Beyond ABA: A New Approach to Autism Care

Autism care is at an inflection point. The old model of diagnose, authorize Applied Behavior Analysis (ABA), repeat no longer reflects what we know about autism, who it affects or what autistic people and their families need. NovaOne partnered with Avela Health for a practical training on what autism-affirming behavioral healthcare looks like in practice and what it means for health plan benefit design.

Here are the highlights from the conversation with Dr. Cynthia Anderson, Chief Clinical Officer and Co-Founder at Avela Health, and Janice Rybicki, Director of Client and Provider Success at NovaOne.

Watch the full webinar recording here.

The Landscape Has Changed but Benefits Haven't Kept Up

For years, ABA has been the default pathway for autistic members. It's also one of the highest costs in behavioral health spend, with treatment spanning multiple years and variable longitudinal outcomes. At the same time, the definition of autism has broadened significantly, particularly with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), and the neurodiversity movement has shifted how both clinicians and individuals understand autism: not as something to fix but as natural variation in how human brains are wired.

The result is a growing mismatch. Health plan benefits were largely built around a narrow model that no longer reflects best practice, and a significant portion of autistic members including adults, women and individuals with co-occurring conditions are falling through the gaps.

Diagnosis Is More Than a Checklist
Dr. Anderson emphasized that a high-quality diagnostic evaluation is not just an autism yes or no. It should be a careful developmental formulation that captures the whole picture: social communication, sensory differences, co-occurring conditions and the contexts where things are working and where they're breaking down.

Presentations that have historically been missed including highly verbal children, girls, youth with co-occurring anxiety or Attention Deficit Hyperactivity Disorder (ADHD) and autistic individuals from Black and Brown communities are increasingly being recognized, though not fast enough. Good diagnosis creates the foundation for individualized care. Generic recommendations like "refer to occupational therapy and speech" are no longer sufficient.

One Diagnosis Should Not Equal One Intervention
Best practice in autism care is individualized, developmentally informed and integrated. For one person, the most urgent need might be mental health support. For another, it might be communication access, family education or simply understanding their own diagnosis as an adult. ABA may be appropriate for some but it is one tool, not the only pathway.

As Dr. Anderson put it: "The question is not how many hours of therapy. It's what does this person and family need to live well right now?" That question changes everything downstream: what gets authorized, what gets delivered and what outcomes get measured.

Virtual and Strength-Based Evaluations Are Expanding Access
NovaOne and Avela are collaborating on virtual, strength-based autism evaluations and the impact is already clear. People who once waited a year or more for a diagnosis are now being seen within days. Geographic barriers are being removed. And perhaps most importantly, clinicians are seeing people in their own environments, which often produces a more authentic picture of the individual than a clinical setting can.

Dr. Anderson noted that emerging evidence suggests well-conducted virtual evaluations are no less effective than in-person ones. The key is rigor including developmental interviews, diagnostic interviews, observations and standardized assessments, not the use of any single tool.

Four Key Takeaways for Health Leaders

1. Start with the right question. Move away from "how many hours of ABA?" and toward "what does this person and family need to thrive right now?"
2. Build for heterogeneity. Autism is not one thing and support needs are rarely one thing either.
3. Measure what actually matters. Hours of service don’t tell us whether someone's life is getting better.
4. Be proactive, not reactive. Build skills before problems become severe.

For a deeper look at how to operationalize these ideas, explore our Beyond ABA: A Strategic Framework for Autism-Affirming Benefit Design handout.

What This Means for Health Plans
The opportunity here is real. Plans that expand their autism benefit design beyond a single pathway will better serve their members.

If you'd like to explore what a more integrated autism care pathway could look like for your plan, we'd love to connect .

Watch the full webinar recording here .