Building Better Businesses in ABA
Building Better Businesses in ABA
Episode 57: Winter (Compliance Storm) is Coming with Rebecca Womack
Rebecca is like-mindedly passionate about all things compliance ... and is an expert in Tricare and what it take to build robust compliance regimes for your payers. She shares my conviction that "winter is coming" for our field if you don't invest in compliance. The good news? She shares some deeply insightful frameworks for how to prepare. Enjoy, kind listener!
Resources:
Rebecca on ...
>LinkedIn: https://www.linkedin.com/in/rebecca-womack-52189737/
>Facebook: https://www.facebook.com/profile.php?id=100004605044887
TONS of articles & resources in this Google Drive folder:
https://drive.google.com/drive/u/1/folders/0AH0-xx1RzWaHUk9PVA
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My name is Jonathan Mueller. I'm the host of Building Better Businesses in ABA Podcast, and my guest today is Rebecca Womack. She's the Vice President of Clinical Standards for BlueSprig Pediatrics. She also is the founder and CEO of RAW, that's Rebecca A Womack Consulting Solutions. In addition to, she serves on the standards committee for the Autism Commission on Quality, Council of Autism Service Providers Public Policy Committee, she has extensive experience in public policy, has been a subject matter expert for the Behavior Analyst Certification Board. Rebecca, welcome to the pod.
Rebecca Womack:Thank you. Appreciate it. So grateful to be here.
Jonathan:I mean, my first question really is, is there anything you don't do but yeah. Is there anything you don't do?
Rebecca Womack:Oh my gosh, a lot like my laundry is piled up. I really need to like look at outsourcing it dishes. Um, yeah, I don't know. Truly though, I really feel like there's so much that I don't know, and I mean that in all sincerity. So I'm grateful that you have podcasts with such a diverse group of people that you interview because those are great learning opportunities just to connect with other segments of our field. So thank you for that.
Jonathan:Shouldn't we be learning all the time? Right. I think it's just, ah, that's a humility lesson that anyone can use. Well, Rebecca, one of the things I know you work with your clinical team on is ensuring that all your BCBAs, your behavior technicians, engage in clinical activities that align with our profession's standards of care, the research, payer policy requirements. So, my reflection on this is that number one, every ABA organization needs a Rebecca. Number two, that's why we're having this conversation, but, importantly, tell me about a project you're currently working on that exemplifies this.
Rebecca Womack:Oh, it's an a very timely question. I think right now our field is in a interesting position. There's lots of layers of things going on. There's audit results, there's policy changes, there's the cloud of VBC or value-based compensation that's coming in the future. At the same time too, there's also a lot of discussion around outcomes and the only way we get outcomes is through delivering services. And then that's where I've tried to turn my focus into the activities around service delivery. So a lot of people are really familiar with the CASP practice guidelines that talk about, recommendation to deliver 20% case supervision of all of those direct hours. One of the things that is often misunderstood is what that means. So a lot of people take the total number of hours. Let's say a client receives 40 hours a week and they translate 20% into requesting case supervision, or 97155. But what is often missed is the fact that case supervision and the practice guidelines are defined as activities that encompass both direct and indirect services. And so, another topic right now that's really hot in our field is, the topic of burnout. And thanks to a lot of work that Sarah, Troutman has done. And so I wanted to really look and see if there's a way to identify, a work week that's 40 hours that's feasible, that incorporates embodying the practice guidelines into a schedule over the course of a month with a caseload and what that actually looks like, but that's also true to life, that accounts for times you need to email, taking a work break or having a caseload in the community and what that looks like in terms of drive time so that there can be, I guess a better expectation management around how to spend time, how to delegate activities and so that is where I've been living in the weeds for the last couple of weeks.
Jonathan:Then I have to ask have you found that it's possible to do, given the practice guidelines, given the realities of a 40 hour work week and caseload size and all the other factors, or TBD?
