Cortica's Value-Based Autism Model Fuels Expansion as Competitors Pull Out
Cortica is growing nationwide by offering interdisciplinary autism care that focuses on outcomes rather than high-volume ABA hours, while many rivals exit states over Medicaid challenges.
Over the past year, several major ABA providers have left whole states because of Medicaid reimbursement and authorization hurdles, yet Cortica has expanded, opening an 8,400-square-foot center in Plano, Texas, and pursuing a larger downtown clinic in Concord, California. Co-founder and chief medical officer Dr. Suzanne Goff designed a value-based, interdisciplinary approach that treats sleep, seizures, genetic, metabolic and gastrointestinal issues, thereby cutting the need for the typical 30-40 ABA hours per one outlet.
The company tracks ten outcome metrics across medical, developmental, behavioral and family quality-of-life domains, earning performance bonuses when benchmarks are met. Cortica now operates 27 clinics across eight states and has attracted more than $250 million from strategic investors such as CVS Health Ventures, Optum, Ascension, Morgan Health and the Autism Impact Fund. Recent Medicaid collaborations with Mercy Care in Arizona and Alliance Health in North Carolina illustrate its growing payer network. Goh envisions a future where autism care is fully integrated into pediatric medicine, eliminating the need for a separate ABA-only industry.
Why it matters
The story shows how outcome-focused autism care can lower costs and improve services, challenging a costly, fragmented ABA industry.
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