Earlier Answers, Better Outcomes: A New Standard for Autism Care

The need for proactive, interdisciplinary and person-centered support for individuals and families with autism

Autism has significantly increased in prevalence over the past two decades, rising from 1 in 150 eight-year-olds* to now 1 in 31* . This is largely due to greater public awareness, better screening and more inclusive diagnostic guidelines.

The increase in diagnoses has also been accompanied by an increase in health care spending on autism care. One study of data from 2010 to 2019* found that among health conditions that had at least $5 billion in total spending, autism had the fastest annual growth rate in spending per person, at nearly 13%*.

Despite this growth, many Autistic individuals and families still struggle to find the right care at the right time. Aetna sees an opportunity to close that gap - helping members get answers sooner, understand what those answers mean and know their care is making a difference - so families can spend less time navigating the system and more time living their lives.

Early identification is crucial given the complexities of autism care

For many families, the path to a diagnosis can become a second job, layered on top of work and family life. Early signs of autism can be missed, as symptoms vary significantly by age, cognitive ability and language level, and some children may be misdiagnosed with ADHD or other conditions.

Access to providers with expertise in autism diagnosis is also limited. Even when individuals and families have concerns about autism, they can often wait significant stretches of time - even years - to see a specialist and confirm the diagnosis. And a diagnosis needs to lead somewhere, not become another search for what comes next, given early identification and diagnosis of autism are associated with improved health and social outcomes.

To address these challenges, Aetna has entered into relationships with both national virtual providers and in-person providers, ensuring members have rapid access to autism specialists with appointment availability in weeks rather than months. Aetna also identifies members newly diagnosed with autism and proactively reaches out to individuals and families with support, advocacy and care resources.

Taking a comprehensive approach to Autism care

Even with a clear diagnosis, the autism care journey is often highly fragmented, leading to frustration and suboptimal outcomes. There is no single pathway for autism care, and specific individual needs may be overlooked.

For example, individuals often benefit from a combination of behavioral therapy alongside services such as speech and language therapy and occupational therapy. Many Autistic individuals also have co-occurring behavioral health or medical conditions, with anxiety, sleep issues and gastrointestinal problems among the most frequent challenges. However, these conditions may not always be coordinated or addressed in some autism care options.

“Once an individual receives a diagnosis of autism, they enter a complex, fragmented ecosystem of multiple providers, often with lack of coordination,” said Dr. Jack Huang, Executive Director for Clinical Innovation, Mental Well-Being at Aetna®. “Supporting Autistic individuals requires a whole-person approach, so that each person receives care that meets their specific set of needs.”

As a result, providing access to comprehensive, person-centered, quality and cost-effective support for Autistic individuals and their families is imperative. Launching in 2027, the Autism Care Path within the Aetna Health app will provide members with a centralized source for resources, benefits and recommended next steps. In addition, dedicated personal navigators provide human guidance around accessing care, navigating benefits, and coordinating care journeys. Looking ahead, AI-powered provider search and navigation will enable members to connect with credentialed in-network providers and access resources that best fit their needs.

Autism quality framework drives high-value care

Effective autism care depends both on streamlined access to care and ensuring that individuals and families are receiving access to quality, evidence-based care. Recent research shows that greater volume of care does not necessarily translate into improved outcomes* and can create financial and time burdens for Autistic individuals, their families and plan sponsors. In fact, autism care – particularly Applied Behavioral Analysis (ABA) therapy – is one of the fastest-growing areas of U.S. health care spending. In Medicaid and CHIP, ABA spending increased by 421% between 2021 and 2025*.

This creates a need to focus on high-quality care that truly improves the lives of Autistic individuals.

“In recent years, new entities have entered the autism and ABA therapy space, driving increased spending, with limited oversight as to the quality and outcomes they deliver,” said Miriam Ferreira, Vice President of Mental Well-Being at Aetna. “With the rapid rise in ABA costs, organizations – including high-performing ABA providers – are calling for a better understanding of ABA quality to ensure that individuals are receiving the most effective care possible.”

In collaboration with providers and academic partners, Aetna is taking the lead in developing an autism quality framework to help ensure that members receive quality, cost- effective care backed by research. In addition to claims-based measures that assess structural and process measures of quality, specialized clinical teams at Aetna are leveraging advanced analytical tools to analyze large quantities of data beyond claims to develop meaningful outcome measures of quality.

This quality framework serves as the foundation for both helping members receive effective care and making that care more affordable. Specialized teams analyze data to identify problematic practice patterns, while also highlighting providers that consistently deliver quality care that improves outcomes. Performance data will be shared with providers, and these insights will enable value-based care arrangements that reward providers for high-quality, effective care.

In front of what's next in autism care

Providing comprehensive, person-centered, high-quality support for autistic individuals and their families is imperative. Through earlier identification and rapid access to care, a more coordinated approach, and greater confidence that care is effective, Aetna aims to change what autism care can look like — so families spend less time navigating the system and more time living their lives.

That's the difference whole-person care should make for Autistic individuals and their families: a clearer path forward. And for plan sponsors, confidence that care is reaching the people who need it and making an impact. It's how Aetna intends to stay in front of what's next in autism care.