Private Equity & You: A Primer

Let’s say you have been working with ABA therapy for a while. 

Turnover is insane. It seems like there’s a new RBT in your house every two weeks. Your analyst is around maybe once a month. Maybe your analyst is only present on a laptop or tablet screen your RBT hands you sometimes. You haven’t seen a behavior plan, except maybe when services have just started. No one really asks much of you, which is kinda nice because you get a break, but your kid is also having the same struggles they’ve always had. The techs are nice enough, but they just aren’t around often enough or long enough. You take a look out of curiosity, and you see that goals were placed right when you started therapy…and haven’t been updated since.

You might have been working with a private equity ABA company.

What is private equity ABA? 

It’s ABA therapy provided by a company that is owned and backed by a financial entity. They are usually chains, they are usually huge, and they usually treat children like a number. Most of their approach is standardized across patients, meaning therapy is rarely geared to an individual learner. 

Why does ABA even have this?

Well, private equity (PE) is everywhere. It’s all over healthcare and in companies you wouldn’t even suspect. Private equity owns Cinnabon, David’s Bridal, Guitar Center, Subway, ⅓ of Europe’s soccer teams, emergency rooms, Neiman Marcus, Taylor Swift’s music, Hooters, highways in India, and Barnes & Noble. There’s more, but I have a life to live. 

Thanks, Good Work! So does private equity own everything?

Why is private equity everywhere?

In short, money. And private equity flourishes because they can pay the most, they buy up individual agencies, and their motivation is (you guessed it) more money. This motivates companies to adopt a churn-and-burn philosophy, to best squeeze the most profit they possibly can out of every case. And it’s hard to compete! A clinician-owned company can’t compete with the number of clients these companies serve (which makes them very attractive to insurances) or the salaries they can offer (which make them very attractive to RBTs and new BCBAs).

Oh no.

Dude, yeah.

So all PE-owned agencies are bad?

Nope! That’s what makes it so hard! 

Think about your local neighborhood Taco Bell. They all serve the same food, with the same model, and employ the same underpaid workers. But the one 2 miles away sucks; it has early closing hours, rude employees, gross potatoes, and somehow it always gets your order wrong. But the Taco Bell 5 miles away…now that’s the good stuff. They’re polite, they’re fast, and the potatoes taste like sweet, sweet love.

It’s the same way for ABA agencies (and all healthcare) owned by PE. The Autism Cares Center in your town might be amazing, but the Autism Cares Center in Chicago might be a cornucopia of human rights abuses and warehoused kids. No shade to any company named Autism Cares Center, I just made that name up, I’m not coming for you. And I didn’t name any actual PE-owned agencies because dear God don’t sue me.

What do I do?

If you’re happy with your clinical team, nothing! There’s nothing to fix!

If you’re not happy, start calling for changes. Start looking around for other providers. Ask if they are independent or if they are funded by private equity. 

Don’t let your child be a number.

If you want to read more about private equity and how it’s everything everywhere all at once, go read Gretchen Morgenson’s book We Are The Plunderers - How Private Equity Runs And Wrecks America. Or go look at other stuff. I can’t make you do anything. I’m not your real dad.