Micah Friddle has worked as a behavior analyst, co-owned an ABA practice, led accreditation evaluations at BHCOE, supervised utilization management at Centene Corporation, and now serves as VP of Payer Strategy at Blue Gems ABA.
He recently joined Motivity’s Scientific Advisory Board to bring the one perspective that is rarely in the room when ABA technology decisions are made: the payor's. We asked him what that side of the table actually looks like and what he thinks the field needs to understand better.
What made you want to join Motivity’s Scientific Advisory Board?
I believe that the field of ABA is at an inflection point. The scrutiny being applied to ABA and the decisions we make as clinicians has never been greater, and how we respond in this moment will shape the field’s future in enormous ways. One key to ensuring that ABA remains effective, accessible, and accountable is having robust tech platforms that are able to support clinicians in making scientifically sound treatment decisions, and communicate their work clearly. I have been impressed by Motivity’s commitment to bring together voices from across the ABA landscape to support practitioners’ present needs while also evolving and adapting to the changing regulatory realities. That kind of partnership is crucial to our ability to continue bringing our life-changing science to the communities we serve, and I’m excited to contribute my perspective to that conversation at Motivity.
You’ve worked as a clinician, run your own practice, evaluated quality at BHCOE, and reviewed authorizations before your payer strategy role. Having seen both sides of the table, what do providers most commonly misunderstand about how payers make utilization decisions?
There are two notable gaps in many providers’ understanding about the payer side. The first is that many providers seem to believe, implicitly or explicitly, that it is the goal of the utilization management (UM) departments to deny care as much as possible, which couldn’t be farther from the truth. Most payers now have BCBAs® and BCBA-Ds making UM determinations; these are people who are clinicians first and care deeply about both the field of ABA and the community of service recipients. They are committed to making sure that every individual can access the ABA services that they need and that the field is continuing to grow in a responsible, sustainable manner.
The second important factor is that the UM reviewer making a decision about whether a requested course of treatment is medically necessary is reviewing sometimes a couple dozen requests a day, has only a few minutes to make a determination, and is basing that determination exclusively on the records that are in front of them. It is therefore essential that the plan of care is written in a way that makes the medical necessity of the requested treatment salient and explicit. Strong clinical reasoning that isn’t clearly visible in the record might as well not exist for purposes of UM review!
Having navigated ABA from different sides, what connective threads matter most for sustainable practice operations?
Two threads run through every position I’ve had. The first is that the clinical story and the operational record have to clearly align. Good data is what makes good treatment decisions possible, and that same data drives authorizations, billing, staffing, and every other practice decision. When documentation is an afterthought, the impacts show up through every layer of the company in the form of denials, rewrites, peer-to-peer calls, lost treatment time, recoupments, and other costly consequences.
The second is assuming positive intent. Most providers are trying to do right by the families they service, and most payers are trying to make sound, fair determinations with limited information. When each side of the equation starts from that assumption, that’s when the relationship can shift from adversarial to cooperative problem-solving.
Those two threads are also themselves intertwined. Each side’s good faith holds up better when it’s backed by clear data, and the data only pays off when it’s approached with honesty and good faith. Assuming positive intent doesn’t mean skipping verification; it means having a shared record that lets both sides trust and verify, which pays off for providers by improving the efficiency of their practice operations.
When you think about Motivity’s role in the future of ABA, what stands out to you most?
The biggest shift that everyone is talking about, but few are ready for, is the adoption of Value-Based Care models. The adoption of VBC arrangements with payers seems inevitable at this point, and conversations are happening across the landscape, on the payer side and provider side, attempting to define what those arrangements will look like—what data is important? What is the connection between process measures and outcome measures? How can funders have visibility into relevant provider data? How do we quantify the value of our services? How do we tell if the model is working? How do we respond when the data aren’t favorable? These are all questions that sit squarely in the purview of the technology companies that are supporting providers, and Motivity in particular takes seriously its responsibility to support providers and their clients through the current and future regulatory shifts.
What do you hope this advisory board accomplishes for the ABA field?
ABA’s next phase depends on not only delivering high quality services, but also demonstrating the value of those services. That requires an understanding of the contingencies shaping each stakeholder’s behavior, including families, clinicians, business owners, payers, and regulators, and building tools that work for all of them. Motivity’s Scientific Advisory Board provides an invaluable opportunity to bring those perspectives together so that providers can keep delivering life-changing care and the field can demonstrate the immense value of ABA.
