Diagnosing Autism - A New Model Designed To Help In Bay State

Parents are struggling to get their children the right diagnosis for behavioral challenges at a young age - our poll of parents with young kids found that 81%, up from 52% 5 years ago, struggle in some capacity with behavioral issues at home or school.

“For my son, I’m unsure whether this is just boys being aggressive, whether it’s something to do with both my husband and I working, or if this is ADHD or autism,” says Paula Collins of western Massachusetts.

Paula is like a lot of young parents trying to figure out what’s happening and get help. Fallon Health, a health insurer in Massachusetts, is partnering with Autism Care Partners on a new model that tries to address diagnostic barriers. Fallon’s partnership will focus on engaging families waiting for a diagnostic evaluation. The idea is to provide continuity of care for the family, whether or not the autism diagnosis is confirmed.

This is the second insurer in Massachusetts to develop a model like this, Point 32 (a partnership of Tufts Health Plan and Harvard Pilgrim) being the other.  Each month, the child’s applied behavioral analyst (ABA) is paid a monthly fee to cover a range of services to help the child, train the family, and even contact and coordinate with others, like the child’s school or pediatrician. The idea is to improve behaviors in a coordinated fashion and reward the ABA group for reducing “events” like hospitalizations or medications.