What We Learned and Took Away from the ABA C.A.R.E.S. Workforce Summit

A session called The Three-Lens Decision Framework got at something almost every ABA organization has some version of: clinical, finance, and ops each doing their own thing, mostly talking past each other. One speaker made the point that silos usually start with good intentions, like protecting clinicians from finance conversations, but they can leave teams operating with an “us vs. them” mindset.

The story that landed hardest: a clinic had eight late authorization submissions and assumed it was an insurance team problem. It turned out families were canceling assessment sessions. Nobody caught it because clinical and ops weren't looking at the same information.

It reinforced something we think about a lot when building Camber. Billing should be able to see when it needs something from clinical, whether that’s a missing note, an incomplete signature, or something else, while everything else keeps moving. Camber surfaces those exceptions so clinical gets involved when they’re needed, without billing having to chase people down or clinical getting pulled into issues they don’t need to handle.

In The Hidden Cost of Bad Tech: How Poor Implementation Drives Turnover in ABA, one speaker brought up some great points about how we should think about rollouts. The speaker's phrase was "implementation plus calibration," and the idea is that you never really finish implementing something. Every new feature or workflow change should restart the whole loop: buy-in, training, feedback, repeat.

• Training in three steps: I do it, we do it together, you do it
• Find the people who pick things up fast and let them help bring others along, instead of treating every user the same
• Ask for feedback in a structured way ("start, stop, continue") instead of a vague "how's it going"
• Actually set 30/60/90-day check-ins, and take that feedback back to your vendor, not just your team

This is very much aligned with how we think about change management at Camber. A lot of vendors promise “zero disruption to existing workflows,” but adopting new technology should change how a team works. If the old way was working, you probably wouldn’t be buying new software in the first place. The goal is less manual work, fewer dropped balls, and more time back for the team. And that takes real buy-in, training, and actually listening to the people using it once it’s live.

ABA Under the Medicaid Microscope: Program Integrity, Outcomes, and the Path Forward opened with a stat worth sitting with: ASD diagnosis rates went from 1 in 1,000 in 1995 to 1 in 31 in 2022. But billable visits went up 4.4x over the same stretch, more than double what diagnosis growth alone would predict. Severity doesn't explain it either. Nobody in the field has a solid answer for that gap yet.

CMS is clearly looking at the same issue. The ABA toolkit, released August 4 (the first day of the summit), focuses heavily on oversight and program integrity, including whether providers can show the clinical rationale behind what they’re billing.

The speaker’s take on payers stuck with us. Medicaid managed care plans operate on roughly a 2% profit cap. They aren’t necessarily looking to deny care. They need cost justification, and when providers don’t have the data to support it, states often step in with blunt tools, like hard annual or lifetime hour caps that don’t account for clinical differences.

The call to action for providers was to put more structure around how care is measured, delivered, and transitioned over time, with a focus on outcomes, consistent standards of practice, and clear points for step-down. Keeping hours flat over several years can raise questions from payers, even when clinically justified. Value-based care is part of the same conversation. It remains relatively uncommon in ABA, in part because providers have been hesitant to define an endpoint, while the current fee-for-service model leaves room for that to change.

The piece we keep coming back to is the role of RCM data in these conversations. RCM systems already capture a lot of what payers want to see: authorized hours, billed hours, denial patterns, reauthorization cycles. But that information often lives in different places across billing systems, clearinghouse files, and spreadsheets, so it’s hard to see the full picture. Organizations can end up going into utilization reviews or contract negotiations without the data they need at hand. Clinical teams should own the standard-of-care conversation. RCM should make it easy to pull together the evidence to support it.

Silos, implementation, and standards of care aren't new problems, but hearing how other people in the field are working through them pushes our own thinking forward. Conversations like these, across clinical and business teams, sharpen our thinking about what we're building. Looking forward to more conversations like these and to seeing where the field takes these ideas next.