Rebecca Womack:Oh yeah. That's a great question. So yes, it's possible, under conditions, and I think that's the biggest piece is that the conditions for success have to be present. Like you can't just hopefully put your feet in there and get into it. You have to be really diligent, have discipline around time management. You have to have skills that relate to thinking about how you prepare for every session and how you wrap up every session, how you communicate with the clinical team or the RBT on that session. I think that's part of the disconnect right now because that, in my opinion, is its own subset of skills that are not distinctly taught in coursework or maybe distinctly addressed in internships. It's something that I think people assume that you learn over time and you pick up, but it's a disconnect that is ultimately resulting in underutilization of services. And what that's communicating to health plans is a lack of credibility in requesting what is medically necessary. And so health plans are saying this disparity between, Hey, you know, I'm a provider, I'm gonna fight for all these hours that I think the client needs. Largely the focus is on that direct 97153, but then because they might be over requesting case supervision and 97155, they're not getting to those hours. And so that push at the onset of services kind of fades away when they're not able to follow through for whatever reason, time management over committing. So I think it's super important because doing it the right way also means that you're more likely to secure better outcomes because you're delivering the service by performing all the activities associated with that service to ensure success. And it's all done within a feasible work week of 40 hours. So that's a long way of saying yes, it can be done for sure.
Jonathan:This is an unspoken thing in our field, Rebecca, tell me if I'm wrong on this, but utilization across different service codes is so poor, and I hear this from payers as well. It is so poor It's almost like, if you're given an antibiotic regimen, What do you do? Do you take 6 of the 10 pills? No, you take all 10 pills. if you're, with your oncologist, do you take some subset of radiation or, chemotherapy treatment? No, you take the full amount. The medical model that we operate in, says when there's a prescription, you follow that prescription. Yet that doesn't happen in ABA and there's lots of different reasons for it, but what do we have to do here, to hit similar levels of medical prescription dosage?
Rebecca Womack:Such great analogies that you're making, what I think sometimes happens in drawing those parallels over into our field is that the prescription process in healthcare, It's marked by, you know, prescription filled bottles. That meeting with the pcp, you've got your directions and you have that context. But the context of ABA services, there's first of all this huge spread. You're in a home, you're in a school, you're in a community, you're in a center, and then you're wearing plain clothes. And you don't have this like clock in, clock um, maybe you do at some centers, but you don't have a time card. And so the umbrella of what, a prescription looks like starts to fade away and you're in this gray area. And then life comes in and you understand that parents have to cancel, that people get sick, that a pandemic happens. And so those contingencies start to like loosen and unravel and so does the medical necessity with it. It's still there, but the impact of what is medically necessary becomes less and less relevant because you're not delivering according to what has been prescribed. And that's what, some of the literature coming out, early this year talked about. There's a couple of articles by Choi et all, and um, I'll share them with you after we talk today if you want, that looked at long term outcomes over the course of a couple years. And while they started out with a larger N they were only able to analyze after a few years, a small subset because of attrition, discharging, low utilization, and so getting to be able to even study outcomes, where clients are utilizing what is requested because they're able to, is not as, common as we would like it to be. And so I think we have to go back to figuring out, really figuring out how to make that work to get to the data that we need.
Jonathan:Yeah, so something you said like super freaked me out. And that is, with that a titration away from dosage means that medical necessity lessons, right? Which calls into the very question like, ABA right now is considered medical necessity, from a sort of payer's perspective and an obligation for payers to fund services. And so I'm trying to think of like, what are the mental models around how we approach this challenge? At one point, I know one of our conversations you described, maybe give the example of, Texas Medicaid and some of its requirements around adherence to treatment dosage and how you and BlueSprig and you think our field are thinking about that?
