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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jonathan (00:30):
My guest today is Dr.
Gina Chang.
Gina is a BCBAD and licensedpsychologist and the CEO of
Autism Learning Partners.
She started her career as abehavior technician 22 years ago
and was captivated by thescience of ABA and seeing
children and family's livesforever improved by the science.
She's on a journey to ensureexcellence and access to care
(00:51):
for more and more families.
Gina, welcome to the pod.
Dr. Gina Chang (00:55):
Thank you.
Thank you for having me,Jonathan.
Jonathan (00:57):
Oh, it's so great to be here with you.
Well, tell me, I mean, 22 yearsin the field, so you are like
old school.
Um, you've been with, You'vebeen with ALP since 2015, I
think.
But when was the moment, Gina,that you realized you wanted to
make ABA your career?
Dr. Gina Chang (01:13):
I didn't, I didn't actually know anything
about ABA.
In college, I was a history andEnglish major and, really left
college, uh, not having any ideawhat to do with my life.
I think my parents were verynervous about me.
I'd always loved working withchildren.
Um, I'd actually thought I wasgoing to be a pediatrician
organic chem ensured that didn'twork out for me.
(01:35):
and, yeah.
And so a friend said she was apsych major and she said, well,
I'm, I'm going to be workingwith, autistic kids.
And I literally thought at firstshe said, artistic kids.
I really didn't know about thispopulation, but sure enough.
I needed a part time job andthey said well We'll hire you
for you know,$13 an hour.
(01:56):
And if you do a good job, we'llsort of do it on a trial period.
And I don't know there was justsomething about as I went
through training and learnedabout the science It made just a
lot of intuitive sense.
I think there were things thatjust resonated and then I still
remember walking up to the door,because it was all in home, of
my first client, and, I don'tknow, like, I literally, I can
(02:17):
picture it in my mind, knockingon the apartment door and going
in, and he and his family justchanged my life in so many ways,
because I think, you know, Ithink I'd always wanted to be of
sort of service and missionoriented work was really
important to me, but I thinkthat combination of then
watching change happen in frontof you, so seeing words come out
(02:41):
for the first time or thingsthat had really been hard for a
family.
you know, being able to go toTarget and him not throw a
tantrum because he didn't getaccess to a preferred item.
I mean...
I watched the family's lifechange and things that were so
painful become joyful.
And I think for me thatcombination of, the scientific
(03:02):
part, but then also the actualchange in a family's life part,
was just something that I hadn'texperienced before in any other
sort of, Part of the world thatI'd been dabbling in from a
educational career perspective.
So yeah, I mean it was thatmoment that I was just like how
do I do this?
And how do I do more of it?
(03:22):
And how do I become asupervisor?
So,
Jonathan (03:27):
I love that.
Gosh, the things that were sopainful become joyful.
I think that speaks to the powerof our science and our
treatment, right?
And what we, and the lifechanging impacts we make on
families.
part of what's so interesting tome about your story, you are a
classic, from mailroom toboardroom, a kind of journey.
And I want to hear more aboutyour journey to becoming Autism
Learning Partners CEO and ALPfor those who don't know, is one
(03:49):
of the largest ABA providers inthe country.
Tell me more about that.
Dr. Gina Chang (03:53):
Gosh, not, not something that felt very
intentional if I'm honest backwhen I was a behavior
technician, it became about howdo I become a supervisor because
I got married young.
We had very little money.
And it was like, okay, well, ifI can make, you know,$28 an hour
or whatever they were paying thesupervisor at the time, then
(04:13):
that meant my husband and Icould afford to live in Southern
California.
but then also just amazing doorswere opened it's always a bit
of, You know, luck, hard work,right?
That combination.
So I needed to get a master's tobecome a supervisor.
And, because I had been ahistory and English major, no
state school would take me if Ididn't redo my undergrad
(04:36):
coursework.
I had to get a certain number ofpsych units to be able to go to
Cal State LA, Cal StateNorthridge.
Right?
Great programs around me.
and I, that felt unfathomable.
And then, I was interviewedwith, Claremont graduate that
had a developmental psychprogram, but not really a BCBA
program.
