Autism digital health startups aim to disrupt amid ABA challenges

Elemy has faced scrutiny from media reports regarding its financial situation, which Yakubchyk disputes. The company has undergone four rounds of layoffs this year, including Friday. Yakubchyk did not specify the number of layoffs but said the positions didn’t align with its software-as-a-service driven model. He said the company is shifting certain positions into automation and moving most of its clinicians into independent contractor arrangements to save money.

A controversial element of Elemy’s business is the fact it almost exclusively uses board-certified behavioral analysts over telehealth. While using them virtually is unconventional approach, it comes at time when there is a dearth of behavioral analysts. According to a study from researchers at the University of Florida, there is one behavioral analyst for every 604 individuals with autism. Most board-certified behavioral analysts can have six to 16 children on their caseload. The shortage has led to Elemy virtualizing the position, Yakubchyk said. 

Yakubchyk also said the economics of the reimbursement rates for ABA don’t scale if behavioral analysts are having to travel physically into homes. Elemy will provide the service in person if requested, he said.

Aaron Blocher-Rubin, founder and CEO of Arizona Autism United, a community-based nonprofit that provides ABA and other services to families, and other critics have concerns over the virtualized board-certified behavioral analyst model. “Autism is way too complex. Therapists are way too underqualified to be expected to [only receive virtual support]. There’s no research on a model like this,” he said.   

The search for evidence 

The investor led, tech-fueled disruption of autism care has critics wondering if the rush for revenue growth will come at a price for ABA, which is controversial even without the telehealth and funding components. 

“It took many years [before] insurance would pay for ABA and it was recognized as a mainstream evidence-based therapy,” Blocher-Rubin said. “[Companies] taking advantage of it in ways it not intended to be done is not necessarily good for the children and the outcomes. It’s a threat we’ll lose that access to care.”

While the increased use of technology in autism care has benefits, providers must back it with evidence-based data, said Mandy Ralston, CEO of NonBinary Solutions, a tech firm that designs clinical decision support systems for autism service providers. 

“Companies should explain what drove the decision to provide care via telehealth,” Ralston said. “I’m not saying it’s not right in some circumstances, but I’m guessing that it wasn’t a clinical decision.”

Those in defense of autism tech say current methods of diagnosis and treatments rarely use verified clinical data and evidence. SpectrumAI founder and CEO Ling Shao has four autistic children of her own. Through her own experience, she said ABA treatments have always been subjective.

“I was watching ABA happen all around my house with therapists scribbling down notes on a piece of paper. I thought, ‘This isn’t a great way to collect data,’” said Shao, who started SpectrumAI to bring AI-enabled clinical decision support into the point of care. 

SpectrumAI’s focus on evidence-driven insights is a big reason why Autism Impact Fund has invested in the company. Male said he vets potential companies based on the evidence their solutions can provide. He also appreciates founders like Shao, who have skin in the game. He said the venture is personal for him and others at the company, most of whom also have children on the autism spectrum. 

“It’s a good thing there is money flowing into this space,” Male said. “The VC focus is needed because there is such a massive problem and a massive opportunity. The supply-demand balance is so great. And digital health and the opportunities we’re seeing, and the great founders we’re funding, we believe are really going to move the needle. We feel a tremendous responsibility to make this happen the right way.”