Rebecca Womack:Yeah, that's a great point. So I do think, a lot of the emphasis of success has to be on the antecedent interventions. So expectation management from the forefront, it definitely starts, first of all with the provider. If they don't have that right mindset about what it takes to deliver services so that they're able to be fully utilized, they're never gonna be able to get there with the family. So they've gotta have that skillset and that mindset. And then with the family, having those discussions with them from the beginning and explaining to them, Hey, Look, I've assessed your child, I think I'm recommending they need at least 40 hours, per week. And if the family, for whatever reason, cannot commit to at least 85% of that, Texas Medicaid says that that jeopardizes essentially their ongoing authorization of services. So what's interesting about all that, you know, up until recently, in the last maybe five years, we really haven't had much in the literature that addresses the concept of what is full utilization, what's the definition of that right now we say ideally it's a hundred percent of what you've requested you fully utilized. So, in studies around 2017 or 2019, they identified full utilization as using 80% of what was recommended for services. So, interestingly, Texas Medicaid a requirement into their policy for ABA services that 85% of services of what was requested must be utilized over the course of authorization for services to continue. And that's for all CPT codes, not just 97153. But this includes family guidance, it includes the case supervision under 97155, so at BlueSprig, instead of focusing on that requirement just for Texas, we've made that a requirement, for all of our providers so that when they're communicating with the family, we let them know, Hey, we're here to support best outcomes and this is our path. If that doesn't work for you, for whatever reason, we're happy to help shepherd you to another provider that can meet you where you're at, and work with you from there. I don't wanna say that that's exactly where we go to. We definitely try to work with the families. We have a lot of contingency plans to try and get them to that requirement before we reach the ultimate destination of maybe we need to refer you out. But I think we have to understand that if we're really gonna get outcomes that speak to the whole of ABA services, we've got to deliver the whole of ABA services
Jonathan:I appreciate that you're holding a high standard to that. That to me feels really important in medical necessity. But just to make sure that I'm clear on this, Texas Medicaid as a program, if families are not accessing the 85% plus, then the Texas Medicaid program will not authorize services going forward for them.
Rebecca Womack:Ultimately, yes. So again, there's a process there. It's not just a hard and fast, A then B, but ultimately, that is where that could essentially put services in jeopardy. It's a lack of full utilization at or at least at 85%.
Jonathan:All right, so I'm gonna put you on the spot. I'm gonna put myself on the spot first, but if someone put a gun to my head and said in the ABA field, what percentage of dosage do you think gets fulfilled? Easily, I would say under 50%
Rebecca Womack:Of what service line would you say?
Jonathan:Across all services. Across all services, I would wager that it's under 50%. And again, I had a conversation with a payer a few months ago, as payers who are better than anyone else at thinking about utilization and, cost management, et cetera. It is described that, ABA services were not nearly as expensive as they originally forecasted, many years ago. And why is it? Because providers, families don't access the authorizations. I won't put you on the spot, but if you have a thought across the 7,000 ABA providers out there, or however many organizations there are, what you think utilization is across codes?
Rebecca Womack:I think that's a great question. For me, I see it in terms of lines of service. So for direct, I think that's gonna be the highest, probably around maybe 60, hopefully 70%. And then the next lowest service would be direction or 97155. And that, payers have reported 50% utilization, a range of 50 to 60% utilization. And then from there, family guidance I think is probably, anywhere from 10 to maybe 40%. Hopefully it's higher. But that is the area where really services are lacking for a lot of reasons, but yeah, that would be the worst for sure.
Jonathan:10 to 40% of the parent training, and we know how phenomenally important it is that we are generalizing skills across different caregivers, right? Not just the RBT and the BCBA, parents and other caregivers have to be able to do that. And that's 10 to 40%. That's insane Rebecca.
Rebecca Womack:That's my estimation. That's not necessarily specific to BlueSprig or any company, but that's where, given just conversations, consulting, it's the code that I think providers, behavioral analysts struggle the most to deliver consistently.
Jonathan:Ah, so this is where I, and believe you, me, I understand at an intimate level all of the things that might get in the way of a provider or a parent being able to access authorizations and get to the levels of utilization that, a Texas Medicaid or others at the 85% plus require. But, what this brings me to Rebecca, honestly, is, and I think you and I share this conviction that there's this compliance storm that's been building. I won't put words in your mouth, let me say, I think there's a compliance shit storm coming for our field and go no further than like OIG right now is doing audits of ABA Medicaid programs across the country, and those results are gonna be coming out in 2023. And I think those results are gonna be similar to what, that report TRICARE released a couple years ago that effectively said 70% of all ABA services, families reported that it's not helpful. And so I don't know what are some of the early warning indicators that you are seeing that this compliance storm is coming? Maybe even more importantly, what do ABA practices need to do to prepare for it?
