Vicki Kroviak, CEO of Acorn Health, rejects the “dots on a map strategy” for growing autism therapy businesses.
Under Kroviak’s leadership, the applied behavior analytics (ABA) provider has expanded its footprint by 47% since 2018.
At the same time, others in the space have had to downsize, laying off staff and even abandoning entire state markets.
More recently, Acorn Health acquired seven sites of Breakthrough Behavior based in Maitland, Florida. Terms of the deal, closed on September 19, were not disclosed.
Acorn Health offers in-office and in-home ABA services at 75 locations following the Breakthrough Behavior agreement.
For Acorn Health, growing while others shrink comes from thoroughly studying all options before making the leap. It also helps grow in areas that the company is already familiar with or even has existing infrastructure. Much of the company’s growth is based on working in its existing markets, Kroviak, who also serves as the company’s founder and president, told Behavioral Health Business.
“We do our homework before entering a new market,” Kroviak said. “That’s a perfect example in Breakthrough Behavior. We understand what we have.
“It is highly unlikely that we will be surprised by what the job market tells us at any of their facilities because…we already understand that.”
Strong local knowledge also provides insight into payer dynamics, allowing for even more planning, Kroviak said.
The autism space has seen two competing forces collide in 2022, precipitating hundreds of layoffs.
On the one hand, private equity-backed autism treatment companies have for years gobbling up smaller offices to gain market share and potential leverage with payers. East has accelerated in recent yearsaccording to own data sources.
On the other hand, pay pressures driven by COVID have led to high turnover rates in Registered Behavior Technician (RBT) roles, the professionals who most often work directly with patients. This, combined with limited reimbursement increases, led some of the largest autism treatment providers to downsize to cope.
“I think there are a lot of risks when you approach your growth as dots on the map, particularly in the year that we had where the labor challenges were so great,” Kroviak said.
The for Autism and Related Disorders (CARD) based in Plano, Texas is closing operations in 10 states, reducing its presence in the state market to 14 states. Since December 2021, the company has reduced its office space by 30%. Following news of the closures, the company said it regularly reviews and develops its operational footprint and assesses its centers’ capacity, staffing and reimbursement rates.
Earlier in the year, CARD closed its Oregon office and 360 Behavioral Health closed 9 locations. A least 665 employees they were hit. It is not yet known how many people will be affected by CARD’s reduction to nearly half of its statewide footprint.
Kroviak founded the company in Coral Gables, Florida in 2018 with the backing of the private equity firm MBF Healthcare Partners. In 2021, MBF Healthcare Partners sold Acorn Health to the Ontario Teachers Pension Plan (OTPP) Board. At the time, Acorn operated 51 locations in Michigan, Illinois, Virginia, Florida, Maryland, Pennsylvania, and Tennessee.
The OTPP takes a long-term view of the ABA industry, Kroviak said. This allows Acorn to strategically plan for the future. Like his company, Kroviak said OTPP understands the ins and outs of autism treatment and is unfazed by recent workforce trends.
“That three to five year old [holding period] in the pressure of private capital generates some impatience”, said Kroviak.
While terms of the deal were not disclosed, the OTPP’s website lists Acorn Health with its “major investments” on its website. It defines big investments such as those valued at $200 million or more. The investment bank Brentwood Capital Advisors estimates the value of the operation $245 million.
One long-term strategy enabled by the owners of Acorn Health is paid maternity leave and other workforce development efforts. Other efforts include mentoring and professional development programs.
Paid maternity leave is especially important in the ABA space because women have 85% from BCBA, RBT, and other ABA-related certificates, based on data from the Behavior Analyst Certification Board.
The same data set shows that about 64% of certificate holders are between the ages of 18 and 45.
“So they are women and they are younger women,” Kroviak said of the workforce. “We made that decision by really doing the work to listen to our workforce.”
the announced company the new policy to the public last week.
