As an ABA company, in order to provide the best possible care to clients in the long-term, your business must also be sustainable. Therefore, it is critical to understand the key metrics that drive your organization. In this article, we will discuss 5 key metrics that we track and make a big impact to the health of our ABA business. We’ll also provide some tips and advice on how you can optimize these metrics.

Disclaimer: The following article describes what we believe to be some of the most important operational metrics for an ABA business. Of course, there are a whole host of clinical and internal human-resource metrics we also track to ensure we are providing quality care to our patients and rewarding work environments for our colleagues. Those will be discussed in follow-up articles.   

Table of Contents

1. Staffing Speed: Earlier Intervention is Better Care
2. Client Utilization: Are Patients Receiving the Care they Need?
3. Therapist Utilization: Is Your Team Getting the Work they Need?
4. Billed / Scheduled: What’s Actually Happening 
5. Care Continuity: Measuring the Quality of Your Matches

Staffing Speed: Early Intervention is Better Care

The staffing speed metric measures how quickly a client can be staffed with their care team (minimally, a BCBA & BT). We calculate by measuring the number of days between the first day we have officially “qualified” a patient for our ABA care, to the day we have a finalized, verified, and introduced our full therapy team to our patients guardians. For us, a qualified patient is an individual that: 1) requires our ABA services, 2) is in the geography we serve, 3) has all the required documentation (e.g. neuropsych evaluation), and 4) has a verified payment method (e.g. insurance is verified). We choose to use the date a patient was first qualified instead of, for example, the date a parent first contact us, because there are often delays in the process of qualification that are out of our control. This metric is important because faster staffing speeds mean earlier intervention, leading to faster learning and growth of the individual. A fast staffing speed is also one of the best ways to market your ABA company! Many of our patients come from word-of-mouth referrals and parents are consistently impressed when we’ve been able to get them a qualified team quickly.

To optimize staffing speed, ABA companies can increase flexibility by maximizing availability of both clients and our therapy team. For parents, this means being transparent about the fact that increasing their availability means they have a better chance of being staffed faster. For our therapy team, this means giving them transparency into our waitlist, and notifying them immediately once a potential client for them joins our waitlist. This is something Teambuilder automates for our own practice. When a new client joins our waitlist, Teamwork automatically finds nearby, qualified therapists with matching schedules and sends them an email to see if they are interested. This technique alone has allowed us to consistently staff clients in less than a week. As one proud parent wrote in a review for us, “Teamwork was able to staff my family within 24 hours!”

A slow staffing speed can have harm your company’s reputation and financials. Therapists may quit because they’re waiting too long to get staffed. Families may leave and give up if you’re not able to support their child in time. Referral sources may stop sending you families if you don’t respond quickly enough. Even if you consider improving average staffing speed from 3 months to 1 months, earning an extra $8k of revenue per client on average, the biggest advantage will always be that you’ll be able to provide earlier intervention and support clients when they need it most.

Client Utilization: Are Patients Receiving the Care they Need?

Client utilization is a vital metric that shows the number of direct therapy hours a client is receiving compared to their target hours. This can be calculated on a weekly or monthly basis. Target hours are often the authorized hours, but in some cases, ABA providers calculate the target hours based on a different number. An example of this is if a client is transitioning toward a graduation criterion for ABA, they might have target hours that differ slightly from the authorized hours. Another example of this is when the client’s schedule does not permit availability of the full authorized hours. This metric is incredibly important because it shows if a client is receiving the care they need. In addition, direct therapy hours are one of the main drivers of revenue for an ABA business (and has approximately a 1:1 relationship with revenue). We’ve also seen a positive correlation between utilization and higher client retention.

The biggest blocker we see to a high client utilization is that many ABA companies stop working to staff a client after they have already started therapy. If a patient needs 25 hours of direct therapy a week, what we see often is that they are quickly matched to a BT that can provide 15 hours. The remaining 10 hours might be harder to staff, and often get deprioritized among all of the other duties a ABA company has. This is not only bad for a child’s progression, but is also leaving money on the table for your business! Proper ABA scheduling software can make this process a lot smoother by automatically identifying these gaps and suggesting appropriate therapists that can fill in a client’s schedule.

Therapist Utilization: Is Your Team Getting the Work the Need?