Rebecca Womack:Well, I mean, you're so right, there's a lot happening in the field when it comes to our performance as providers with audits. It's not good. And from my perspective, there's definitely been, a response from health plans, whether they're commercial or medicaid to those audits, and not just those audits, but also their internal audits. And by that I mean I've seen increase in the specificity and the language in their policies. And the intent in my opinion, is really to safeguard services. But sometimes there's, like maybe an overstatement of restricting certain activities, that are essential for us to deliver ABA services according to generally accepted standards of care. Excluding, charting skills, excluding being able to perform certain activities associated with the AMA definition of the CPT code. And, that in addition to just communicating with payers about work products, there's some really difficult, things that I can't speak to or answer for. Examples are goals that relate to a person's thoughts about their faith in God as a goal being targeted during a service. That was an example that was brought up and look, that's important and that's valuable, is that a goal that can be measured as written in ABA? Without more context, I don't know how. And so there's challenges with the caliber of work that's being sent in. And all of those examples are not meant to speak for the whole of our field because there are excellent providers in our field. So I don't wanna be this doom and gloom type of messenger, but there's enough data points with work products that don't necessarily meet the definition of high quality that are causing payers to really look at how they can still safeguard what they're requiring so that their customers, which are our clients, get the services they deserve. And that's unfortunate. So in terms of what providers can do and organizations can do, I mean, if you're starting now, it's never too late to start, I would say, but, you have to be really diligent and understand that compliance is not a cost, it's an investment. It's an investment in your future. It's an investment in your sustainability of your organization. It's something that will bring good return, not just in safeguarding auditing, it is truly about the quality of services that you're investing in, the best services for the families that you provide care for. The OIG gives, seven steps for setting up a compliance program if you, really don't know where to start, that's a great place to start. And I think it's also important that if you're looking to set up a compliance team, or if you're looking to maybe deepen the skillset of your compliance team to make sure that the members are multi-disciplined, that they come from different backgrounds: healthcare, behavior analysis, revenue cycling and management. So that you get that needed lens across the whole of the service to ensure that you're accounting for all those different variables that can impact sustainability and quality care.
Jonathan:Let's put a pin in that seven steps of setting up a compliance program. I'm gonna dig on it, but before I do, something that payers can do really easily is say, all right, well, all ABA is bad and therefore we're gonna slash rates, or we're gonna have increasingly restrictive, protocols that providers operate against. And that's just, that's a blunt force instrument and it seems to me, but Rebecca gut check me on this, that a simple solution instead of just trying to push ABA providers to become more compliant and set up OIG and other compliance programs is instead create a carrot and tier a payer network. Right? And we can debate separately on how you would define different tiers, whether it's by accreditation or meeting certain, intake metrics or outcome metrics. Who knows? Put that aside for a moment, but having those tiered networks, wouldn't that separate the wheat from the chaff and organizations that to your point are investing in compliance and investing in, fulfilling, authorization dosage and, quality assurance programs. Everything else that comes with what we know is the beautiful science of ABA. It's not a simple answer, but isn't that the answer instead of the blunt force instrument?
Rebecca Womack:Agree. I think that that's where things need to go to support improving all the ways that you just described. However, one of the constraints around that possibility is how our services are delivered now, which are pretty insulated. So by that I mean we deliver services in a center. We might have OT or ST there, but maybe not, not all do. Or we're in the home, we're in the school. There's this vacuum around what we do. And if we're delivering services alongside maybe a healthcare provider, a dentist, a pcm, those services are often not reimbursable because that's considered double dipping. Get that completely. So one of the hallmarks of a value-based care model is collaboration of care, and integrating that care. And I don't think that we can get to, the type of tier model that you're talking about with at least accommodating for an increase in collaboration of care because you cannot look at a client as just having a singular diagnosis if they have other diagnoses and expect improvement, in them as a whole, if they're being impacted by other things that you're not allowed to address. And, and that makes sense, right? And so that's where that piece, there has to be a framework there for our field to navigate in, appropriately to get to the outcomes that you're talking about. But I think that's where we absolutely need to go for sure.
