Elemy has come under intense media scrutiny regarding his financial situation, which Yakubchyk disputes. The company has suffered four rounds of layoffs this year, including Friday. Yakubchyk did not specify the number of layoffs, but said the positions did not fit its software-as-a-service model. He said the company was shifting some positions to automation and shifting most of its clinicians to independent outsourcing arrangements to save money.
A controversial element of Elemy’s business is the fact that it almost exclusively uses board-certified behavior analysts rather than telehealth. Although their virtual use is an unconventional approach, it comes at a time when there is a shortage of behavior analysts. According to a study by researchers at the University of Florida, there is one behavioral analyst for every 604 people with autism. Most board-certified behavior analysts can have six to 16 children on their caseload. The shortage led Elemy to virtualize the position, Yakubchyk said.
Yakubchyk also said the economics of ABA reimbursement rates do not scale if behavior analysts have to physically visit homes. Elemy will provide the service in person upon request, 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 worry about the virtualized certified behavior analyst model by the board of directors. “Autism is far too complex. Therapists are far too underqualified to be expected to [only receive virtual support]. There is no research on a model like this,” he said.
The search for evidence
The investor-led, tech-fueled disruption in autism care has critics questioning whether the rush to revenue growth will come at a price for ABA, which is controversial even without the telehealth and telehealth components. funding.
“It took many years [before] insurance would pay for ABA and it was recognized as an evidence-based therapy,” Blocher-Rubin said. “[Companies] taking advantage of it in an unintended way is not necessarily good for the children and the results. It is a threat to lose this access to care.
While the increased use of technology in autism care has benefits, providers need to back it up with evidence, said Mandy Ralston, CEO of NonBinary Solutions, a technology company that designs systems for clinical decision support for autism service providers.
“Companies should explain what prompted the decision to provide care via telehealth,” Ralston said. “I’m not saying it’s wrong in certain circumstances, but I guess it wasn’t a clinical decision.”
Autism technology advocates say current methods of diagnosis and treatment rarely use verified clinical data and evidence. SpectrumAI founder and CEO Ling Shao has four children with autism herself. Through her own experience, she said that ABA treatments have always been subjective.
“I was watching ABA happening all over my house with therapists scribbling notes on a piece of paper. I thought, ‘This is not a great way to collect data,’ said Shao, who has launched SpectrumAI to bring AI-based clinical decision support to the point of care.
SpectrumAI’s focus on factual information is one of the main reasons Autism Impact Fund invested in the company. Male said he reviews 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 company was personal to him and others at the company, most of whom also have children with autism.
“It’s a good thing there’s money flowing in this space,” Male said. “The focus on venture capital is necessary because there is a huge problem and a huge opportunity. The balance between supply and demand is so great. And the digital health and the opportunities that we see, and the great founders that we fund, we think they’re really going to get things done, and we feel a huge responsibility to make it happen in the right way.
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