And they said I could come inand sort of do that coursework
(04:58):
as a part of my program.
They would waive thatrequirement.
But then I got connected to awoman who was doing research in
ABA at Claremont McKenna, Dr.
Charlotte.
And I went to go meet with her.
And she just said, I don't takemaster's students, I only take
PhD students.
I was like, oh crap, go home.
I like, retake the GRE that Ihad not done well on.
(05:18):
change my application.
She took one student that year.
And it was me.
And to this day, I don't know...
how that worked.
but it really changed the courseof my journey because now not
only was I on path to get mymaster's, which was important to
get the the 28 an hour that Ineeded, but it just allowed me
(05:39):
to dive fully into the space.
I mean, and then I, able to getmy PhD, which really was not in
the cards, earlier, like thatwould not have been, um, Um, but
I loved it.
I actually really enjoyed theresearch.
and then I was able to do predoc hours with her so I could
get my license, which alsowasn't really that wasn't in the
cards necessarily.
Again, I was just trying to bethe supervisor.
(06:00):
so no, I think that, that wascertainly just a massive door
that got opened that, to thisday, I'm.
So grateful for.
and then I think I just, Ireally fell in love with
operations, which I think notnecessarily all clinicians are
really into, but, I spent, uh,almost a decade at it at Autism
Spectrum Therapies, which wasacquired by Learn just before I
(06:21):
left.
but there I really learned, Ithink a few things like one,
just operations have to betight.
To do what we do, especially inhome, right?
I mean, it is literally like UPSmeets clinical care.
I what you're trying toaccomplish.
So I think that work, andreally, a woman named Dr.
(06:42):
Andrea Ridgway was bothincredibly instrumental for me,
both in operations and inclinical development.
she taught me so much about whatI understand about clinical care
I did a lot of work with brieffunctional analyses when I was
there, but then also opened upservices for areas of California
that didn't really have greataccess to care and loved that.
(07:03):
Like loved the idea that I wasgoing to build infrastructure
around training and access thathadn't existed.
That really was a spark for me,in that time.
Those 10 years were really bigfor me as far as things that I'm
deeply passionate about.
Jonathan (07:17):
Is that so crazy how X post factor looking back, it can
feel like everything like fellinto place to make it happen.
But like the reality of so manyof our journeys, it's wow, this
little moment changed where thetrajectory went, but you know, I
want to probe more on, onoperations and you cannot be
more correct Gina that,particularly for in home, but
for any type of ABA services.
(07:38):
If you don't have the tightestoperations,
Dr. Gina Chang (07:41):
Yeah.
Jonathan (07:41):
you cannot be successful.
And especially in this time ofcompressed margins and
increasing wage rates.
And, we've known each other for,I think almost a couple of years
now, but when we chatted at theCasp CEO event, I was just blown
away for how you brought thisoperational mindset just to
describe the work that, that youdo and ALP was doing, but that
doesn't get taught in schools.
(08:01):
Doesn't even get taught reallyin an MBA program.
So how did you build your reallykeen operational skill sets and
the mindsets that you knew youneeded to be a successful
leader?
Dr. Gina Chang (08:11):
Yeah.
Um.
Man, and it is, it's, it's thesame thing where you just have
different people come into yourlife at sort of different key
moments.
So again, I think Dr.
Ridgeway was like, I think whatwas so clear in our work
together was you have to managethe relationship between your
sort of supervisor costs andyour behavior technician costs
(08:32):
one piece of advice I would giveto anybody, it's that
relationship and the caseloaddynamics that will, from my
perspective, with how we arepaid today, right, the context
you're in, is really drives theability to build sustainable
businesses.
So I think that was probably abig nugget of truth I had that I
(08:54):
took when I came in as Chief ofClinical Operations at ALP.
But, I would say the next bigpiece was I worked then really
closely with the CEO thatbrought me in to ALP, who was
just really great one of thefirst things we did was put in
place a balanced scorecard.
And so for us that has, youknow, a people column, an
operations column, a clinicalquality column, and a growth
(09:16):
column.
