagnosis details and medical notes, drastically reducing errors. Acclaim employees still review everything to ensure all data is accurate and up to date
Ø Speed: Patient wait times have decreased from 3-6 months to less than month. In some cases, services can begin in as little as 10 days.
Ø Efficiency: Automating the most time-consuming processes allows our staff to focus on higher-value tasks, such as personalizing treatment plans and engaging with families.
Ø Compliance: Appian’s AI ensures HIPAA compliance, safeguarding all patient information and adhering to strict privacy regulations throughout the intake process.
How does the technology work? The Acclaim Autism leaders note the following:
Ø Document Processing: The AI scans and extracts crucial details from diagnosis documents, doctor notes, and other medical records, minimizing the need for manual reviews.
Ø Verification: Information such as DSM-5 codes and patient demographics are automatically verified, ensuring accuracy before the patient file is submitted to our clinical team.
Ø Compliance Checks: The system ensures that all records meet HIPAA and other privacy standards, reducing the risk of human error in data handling.
Ø This streamlined process speeds up every step, from initial inquiries to final approval, allowing families to access care much faster than ever before. By utilizing this advanced technology, we maintain the highest standards of accuracy and compassion in everything we do.
Per all this, Healthcare Innovation Editor-in-Chief recently spoke with Ryan Cox, Acclaim Autism’s vice president/COO and co-founder, about this landscape of challenge and opportunity in the behavioral care sphere. Below are excerpts from that interview.
Tell me about how your organization operates.
We’re a provider organization. We provide autism services for children with autism. We were founded in 2019 in Philadelphia, and that is our headquarters. Besides Pennsylvania, we are now also operating in Delaware, New Jersey, and California, and will be expanding further next year. We started providing services because of the trajectory of the COVID-19 pandemic, in 2021. The company was founded in 2019, and our first services were offered in March 2021, and since then, we’ve grown fairly rapidly. It’s an asymmetric field right now; there just aren’t enough services available nationwide. We now have more than 150 employees; and we are among the minority of provider organizations that have developed our own technology.
In 2023, we partnered with Appian. The landscape around all of this is that wait lists for care were incredibly long in our field. And we also faced challenges in terms of customer service quality and showing empathy towards our clients, as well as the need to reduce paperwork and to processes that used to be done through emails and phone calls. There is no equivalent in behavioral health to the giant electronic health record vendors in the physical health sector; it’s very fragmented in behavioral health. So we have to rely on a lot of things outside of those systems. So we started focusing on intake software. One consideration was patient and family privacy, and Appian’s tool incorporates privacy, so we can be certain that we’re not disclosing information or feeding a large language model outside of our organization. And that’s where we started in terms of this journey. We’re now building automation in other areas; in fact, we’re in the early stages of a very large tech transformation that we’ve just begun and that will continue through at least the second quarter of next year.
How many individuals do you serve a year?
We serve about 175 families right now. It’s quite intensive; the employee-to-client ratio is about 1 to 1. We use the term “client,” referring to the family; because it’s not just one child getting services; the whole family is getting services. So we refer to that entire entity as the client, rather than the patient. We’re roughly doubling every year. And we’ve done all of this without outside private equity investment.
What kinds of professionals provide services to clients?
It’s primarily a board-certified behavioral analyst (master’s or doctor’s level) who provides clinical; that’s the primary credential. We also employe registered behavioral technicians. It can involve 15-40 hours a week per child. We also employ licensed clinical social workers; for the diagnosis, it’s usually a psychologist, psychiatrist, or neurologist; it’s generally governed by the insurance companies. BCBA or BCBA-D, if with a doctorate. The credentialing board is the BABC, the Behavioral Analytics Certification Board. And the registered behavioral technicians report to the behavioral analysts.
So, onboarding professionals and client families was the biggest initial challenge you took on?
The entire onboarding process is complicated in terms of the process that helps to reach a diagnosis for autism. It’s complicated: before the Affordable Care Act, autism didn’t receive any funding on a national scale; then the mandate was put in place nationally in 2012, requiring states to implement some structure for autism treatment. The funding came primarily from special education departments. And they’re not trained the way physicians are, in terms of administration and charting. There was none of that in this area; that wasn’t part of their training, in terms of documentation in particular; and we saw that as a major barrier.
