Autism Business
Within healthcare business and industries, much of the conversation on autism healthcare generally focuses on autism services and autism markets and the efficient administration of providing the former within the latter.
How to identify and reach “underserved” (or what might perhaps more accurately be called underexploited) markets, both geographically and demographically.
How to better streamline timelines from diagnosis to service provision.
How to make billing more efficient and cost-effective.
Some of these conversations–largely about autism business–address the more mundane administrative matters of addressing diagnostic eligibility, coverage gaps, CPT codes, billing denials, or claims management. Others address the more transparently financial considerations of diversifying investment strategies to scale up autism businesses and consolidate service providers within existing (and ever-expanding) autism markets.
These conversations ultimately don’t advance the goal of providing better (or even much of any) healthcare for autistic people.
The past 5-8 years have seen a rapid expansion of “autism services” markets, particularly through the large-scale and widespread investment of private equity and venture capital. This rapid commercial expansion was enabled in part by state insurance reforms that created legislative mandates to fund particular autism intervention services in all 50 U.S. states (primarily applied behavior analysis, or ABA), and accelerated by the relatively underregulated nature of these markets.
As multiple journalistic investigations and scholarly analyses have recently demonstrated, this boom in autism business has not necessarily translated to better healthcare for autistic people.
And maybe that is good business. But it’s not good healthcare.
Autism Healthcare
What if we talk instead about autism healthcare?
Within autism healthcare, business models generally offer autism intervention services–primarily psychological services; behavioral health services; and speech and language, occupational, and physical therapy services, among others. The healthcare provided is largely aimed at treating autism. The treatments, therapies, and interventions attempt to make autistic people just a little less autistic. That’s the primary purpose of most existing models of autism healthcare.
In autism healthcare, autism is generally considered the medical or health problem to be solved, the disease to be treated, the disorder to be addressed–the symptoms of which need to be improved or lessened through various therapies.
The essential, overriding reason that autistic people need healthcare services within most autism healthcare models is (wait for it)–autism.
As if autistic people don’t have the same full range of healthcare needs as nonautistic people (and then some–lots of additional chronic healthcare needs are actually created by living as an autistic person in a neurobigoted and often traumatizing neuronormative world…).
Simply being autistic does not, in and of itself, require medical care.
This model of autism healthcare is inadequate, at best. And harmful, at worst.
Autistic Healthcare
Autistic healthcare would provide comprehensive healthcare for autistic people, throughout autistic people’s lives. Healthcare that is integrated, neuroinclusive, neuroaffirming, and non-traumatizing. And very few autistic people receive or have adequate access to that.
Autistic people require the same range of healthcare services as nonautistic people.
Many trans and nonbinary autistic people require access to gender-affirming care.
Many autistic people require routine gynecological, midwifery, obstetric, and postpartum care.
Many will require routine endocrinology, pulmonary, immunology, proctology, urology, or cardiac care. Some require oncological care. Many require surgical care at some point in one’s life for a wide range of possible reasons.
Autistic children require the full range of routine pediatric healthcare, including vaccinations (they don’t make anybody autistic–it can’t be articulated frequently nor forcefully enough).
Autistic people also require routine dental care (which is a common source of healthcare trauma–and therefore, healthcare avoidance–for many autistic people).
How many of these myriad general and specialized healthcare providers are neuroinclusive and neuroaffirming in their clinical practice?
Not enough.
How many recognize that they need to be?
Not enough.
Healthcare business has not yet adequately provided comprehensive healthcare to autistic people. If routine, preventative healthcare were more neuroinclusive and neuroaffirming, and thereby more accessible, more autistic people might seek–rather than actively avoid–routine healthcare services.
Which would save untold hours, days, and years of misery and trauma for autistic people.
And which, incidentally, could also save countless dollars in the provision of acute, crisis-induced emergency care for autistic people later.
What’s Neuroaffirming Health Care?
Neuroaffirming health care does NOT begin with the premise that the person seeking healthcare is disordered, diseased, or is necessarily seeking to become less autistic. It presumes the opposite.
Neuroaffirming healthcare recognizes and validates the lived embodiments of people with autistic and otherwise neurodivergent neurotypes.
Neuroaffirming healthcare recognizes that many specific healthcare needs of autistic people (cardiac, psychological, immunological, etc.) are actually collateral damage–the result of living under the extreme and prolonged stress and chronic trauma of being autistic in a world designed by nonautistic people, for nonautistic people.
And probably also the result of years, perhaps decades, of having avoided routine preventative medical care because it was NOT neuroinclusive or neuroaffirming, and may even have been traumatizing.
Neuroinclusive healthcare accepts responsibility for working to make this better, in partnership with autistic people.
More autistic patients would seek routine, preventative healthcare if that healthcare were nontraumatizing, neuroinclusive, and neuroaffirming.
What if waiting rooms in healthcare practice offices didn’t assault people with loud, vacuous daytime television programming when you walk in the door? And then with inane social chit-chat for the first 60 seconds of every consultation?
What if healthcare providers recognized that every element of their workplace environment might be trauma triggers to autistic patients, thereby creating anxiety and even fear during the most routine of interactions? The flickering and buzzing fluorescent lights, the antiseptic smells, the constantly crinkling paper on the examination table, the scratchy cotton examination gowns with horrible tags in them, the random NOISES–the beeping, buzzing, pinging of the various tools of the medical trades (from rotating toothbrushes to MRI machines).
These create barriers to accessing healthcare for autistic people. Which could be ameliorated with awareness, attention, and care.
What if autistic people had the option to seek the care of openly autistic healthcare providers (see autisticdoctorsinternational.com ), or at very least to choose to access care from medical practices that aspire to provide neuroaffirming care to autistic and otherwise neurodivergent people?
What if there were criteria and standards for excellence in neuroaffirming healthcare?
What if healthcare industries participated in conversations about what that actually means, why we should value it, and how we should provide it?
Health outcomes would be better for autistic (and lots of other) patients if that were so.
Costs would be reduced for healthcare businesses if that were so.
This would add value for everyone.
Expanding markets to provide more people with fundamentally insufficient, inadequate healthcare isn’t better. Endeavoring to provide comprehensive, neuroaffirming healthcare to autistic people would be.
Now that’s what I call an untapped market.