As autism diagnoses climb and costs and utilization rise, many payers are tightening utilization. Frisco, Texas-based Magellan Health’s Autism Connections — developed in 2009 amid expanding state autism coverage mandates — has taken a different route, emphasizing clinical expertise and provider collaboration.
Autism Connections is a clinically driven utilization management approach that supports payers, providers and families in coordinating and managing autism care, including applied behavior analysis services.
“We don’t want to be an obstacle to treatment,” Steven Pratt, MD, chief medical officer, told Becker’s. “We want to be a facilitator of treatment.”
When Magellan identifies a member with an autism diagnosis, the program facilitates timely assessments, connects patients with providers and ensures authorization requests are reviewed promptly.
In 2025, the program supported more than 12,000 members receiving applied behavior analysis services, backed by a specialized team of 46 staff with expertise in autism and ABA, including approximately 40 behavior analysts.
It emphasizes what Dr. Pratt calls “care shaping” rather than traditional utilization management, with an aim to minimize denials and maximize engagement with providers. He said cost containment is primarily focused on developing collaborative relationships and problem solving with providers.
“We want treatment to be effective, but we also want it to be efficient — to use the right number of resources, the right units of intervention,” Dr. Pratt said. “I don’t think there’s magic. It’s clinical expertise and developing relationships that makes our program work.”
ABA managed by other organizations falls between $40,000 and $60,000, the company said. In contrast, Magellan’s managed ABA averages $29,161 per member.
The company also said 75% of members achieved substantial developmental progress on adaptive functioning as measured by Vineland scores. Additionally, members demonstrated a 54% improvement in social behaviors and a 58% improvement in behavioral domains on the standardized assessment.
Autism care has seen a rapid increase in diagnoses and utilization of services, he said.
In 2020, around 1 in 36 children had been diagnosed with autism spectrum disorder, and in 2000, it was 1 in 150, according to CDC data. Unmanaged ABA ranges from $125,000 to $300,000 per member annually, according to Magellan’s data.
As a result, some states have moved to reduce Medicaid payments for ABA therapy. Dr. Pratt said although leaders must monitor reimbursement and utilization trends, the program remains centered on cultivating relationships.
“Our preference is to give providers the benefit of the doubt and work with them to make sure that we’re a collaborative team, rather than sort of having a policing function,” he said. “I like the idea of networking with our providers rather than managing our network.”
The program also emphasizes caregiver training, helping to establish clear endpoints for services and supporting long-term progress. This approach equips caregivers with the skills needed to manage behaviors and, in some cases, reduce the need for ongoing services.
“Standard parent[ing] techniques that most parents have need to be tweaked and adjusted,” Dr. Pratt said. “Caregiver training is the way of bringing those specific skills to help shape behaviors that are needed in children with autism.”
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