So those for us, at the time,again, all your context, right?
At the time I was landing atALP, the business was in not a
good spot, we needed, some realgrowth to balance overhead
costs, and we needed to reallyroot the team in clinical
excellence and operationalexcellence.
And so that scorecard, was socritical to that.
(09:36):
And then it was just everymonth, I mean, that, routinized
focus on execution.
and they were toughconversations, so you know, you
don't transform a business byall good stuff, right?
There's going to be hard momentswhere there are honest
conversations about where theperformance of the business is
going, and I think that, thosethings for me were so
(09:57):
instrumental, in what hasbecome, a toolkit that I really
depend on in how we lead thebusiness.
Jonathan (10:07):
Hmm.
Tell me some more about, thebalanced scorecard is this
concept that's been around, Ithink for at least a couple of
decades, right?
But it's much newer to ourfield.
I want you to tell me a littlebit more about that.
And also, this idea that theimportance of managing that
relationship between yoursupervisor costs and your
frontline workers and what, whatdoes that actually look like day
to day?
60
Dr. Gina Chang (10:27):
So I think as far as the balanced scorecard, I
think for us it set the tone fora monthly review of the business
at the regional level.
So I mean, I'd say that's a bigpart of it.
Um, but you're right.
That other question you asked,Those metrics all float onto the
balanced scorecard.
So, just to dive more into that,what we really focus on I mean,
(10:48):
we call it gross margin, otherpeople will call it lots of
different things, but it'sreally how, you know, you can
look at a BCBA's product call itproductivity, hours they bill,
care they provide, all of thatgood vernacular.
But honestly, that, for most ofus, given the landscape of the
reimbursement rate, because, atleast in our organization,
(11:10):
they're typically only about 6070 percent billable, right?
So, there are other things theydo, um, that depending on how
you're being reimbursed, that'sthe level of Productivity or
reimbursed time we get from themand because of that typically
what they're doing is reallypaying for their costs they're
not generating anything thatSupports the rest of the
(11:34):
functioning of the business Ifyou were to have that position
say bill at 90 95 percent time,so If there is someone out there
getting 35, 37 hours out ofproductivity a week out of their
BCBAs, God bless you, we arenot, then that probably could
work as far as that being yourfocus.
(11:56):
but for us, because that isn't,we give them time for other
things, most of the margin ofthe business is made off of the
behavior technician hour.
Um, in this season, that'sobviously been, compressed a
lot.
And so there's, you know, workwe're doing there.
but that for us has been sort ofthat understanding.
(12:17):
So we want to pay our behaviortechnicians well.
And so in order to do that, youhave to really watch how many
behavior technician hours youcan have per BCBA.
That relationship becomes moreand more important in being
sustainable.
I think in a world where wecould imagine really great
(12:37):
reimbursement rates, then thatcan be less, like someone,
actually a guy at AST, Rob Haut,once said to me, when the, when
the tide is high, you don't knowhow much shit is at the bottom
of the ocean.
and I think that's just reallytrue, right?
I think about that statement alot, like when, you know, those
of us, and I wasn't inoperations at this time, but I
mean, there was a day when wewere regularly being paid 90,
(13:01):
100 bucks an hour.
For BT work, right?
That's not the world we live in.
This is not going back, 15years, 20 years.
And so yeah, then I think youcan do all sorts of things,
right?
Your BCBAs don't have to bill,it doesn't matter what the
caseload looks like.
you can have a lot of fun.
Um, but that's, that's not ourreality.
And if people have the same sortof reimbursement profile that we
(13:23):
do, which I think is not thelowest, but not the greatest,
you have to watch those.
To be able to then provide otherreally amazing things to your
team members, to your families,right?
To afford, um, the technologyyou need.
To afford, somebody else to doyour scheduling, and
contracting, and credentialingall those things that no
clinician wants to do.
(13:45):
you've gotta watch thosedynamics to have the resources
left over to invest in thosethings.
Jonathan (13:50):
This is so true.
from when we started Ascend fiveand a half, six years ago, we
said the same thing.