Jonathan:Uh, so well said. We just had on the pod, Dr. Steve Merahn who's a pediatrician, said the same thing, right? Interdisciplinary care is not integrated care. And so to your point, that has to be how we collaborate with others, how we get reimbursed appropriately for that collaboration feels really important to separating out tiers of network.
Rebecca Womack:Absolutely. And right now Tricare is one of the funders that has a steerage model. I'm, not exactly sure how, what metrics they use to inform the model, and there hopefully is information out there somewhere, but I know that there's certain things that providers do or don't do that impact where they sit in that model. So I think it's good to have preliminary ways established. But right now our field feels a bit behind healthcare and where it needs to be. We've got the influx of technology. There's different products right now that are impacting our field and we've got to think ahead faster. Doesn't mean we have to make impulsive decisions, but we've got to think ahead and be more sophisticated in how we're deciding, what to do with outcomes and services so that all of this truly is for the clients who get services. It's all about them, that's it, so that they get what they need in the day and age that they're getting those services in.
Jonathan:Amen. Thank you for bringing back to the kids, right? Everything we do as providers and everything we work with payers on has to be ultimately in service to not ourselves, but the outcomes, and the kiddos we serve. That's well said. Well, I wanna get practical on this now, Rebecca, maybe this is the OIG seven steps model or something else, but I'm curious if you have a framework for what a good compliance regime looks like. Again, either OIG or BlueSprig or just how you, like, what your mental model is for that. I'm very biased cause, I lead a revenue cycle management organization, but my framework is generally in the context of upstream to downstream revenue cycle management. That is how are your contracts set up? And, are you compliant to those? How do you credential your providers? How do you check benefits and insurance eligibility? How do you get authorizations? How do you document sessions in the right way? How do you bill in the right way, respond to auditors? So again, I have this bias and frame around revenue cycle, but how do you think about the right mental model with compliance?
Rebecca Womack:I mean, you did a beautiful job of describing what I'm envisioning in my brain or what I have in my brain. What's difficult with compliance is that it is this kind of spider web that's imposed over an organization, and that spider web has connections between all the different moving parts, whether it's the activities of the providers or the operations at the center. It's the C-suite team, decision making, all of those decisions, all of those activities, all those job descriptions, to some extent, impact compliance. The informed compliance. It's about what you've talked about. It's about licensing, contracting, credentialing laws, policies, what you bill, what you don't bill, how it's put together, how it's documented. And so that compliance program has to encompass, to some extent, the ability to capture those elements in a multidisciplinary team. So that's where you have healthcare, that's where you have a behavioral analyst. And it's not just a behavioral analyst, but someone who is informed about public policy, who can stay up to date with laws in your state or states where you have organizations in. Who understands advocacy, who knows about ethics and the intersection with payer policy, and then also someone who's fluent in RCM contracting and credentialing. And that compliance department has to work in concert in close collaboration with all other departments because as time moves forward, there's so much that happens with billing, with services being delivered, with data points being collected. It's kind of like a symphony if there isn't a concert going in harmony one misstep or negating one department or one department moving in isolation away from another causes such a disruption of information. And it's not that it's irreparable, but it becomes much more effortful to make it work well. But if there's collaboration, then it makes the whole thing completely different, it changes the whole dynamic.
Jonathan:So for smaller providers, Rebecca, who maybe haven't thought about this idea of compliance as an investment, not just a cost, but an investment. And knowing there's so much, it's a beautiful analogy around the symphony, I can like picture this in my mind right now. What is the first step you always recommend to a smaller provider who wants to do the right thing compliance wise and just doesn't know where to start?