How it appears to clients is that things are disorganized and unprofessional in the field; that’s a lot of the feedback that providers get. Services are interrupted and people quit. There’s extremely high turnover in the field. You set up cases, and your processes are interrupted. You have to secure an environment at home, at the clinic, and it can take up to six months to secure payment. And you need a service team in place, and there’s a huge gap between the provider and the client need.
A few years ago, wait lists of up to two years were common. Now, imagine that you get a diagnosis for autism, and the neurologist says, you need immediately to go out and get services; you’re a parent, and it’s an overwhelming experience. And you get on the phone and call 100 providers, if there are even 100 providers in your area. So then people tell you, it will take a year or more, and sometimes, they never call you. So what can we do to remove the barriers? Micro-targeting certain services. There’s a service provider and you put out a listing on Indeed or something like that; and you get ten interviews, but nobody’s able to drive to the home because it’s too far and it’s economically ineffective for the provider to do so. So we realized we needed to develop pairing technology. Does the provider have a pet allergy? But the family has a cat in the home. And ADHD [attention deficit hyperactivity disorder] is a healthcare service, but it’s staffed by people with different backgrounds. And these variables are all involved, and there’s a service ecosystem with parents, grandparents, etc.; further, you need to get special authorization to go into a school; and this was all disorganized. And there’s a very high error rate, around things like getting a phone number wrong. It’s not uncommon to have a provider showing up at a school, but the provider isn’t let in, because the provider’s phone number was written down wrong, for example.
So we put all the variables for the client in one place and all the variables for the provider, and put them in one place. We were the first HIPAA-compliant AI implementation of Appian’s technology. We built this together using my small dev team and Appian’s developers. We spent weeks together and put together the DSM5 codes together in the solution. And what’s really cool about this use case is that we’re extracting information that can be put into a relational database from an unstructured document; and that’s not new. But now we can do treatment plans and put everything else we need to, into the system, in a secure document.
We have a lot to build now, because the use case has been proven, and we don’t have to wait on a tech vendor to build it, we can build it ourselves. And we can provide things to small and medium sized providers who are dogged by billing errors and other issues. We’re building it out and perfect it internally, so that people don’t get absorbed by really large players during an industry consolidation. We want small providers to be able to continue forward. It’s hurting our client families, because they’re being absorbed by big players. So we’re using objective technology to allow the providers to provide services while putting the human first, and it allows us to stay operational without going out of business. Some of the biggest players in the field have gone out of business because they were overly leveraged by private equity companies. A lot of providers went back out onto the market. We’ve done our best to stay pure in that we don’t have financial motivations as the primary motivator in this area. But margins are very tight.
What have been the biggest lessons learned so far on this journey?
We decided to build everything in Java, and it’s a difficult language to develop in and requires a lot of resources. We had a false start and realized we couldn’t do it at our level of scale. And eventually, we went with Appian, because they said, sure, we’ll partner with you. They understood the data structures needed to work with insurance companies. And I found out the best thing we can do is to focus on the client, but from a technological perspective, that means developing micro-use cases. The diagnostic document enables all the use cases we’ve built, and that we can build in the three to four months; and by switching to low code, it allowed my dev team to scale up fast.
And the link between the business side and the tech side has been created, so that we can work more quickly, and can build out an application or use case in several weeks. That’s great, because historically, the providers have been tech-averse, because tech hasn’t supported them adequately in the past. And keeping humans in the loop has been a pretty big game-changer. In the past, people had to touch as many as two dozen systems. And even if you have more than one point of contact, the tech allows the client to go to one place. And it’s only going to get better with what we’re building.
What will the next couple of years look like for your team?
Especially because of regulatory uncertainty, things are going to change, and we’re probably going to have to deal with lower margins, so greater administrative efficiency will be essential to survive. So we’re focused on looking at the experience of the clients we serve. We provide ABA [applied behavioral analysis] therapy primarily. How can we give them a more comprehensive, unified experience? And we’re starting to look at areas adjacent to autism, including ADHD. Oftentimes, children and adults with autism are generally underserved and have other diagnoses besides autism. So we’re looking at adding services, including tech-enabled services, basically through automating the whole system, and expanding services. We really want to reduce wait lists for people and serve them. That will be driven by technology—telehealth, administrative technology, and applications that people will use.