Like the true measures ofproductivity around caseload
size defined specifically as thenumber of direct therapy hours
in this pyramid.
under a BCBA.
and so I, I love that, your mindworks that way.
And like we're a human servicesbusiness, right?
we don't make widgets.
(14:10):
So unlike a UPS or some of theseothers where we could like
Dr. Gina Chang (14:12):
tweak some levers I know,
Jonathan (14:13):
levers and so this is the, I believe, hardest thing.
That organizations have to do tobe successful, even harder than
like the hard clinical deliveryof treatment.
So what feedback do you have forABA providers when it comes to
increasing utilization and justmaking sure the providers are
working as efficiently andeffectively as possible and in a
supportive environment?
Dr. Gina Chang (14:34):
Yeah.
Um.
Look, first, I'm not gonna lie,like, I think it's really hard.
You know, I think for us, and Idon't know that we do it well,
or always do it well, but Ithink it's been about, Also,
just, Just trying to be astransparent about this reality.
I actually read this great SimonSinek quote that said like
transparency isn't tellingeverybody all the details, but
it's telling them sort of whythe context for why the decision
(14:58):
is being made.
And I think that, you know,there is feedback I would give
is I just, I think giving yourteam levels of transparency.
I actually think.
A lot of humans, if they had thesame information you had, would
actually make a lot of the samedecisions.
It's, it's not that people, likemost of the supervisors we have,
(15:18):
or when I talk to them, they getit.
do we always do a good job ofmaking sure they understand the
why?
And that includes the financialwhy.
You know, I think sometimesthose of us who are clinicians,
would much rather talk about ourwhy clinically and, um, the
amazing clinical work and we doa lot of that, but it's also
about explaining the financialcomponent or making sure they
(15:40):
understand how the businessworks.
And so that was a part of thatscorecard.
That was a lot of what we weredoing month over month was
actually equipping the directorso that they could communicate
with their supervisors like,this is how the business works.
It's not like we need you tobuild 25 hours just, or 27 hours
just to do it.
(16:00):
yes, that maps onto clinicalcare, right?
If you're doing the 10 to 20percent, I mean, it lines up.
But we do monitor it alsobecause that supports the
sustainability of the business.
and that, that is our reality.
And let me then walk you throughthat, you know?
So I think for me it's, I wouldsay it's trying to bring people
(16:22):
along.
with understanding the businessand not trying to hide that from
them.
I do think sometimes asclinicians, we don't want our
BCBAs to have to get caught upin that stuff, right?
Or we, we don't want to feellike they need to worry
themselves and they shouldn't,but I do think if they don't
know the why behind the fullstory.
(16:46):
You know, you can share theclinical, but the full story of
the why, I think we do ourselvesa disservice in, in their
willingness to come along.
but again, I don't know that wealways do that well, but that's
our intent.
Jonathan (16:57):
But you've pointed something really critical.
and I think I had a mentor tellme once, this is the hard
leadership work that we get todo.
That is the teaching.
Not like just telling aclinician, one of our team
members, this is what you do,but like, give them that
context, teach them the why.
Being a teacher to help themunderstand, how certain
decisions have to be made.
this is so critical.
Why do you think as a fieldthat, we've shied away from
(17:19):
that?
Is it because we haven't wantedto expose, clinicians to the,
harder financial realities,right?
Or, what drives that?
Dr. Gina Chang (17:28):
I don't know.
I know my own journey, you know,and I know that even for me at
times, like, I have my ownstruggles with overextending
myself to care for people,right, whether that's in my
personal life or in my worklife, I will give a lot to, to
do right by somebody, to get itright, right?
And I think sometimes that cansort of overgeneralize to like
(17:51):
financials and budgets And Idon't doubt that there are
amazing clinicians runningbusinesses today that are either
running at a loss or bleedingtheir personal finances because
they are trying to do right, andbecause they will give of
themselves to that.
(18:11):
And I think, you know, that,that whole notion of boundaries
allow you to Give appropriately.
I actually think that's true, insort of your own emotional and
cognitive and sort ofpsychological development.
And it's sort of truefinancially.
to me that almost feels like abit of a universal truth.