Rebecca Womack:Oh, that's such a great question I appreciate you thinking about smaller providers and I'm in a larger organization, so that's where my mind sometimes goes. It is for them to, first of all, hear my apology, that is a flooding of information and that's a lot. But this is still achievable for you. I would definitely start with documents that are already, developed in our field. The CASP practice guidelines, the model coverage policy, the supplemental guidance from the Coding Coalition. Review all their documents on their page, by getting yourself familiar with what our field has already established as generally accepted standards of care, models of payer policies, um, white papers. That is like half the step, and what a lot of providers are lacking is that information, it's information that's rooted in our behavior analysis, our field, but it's linked to healthcare. It's the bridge to understanding how do we act as providers who are rooted in our field, in a healthcare world that we don't really know a lot about probably. And if you can do that and then after you've got that kind of under your belt, develop some really good auditing practices and habits and get a good cadence going, you've got a huge chunk of compliance out of the way.
Jonathan:So true,. and I'm gonna drop a link in the show notes to a number of those documents. I think it's, that's so important, awareness or fluency in that is always the first step. I always like to recommend providers If you take commercial insurance, make sure you've got a copy of your signed contract, know when it's going to be coming up and, know what's in there. Have the provider relations manual, and just start there. Pull all of those things into one place. And even I'm surprised, right as I go back and we're working with like 90 different insurance companies at Ascend. Every time I go back and read one, like there's something new that it sparks. So compliance is not like this end game. Oh, you're compliant, so you're good. It's a process of continuous improvement and learning and incorporating those feedback loops
Rebecca Womack:Totally, a hundred percent. And that's actually, I. like the fun part of it is, having some really well developed tools that support a good auditing process, and then aggregating that data, identifying areas of opportunity in your item analysis, and then developing a training plan to target those opportunities so that you learn as you go and then you can watch your data over time and hopefully if your interventions with your training and, and some of your changes in your operations. are right, you can see improvements. And then again, all that improves, you know, maybe some revenue, and performance on audits that's second to the clients, the children, the families receiving better services because of that improvement in your compliance program.
Jonathan:So true. You know what I'm envisioning here, Rebecca? It's almost like, we've got treatment integrity checklists. There's like compliance integrity checklist, which I don't know if those exist. I think like the OIG and some of these other models, are out there, but it's yeah, just check how you doing against that checklist at intervals to tell you if you're improving all the time. And gosh, just watch that graph go from like middling to hockey stick.
Rebecca Womack:That's awesome. Yeah, I think that's great and I like that you have that appreciation as well, because the more that people can, if you don't even know anything about what we're talking about, that's okay. But the more you learn, the more you implement, the more it catches on and it really does make a huge difference in, in what you're doing.
Jonathan:And this is part of that, my comment earlier around the compliance storm that's coming is, compliance right now maybe there's sort of a perception in our field that that's a nice to have, but no, the medical model is this is a must have. And so just starting with that fluency, as you described, is important. One of the things, Rebecca, a few months ago, at the, Autism Law Summit you did, it was a full or a half day session on Tricare. You are glutton for punishment. So I love that about you. What I've always understood in my, years in the autism services field, but what I'm about to say applies across all of healthcare is that Tricare, where their requirements go, all other payers requirements end up going. I feel like I've seen this in a number of different ways over the years, whether it's rate adjustments and decreases or it's, increasing protocols on the types of assessments that are required. I mean, the list goes on and on. I just love your perspective on, how you've seen increasing compliance regime at Tricare, how that's evolved over the years and then what that pretends for other payers future behaviors.
