At CareFirst BlueCross BlueShield (CareFirst), our mission is to ensure every member receives high-quality, compassionate care tailored to their unique needs. This includes a growing number of members diagnosed with autism spectrum disorder (ASD), a neurodevelopmental condition that affects how individuals communicate, interact and experience the world. ASD presents differently in every individual, with symptoms ranging from challenges in social communication to repetitive behaviors and sensory sensitivities.
Autism diagnoses continue to rise nationally, and CareFirst’s data mirrors this trend. Many of our members with ASD are under the age of 12, underscoring the importance of early intervention. Yet, access to care remains a challenge. Waitlists for therapy can stretch three to twelve months or more—a significant portion of a young child’s developmental window.
Timely access to care is not just beneficial, it’s essential. CareFirst is actively working to reduce delays and ensure families receive the support they need when it matters most.
Understanding Therapeutic Pathways for Autism
Once an individual is diagnosed with ASD, families typically explore two primary therapeutic models:
- Behavioral approaches, such as Applied Behavior Analysis (ABA), that focus on reinforcing desired behaviors and functional skills through lengthy and intense methods.
- Developmental approaches, including Developmental Relationship-Based Interventions (DRBI), which integrate occupational, speech and mental health therapies to support children through developmental stages and utilize play and connection to achieve growth and quality of life.
While ABA has long been the standard, emerging research highlights the effectiveness of DRBI models. Providers such as Positive Development offering developmental relationship-based models of treatment have resulted in improved social communication, parent engagement and functional outcomes.
A Shifting Clinical Landscape
The clinical community increasingly recognizes the value of alternatives to ABA. The American Academy of Pediatrics (AAP), American Medical Association (AMA) and now the American Academy of Child and Adolescent Psychiatry (AACAP), the nation’s leading authority on children’s mental health, have all endorsed DRBI as a therapy option physicians and health insurers can recommend to families.
DRBI therapies are evidence-based, clinically valid and offer families more choices in how care is delivered. This shift reflects a broader movement among individuals with ASD—and their families—who seek therapies that align with their strengths, preferences and developmental goals. CareFirst is proud to support this evolution by expanding access to a full spectrum of clinically appropriate options, including DRBI.
Therapy Intensity and Cost Trends: The Case for Alternatives
ABA therapy, while effective for many, can be both time-intensive—often requiring children to be in therapy for 20-40 hours a week—and costly. For instance, a review of CareFirst’s commercial members showed 1) a 15-20% annual increase in per-member ABA costs since 2022 and 2) a 28% rise in total ABA therapy costs year-over-year, with 2025 projected to be the highest yet.
Another benefit of DRBI models is that they are often less time intensive than ABA programs (typically requiring 6-8 hours of therapy per week), and more cost effective as a result. In comparison to annual spending per member for the most recent measurement year, CareFirst found that therapy costs for DRBI members were 68% lower on average than comparable ABA therapy costs.
Incorporating ABA alternatives like DRBI can help ensure we offer high-quality, affordable care. These trends highlight the need for scalable, cost-effective alternatives like DRBI that offer strong clinical outcomes with potentially lower resource demands.
The Promise of DRBI Models
CareFirst views DRBI not as a replacement for ABA, but as a complementary tool in a diverse therapeutic toolbox. This approach allows us to better serve children who may not respond optimally to traditional behavioral models.
DRBI therapies provide a personalized, relationship-based approach to care that adapts to each child’s developmental profile. These models often integrate more seamlessly into daily routines and empower caregivers to play an active role in their child’s progress.
Addressing System-Level Barriers
With our wide-reaching network, CareFirst can efficiently pinpoint and overcome obstacles to care for members with ASD. We are collaborating with providers to streamline referrals, reduce wait times and improve coordination across disciplines. Our goal is to build a more responsive and inclusive system that meets families where they are.
Our Commitment to Members
Families are increasingly seeking flexible, family-centered care models. Demand for telehealth and developmental therapies is rising, reflecting a shift toward care that integrates more seamlessly into daily routines. CareFirst remains deeply committed to advancing care for our members with ASD and their families. We will continue to support diverse, evidence-based therapies, collaborate with providers, monitor utilization trends and use data to drive innovation. Our goal is to meet members where they are and provide the right mix of tools, support and access to care so that every child can thrive.