The most common question we get from behavior technicians during the recruiting process is: “do you have enough clients I can work with to fill my schedule?” ABA therapists, like everyone else in this world, need to make a living. This is especially important for hourly employees without a full-time salary. If you are not able to provide them with enough work, they wont be with with your company for very long! Turnover is one of the biggest challenges in our field and that’s why measuring and optimizing therapist utilization is so critical. It not only affects your bottom line, but also has a huge impact on retention of your staff (and therefore, an impact to quality of care as continuity of care appears to have a strong correlation to the number of skills acquired for our clients). To measure therapist utilization, divide a therapist’s scheduled therapy hours by their desired working hours. Similar to client utilization, this can be done on a weekly or monthly basis.

To improve therapist utilization, ABA businesses should aim to hire staff with availability that matches their waitlist availability. Additionally, adding more clients with varying availability (e.g. daytime vs. evening) to fully staff schedules can help ensure your full-time therapists can achieve their desired hours. This can be done by placing a concerted effort to increase the variety of your referral sources or by offering both center and home-based services. Finally, you should develop a process to regularly check-in with your technicians and suggest clients than can help fill those “holes” in their schedule. Again, this is something Teamwork can help you with by systematically identifying potential matches and automatically sending emails to those therapists to check if they are interested.

Billed/Scheduled: What’s Actually Happening

The billed/scheduled metric helps ABA companies determine the true utilization of their services. This metric is calculated by taking the actual billed hours for your client and dividing it by the number of planned scheduled hours. Whereas the scheduled hours shows the “ideal” circumstance, billed hours tells us what actually happened. We recommend doing this on a rolling 30-day basis (i.e. what happened the past 30 days with this client). You can separate this metric by authorization code (e.g. billed/scheduled for direct therapy vs. billed/schedule for supervision) or aggregate all hours into one overall number. This metric is important because it gives a more accurate representation of utilization beyond insurance authorization.

If you want to improve billed/scheduled, it’s important to figure out why the client is missing scheduled hours. Was it unplanned cancellations? Planned family vacation? Did sessions end earlier than expected? Billed/scheduled is a starting point that allows your clinical team to figure out which clients need more oversight. A 100% billed/scheduled metric is unlikely, so we recommend having a target rate that will cause a further investigation. For example, if any individual client dips below <80% billed/scheduled, then the BCBA assigned to the case will receive a notification asking them to document the reasons behind this. In addition, it’s useful for ABA companies can compare billed/schedule rates to clinical outcomes in order to determine the effectiveness of their care. Erika Byers, Chief Clinical Officer at Teamwork Healthcare, says “Tracking our billed/scheduled tells us more than just what the insurance has authorized. It shows us what is actually happening with each learner.”

Care Continuity: Measuring the Quality of Your Matches

Care Continuity is defined as the average number of days a therapist works with an individual client. This is important because it takes a long time to develop a relationship with a client, and if new therapists are being rotated in frequently this will affect the quality of care delivered. Additionally, keeping a stable team of therapists for each client can lead to better relationships and trust between the patient and their family, which can improve retention of both the family and your therapy team. A growing ABA business should monitor this metric closely to ensure that you are continuing to provide the same-level of quality care at scale.

To optimize this metric, it is important to have buy-in from the therapists before the match is confirmed. Are they aware of the client history and behaviors? Are they committed to commuting to this client location for the next year? Are they aware of any special requirements from the parents (e.g. we have a dog so no therapists with a pet allergy)? This information needs to be transparently communicated to a potential therapist up-front. Teamwork helps with his via our provider portal, where therapists can see anonymized information about the client and quickly confirm their interest to your scheduling team. In addition, once therapy has started, conduct regular check-ins with therapists and families can help ensure the relationship is working for everyone involved, and making any necessary adjustments can help maintain care continuity.

Conclusion

Tracking operational metrics is crucial for an ABA business to ensure they are providing the best possible care. From client utilization to staffing speed, it is important to closely monitor these metrics and continue to optimize them. By doing so, ABA companies can provide better care to their clients, retain their staff, and increase their bottom line. The use of ABA scheduling software can help streamline this process, allowing for better tracking and optimization of these metrics. If you’re interested in tools that better help you manage your business, book a demo of our software and take the first step towards unlocking the full potential of your ABA business!

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At Teamwork,we pride ourselves on being different from our competition. Teamwork is built specifically for ABA providers with a focus on clinical quality. We automate manual work associated with scheduling (e.g. calculating commute times) so your team can focus on what’s important: delivering quality care to your patients.

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