Rebecca Womack:interesting, It's been an interesting process to observe, like, when I think back about all the different cycles Tricare, uh, operation manual or, or the TOM, has gone through, say that, um, over the years, what has been done has, from my perspective, has been done with the best of intentions. The DHA set out to figure out, because they don't accept that ABA is, evidence based according to how they evaluate evidence-based research, and so study it, and so I'm thankful that they are. And so over the course of the years, they've tried to figure out the best way to do that in a form of a policy. And so some of those iterations of the policy have had good intentions, but have been misplaced and to their credit they've made changes very quickly. However, in 2017 and 2018, the OIG audited providers in both, two of the three regions at the time. There's two now, but there were three in the past, and providers did very poorly. They weren't auditing auditing the providers for save, but what they were auditing is the contractors of the MCOs oversight of the implementation of the benefit and, found that providers were submitting notes with, lots of challenges. You should definitely read the reports if you haven't yet to see what those were. And parted an effect of those audits was a very constricting tightening of the policy in directions that, unfortunately have cut out some of the services identified and are generally accepted standards of care and the code definitions for the AMA. I think there's, again, I think it always comes place of good intent and reasoning based in the audit findings and current work products that providers are submitting. But what that's done is, it's departed the delivery of services from the whole of our science that is being delivered, in other policies with healthcare. And to your point, they've started to set standards of, we have to do these assessments to get this information. And we've seen that ripple effect across, other health policies, commercial policies. And so one of the things that, I'm thankful to do as a public policy member with CASP is to advocate with TRICARE right now to say, Hey, look not negating the fact that TRICARE providers have had challenges, and we absolutely own that. However, you've made some great changes in this current policy that reflect safeguarding the implementation of the science, and you know, that's wonderful. Our encouragement is for you to continue to put the onus of implementing quality services on the provider's shoulders and not cut out the science so that the family isn't suffering the impact of that. And that's the focus for advocacy because the risk is in the ways that other health plans have followed Tricare. They may choose to follow this way as well, not understanding the full picture or all the context. So there's always risk there and thus the effort to engage.
Jonathan:Yeah, I will absolutely include a link in the show notes to that report. And, I know there have been many ABA providers over the years who have sort of made what feels like the quote, unquote simple decision of, oh, let me just leave the TRICARE network and then things will be good. Whatever an individual ABA practice decides is up to them. I just, I think with this coming storm, whether or not you're engaged with TRICARE now and you're contracted in network and following the TOM, start working your way toward getting there because other payers are gonna get there as get as well.
Rebecca Womack:Absolutely. And you know, there's always two tracks, this is one thing I try to convey to providers is there's two tracks. There's the policy, and look, if you sign that contract, follow the policy, it doesn't mean you have to like, it doesn't mean you have to agree with it. But if you have pain points, which there are pain points, raise those with the policymakers. The DHA has been very clear that, if there are policy design challenges that they have made their email available to providers and providers should use that and communicate with them. If there's difficulties with the implementation of the benefit connect with the MCOs and the MCOs have been really excellent to connect with and, from my experience to work with, to address those challenges. And so I think you're absolutely right because those habits following the policy and then advocating outside of it, whether it's TRICARE or any other payer, are essential for maintaining that relationship. Because if the policy improves and you're contentious with the payer, it's gonna make for a difficult road, however long you're in contact with the payer. Right? Like that's awkward. You don't wanna be stuck in an elevator with someone you're fighting with. You wanna get along, right? And so that's the point there.
Jonathan:Absolutely. And to clarify, MCOs manage care organizations and in tricare, because TRICARE doesn't directly manage the benefit. Right, and the network and authorization. So for Tri West, that's MHN and Tri East, that's Humana. AND so those are the ones that are actually implementing and building the networks and following the TOM guidelines and all of that. Rebecca, you have a line on, I think it's on your LinkedIn banner that says, speak up for those who cannot speak for themselves. And I think it comes from Proverbs, originally, I just think that's beautiful. What inspired you to live that beautiful conviction?
Rebecca Womack:Oh, um, well, thank you. I don't presume that I know what others, who can't speak or who don't maybe have the abilities to express themselves in the way they want, that's meaningful them, I don't presume that, but I can speak up and ask and advocate for the fact that they be given access to the type and level of services and opportunities that they deserve according to our field's generally accepted standards of care. When communication is hampered in someone with a disability or without that bridge to being able to release, the ability to communicate is creating that opportunity. And that opportunity has to be accessed through advocacy work, which is including asking for ABA services aligned with our code of ethics and all the other things we've talked about. So it's around the thought of understanding that, I don't speak for anybody, but I can certainly ask that they have the opportunity to speak.
