Overcoming Barriers to Care: Insights into Autism Payor Challenges

This week, CNN and ProPublica published an article shedding light on the barriers families face in accessing autism therapy, focusing on insurers like UnitedHealthcare. Link: https://lnkd.in/gQs-CPb7

Having spent over a decade at UHG, I experienced both the privilege and responsibility of helping provide care to a significant portion of the U.S. population.

Providing "access to care" is paramount, but efforts to protect resources and improve care quality are also essential. A payor must address waste and fraud—for example, ensuring claims aren’t billed from closed clinics (a practice surprisingly framed negatively in the article)—and advocate for state regulations and funding that align with best outcomes for the growing population of autistic children.

However, some practices are deeply concerning. Limiting network participation at a time when demand for therapy is skyrocketing and ending ABA care for children without offering viable alternatives leave families struggling in an already challenging system.

Insurers often serve as gatekeepers to costs, a role shaped by low Medicaid reimbursement rates and the reliance on employer and individual plans to subsidize public programs. But we need solutions that go beyond cost-cutting—solutions that expand access, build capacity, and support families. Collaboration with providers and innovative tools like AI can help create better care models and measure meaningful outcomes.

Healthcare for vulnerable children requires collective action. We can and must do better—for the kids, their families, and their futures.