Care Management Solutions

Learn how Rethink can streamline utilization review and standardize the decision making process while monitoring member progress on an individual level.

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Medical Necessity Assessment for Autism/Applied Behavior Analysis (ABA)

Applied Behavior Analysis as a covered benefit is a relatively new venture for Behavior Analysts.

Combining the large discrepancies between provider treatment plans, the array of severity of symptoms and treatment methods, unclear documentation and specific health plan requirements with complex medical necessity criteria, utilization managers are being set up with a subjective, inconsistent decision-making process.

Ensure Clinical Standards of Care

By using Rethink’s Medical Necessity Assessment developed by industry leading behavior analysts and validated with over 11,000 assessments across 6,000 patients. The tool enables health plans to monitor quality care indicators, coordination of care, barriers to treatment and consistently apply ABA benefits and quantify responsivity to treatment.

Support Clinical Decision Making

With evidence-based treatment approach, including appropriate dosage of ABA therapy, utilization reviewers are able to make clinically sound decisions in a standardized, objective way. The structured elements in the MNA tool ensure a complete medical record is submitted by the provider, and reviewed by the health plan systematically.

Manage Progress

By tracking and analyzing initial service authorizations, re-authorizations and quantifying responsivity to treatment, considering Social Determinants of Health, barriers to treatment progress, caregiver involvement and changes to standardized and ABA curriculum assessments, the health plan increases objectivity and accuracy in decision making and reduces opportunities for outcomes that lead to avoidable harm or wasteful allocation of resources.

Simplify Your Workflow

With single-sign-on (SSO) capabilities that integrate with existing utilization management systems and a recommended dosage of ABA therapy, the Medical Necessity Assessment ensures inter-rater reliability between reviewers, pinpoints areas for case management and reduces communication barriers between payors and providers.

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ABA Clinical Progress Tracking

The purpose of Applied Behavior Analysis for children with Autism is to increase quality of life by decreasing symptomology.

This goal is agreed upon by providers, families, and payors alike. The trouble achieving best outcomes stems from inconsistency in the monitoring of individualized progress over time. By comparing previous and current treatment records, all involved are better able to determine clinically significant progress and potential barriers to treatment, thereby ensuring quality of care is provided. Taking that data a step further, synthesizing and benchmarking it, allows for the potential to meet quality of care standards and can lead to value based care initiatives.

Implement Value-based Care Initiatives

By collecting and analyzing quantifiable quality indicators within the Medical Necessity Assessment related to best-practices, identification of resource needs, coordination of care, client dignity, caregiver involvement etc., a cohesive and productive value-based care structure can be formed.

Analyze Trended Data

Related to provider performance as it relates to authorizing care and quality of service.

Track Progress

Automatically track rates of skill acquisition, behavior reduction and progress on ABA curriculum assessments (e.g., increases in VB-MAPP) along with Medical Necessity Assessment hours recommendations over time.

Download Our Whitepaper

Inherent Challenges in Managing ABA Treatment

Inherent Challenges in Managing ABA Treatment Whitepaper
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