Jonathan:So well said. Well, Rebecca, what's one thing every ABA practice owner should start doing and one thing they should stop doing?
Rebecca Womack:Huh. You know, I think when it comes to leaders, one of the things that, leadership is associated with is a weight and one of the weights is being observed. So everything you do teaches those that you lead who are watching you and you teach whether or not you realize it. So you teach in how you treat others, how to respond to pressing conditions, how to handle conflict, stress, joy, all those things. So I guess think about the fact that, if you measure your behavior and your words with this in mind, people are observing that and that's a different kind of, leading than if leading, not realizing that people watch you even when you don't realize it. When it comes to maybe stop doing things, I guess I say this maybe more to myself, although I'm not a ABA business owner, but, I think it's important to stop thinking that you have all the answers. Because over time, you learn more so you you're able to answer more. But there is a great freedom in asking for help or seeking guidance from others and learning from others. So even things that are in your wheelhouse that you're really good at, it's good to ask and reach out, to others for support.
Jonathan:Wow. I love that there is great freedom in asking for help. Yes, and yes. I don't know about you, Rebecca, but every time I learn some more about anything in life, it only opens up this like window to all the, that many more things that I don't know about that particular topic. Yeah. And for me, our field is a great example of that. I learned more than it's like, oh wow, okay, now I'm ready to go down this rabbit hole. So it that's so true. Uh, Rebecca, where can people find you online?
Rebecca Womack:so I'm on LinkedIn and I also have a website. it's RAW Consulting, so R-A-W, RAW Consulting I have a consulting business where I work with ABA organizations, healthcare organizations on all the topics that we talked about on a limited basis, but I do it one because I love it. I love connecting with people in the field and wanna help where I can. And then I'm on Facebook, I guess as well, although I'm not very social media savvy as I would like to be,
Jonathan:Well, I will drop all of those links in the show notes. Um, alright, well, you ready for the hot take questions?
Rebecca Womack:Yeah, sure. Fire away.
Jonathan:All right. You're on your deathbed. What's the one thing you wanna be remembered for?
Rebecca Womack:I would say that I don't want you to remember me, but if you want to think about me, Then think about what I cared about and if that matters to you, then go and do something about it.
Jonathan:I have goosebumps from that. What's your most important self-care practice?
Rebecca Womack:I would say going outside in the evening light. by that it's like the light where the sun is setting and it's just, there's golden light everywhere. No matter what kind of, um, day it's been, good or bad, there's just something about going outside and soaking in that light and putting the largest of experiences into proper perspective. It kind of just minimizes the day in a good way.
Jonathan:What's your favorite song?
Rebecca Womack:I don't have a favorite song. I am not a music buff at all. I like music in general. I like to run to music. Uh, Judah and the Lion is a group that I like, but I'm sorry, that's a lame answer, apologize.
Jonathan:No, it's not at all. Hey, Judah and the Lion super fun and I love that you use that for workouts, uh, and for running. Well, if you could give your 18 year old self one piece of advice, what would it be?
Rebecca Womack:I would say it's okay if people don't like you. That's okay.
Jonathan:Wow. There's vulnerability and power that comes with that. Nice. And, alright, you can only wear one style of footwear. Which would it be?
Rebecca Womack:I am gonna have to go with Brook's Shoes specifically. I think it's called Cascades. Um, they're like a trail running shoe. They're great for chasing goats and or puppies. And going on runs
Jonathan:I love it and, and or maybe pigs. I mean,
Rebecca Womack:pigs.
Jonathan:some extraordinary pigs that I've been fortunate to see videos of that are just literally.
Rebecca Womack:Forgot about that.
Jonathan:Uh, Rebecca, thank you so much for coming on the pod. This has been a deeply insightful conversation.
Rebecca Womack:Thank you for having me and thank you for creating space for this topic. I mean, it's not necessarily the most thrilling thing to talk about, but I appreciate it cuz it is so important. So thank you. You're a great guy.
Jonathan:Thank you.