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Advances in Autism Awareness

With autism diagnoses on the rise, employers are expanding benefits offerings to help families struggling with the disorder.

Wednesday, October 19, 2016
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Descriptions of people exhibiting autistic symptoms date all way back to the 16th century. Yet the term "autism" wasn't applied to the neurodevelopmental disorder until 1943, when Austrian-American psychiatrist and physician Leo Kanner coined the label in a report on 11 children with striking behavioral similarities.

These days, references to autism are seemingly everywhere. From concerns over a suspected connection between childhood vaccinations and the disorder to studies of promising new autism treatments to speculation over a possible autism diagnosis for Sheldon Cooper, the quirky "Big Bang Theory" television character, there's no shortage of attention paid to the brain disorder.

According to the Autism and Developmental Disabilities Monitoring Network, a group of programs funded by the Atlanta-based Centers for Disease Control and Prevention, the estimated prevalence of autism spectrum disorder increased 123 percent from 2002 to 2010, making it one of the fastest-growing developmental disorders in the U.S. Today, the group estimates that one in 68 American children place somewhere on the spectrum. According to Autism Speaks, a New York-based advocacy organization, the disorder costs an affected family $60,000 a year on average.

The increased prevalence of autism and associated high cost of care has led many employers to add autism coverage to their health plans. According to the Washington, D.C.-based National Business Group on Health's Large Employers' 2016 Health Plan Design Survey, more than three-quarters of the 140 U.S. companies surveyed cover one or more types of ASD treatments. Most commonly covered is speech therapy (78 percent), followed by physical therapy (75 percent), occupational therapy (74 percent), medication management (53 percent), and applied behavioral analysis-based approaches (36 percent). Just 12 percent said their plans don't cover any ASD treatments, while four percent only cover diagnostic services.

The tech industry was the "first to get on board," says Karen Fessel, founder and executive director of the Mental Health and Autism Insurance Project in Moraga, Calif. Often, she says, autism awareness events got the conversation started and emboldened employees to ask for the benefit. In other cases, employers added autism benefits as a result of state mandates and concerns over violating the mental health parity act of 1996, which was expanded by the Affordable Care Act in 2014. The mandate requires limits on mental health benefits to be no lower than any such dollar limits for medical and surgical benefits offered by a group health plan.

"Most insurance companies and the law characterize autism as a mental health condition," says Fessel. "To provide no treatment for a condition where behavioral therapy is the main form of treatment is a violation of the federal parity law."

The trend toward autism benefits has now made its way across the nation, according to Brent Vaughan, CEO of Cognoa. The Palo Alto, Calif.-based digital health company just launched Cognoa for Employers, an app that allows parents to assess their children for developmental delays, including autism.

Vaughan says companies that are conservative about benefits but pride themselves on being family-friendly are often surprised to learn they have the option of providing autism screening services. Such organizations have experienced remarkable results when employees have gained the ability to get their autistic children diagnosed at an earlier age, he says. Not only does that help ensure the child gets treatment, it also enables the parent to stay better focused at work -- or in some cases, remain employed.

"The employees who have kids that are getting into school age are quite focused on their career," says Vaughan. "They can't be focused at work if they are worried about their child's development at home. This is a benefit that is going to fundamentally change the lives of some of their most productive employees."

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Many employers fear that autism benefits will be prohibitively expensive, but Fessel says providing them actually positions employers to save money in the long run. By providing such benefits when employee's children are still young, they are more likely to receive early intervention which increases their chances of leading productive lives. That makes it less likely they will be dependent on their parents -- and their parents' insurance -- as adults.

Employers should consider several factors when deciding which autism-focused offerings are best for their workforce, according to Dylan Landers-Nelson, a senior analyst on healthcare cost and delivery at the National Business Group on Health in Washington. Working with their health plan partners, he says, they should review evidence of treatment and medications to determine if they are clinically appropriate. They should also attempt to quantify the effect on productivity by considering whether employees with autistic children frequently miss work due to their child's disorder.

According to Fessel, whose son is on the autism spectrum, an employer's willingness to assist with caring for such a child can be an effective recruitment and retention tool.

"If you have an offer from two companies and one of them has an autism benefit and the other doesn't and you have a kid with autism, that's a powerful incentive," she says. "And morale-wise, people feel like their company is rooting for them, rather than against them. That goes a long way."

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