And I think that's been my ownjourney it's actually really
(18:32):
appropriate to not Give outsideof what is sustainable so that
you can keep giving and you cankeep doing it.
and so I, think sometimes, youknow, we feel badly saying, no,
we're not going to do that.
You know, because you could sayit's in, best interest of client
(18:52):
care.
It's the best interest of thestaff, so I think then we try,
but it's like, no, we just, wehave to live.
within the reality and give theright feedback loop.
I think sometimes we almostabsorb, like we get squeezed
rather than no, payers need topay us more for this work.
I mean, I think I've been, it'sbeen really hard, we've made
some tough decisions to leavemarkets and I never will do that
(19:14):
flippantly, but at the sametime, how do you send a message?
To a payer or to a state thatdoesn't want to fund services.
When you just keep taking.
When you just make yourself,your team members squeeze
because they won't show up.
(19:36):
I just, I don't know.
And so it's painful becauseobviously then there's a client
or a patient but I do feelstrongly that we've got to
figure out a feedback loop thatputs the accountability on.
payers and states to show up forthese patients, not just on the
provider being squeezed in themiddle.
Jonathan (19:53):
it's so brilliantly said, you know, the universal
truth I'm hearing quality costsmore, right?
and if payers and states arewilling to put up with a low
reimbursement rate, then like,what are they going to get?
You're going to get servicesprovided essentially by like
staffing agencies, right?
And just.
Sort of like home health care,but you send someone in and not
trained and not well supervisedquality costs more full stop.
(20:16):
You know, one of the things Ithink I've always been reluctant
in my 11 years in the field, I'mnot a clinician.
And so when I approach thesekinds of conversations about,
utilization and productivity andmargins, like this worry in the
back of my head is shoot, like,They're just going to see me as
this MBA that only wants like tomake money.
And so I've had to over indexand a lot of times like way too
(20:37):
over index on not having thoseconversations, which taken me
away from that.
but I love this sense of like,Hey, we can't overgive, right.
quality costs more and we needto be upfront and transparent
with our team members about thedynamics of our business.
Like they deserve that.
one of the things you and Ireally agree on, um, well, I
don't want to put words in yourmouth.
Dr. Gina Chang (20:57):
No, go
Jonathan (20:57):
is like, there's this debate in our field these days
about like private equity versusnon private.
I don't know.
I, I think it's sad and, and atbest, it's just distracting, but
at worst, it's actuallydangerously destructive and I
love you told me at one point,Gina, like that it's.
It's about the choices you makeand how you run the business.
Like, that's what counts.
(21:18):
Can you tell me more, like, whatyou mean by that?
Dr. Gina Chang (21:20):
sure.
Um, yeah, and I, again, right,you, you only can speak from the
context you've, like, lived,right?
so, when I joined ALP, there wasanother private equity firm.
that held the organization.
and then there was a transfer ofownership.
and then the current team I'vebeen with since 2018.
So for, I know them very well.
and I, I stepped into the CEOrole in 20.
(21:43):
So, so really have gone throughthe journey of COVID and all of
it.
Right.
The great resignation.
so I've, I've walked with these,humans through just really tough
times.
And I think.
for me and my experience is thatthey are looking for as much
expertise and leadership fromthe management team, um, more
(22:05):
than anything.
So my experience has been thembeing highly supportive of
decisions and approaches butalso requiring.
a level of transparency withthem, right?
So, in the same way I need to betransparent with my supervisors
to bring them along, it'srequired transparency with them
to bring them along.
(22:26):
And sometimes that means hardconversations with them about,
no, you can't just do that.
You don't, you don't understandwhat we do.
but then also trust, right?
I'm a big believer that when wetalk about integrity or trust,
it's all about say do.
Like, you say something, thenyou do it.
And I think on both sides, youhave to demonstrate that.
(22:48):
And so I think they've seen ussay what we think needs to be
done, do it, and then see theright result.
Right?
Whether that's improvedretention.
I mean, it's not always justfinancial, but it is also that.
Um, and so...
So, I think from my perspective,I have been really respected
when I've, sort of when I'vedisagreed.
(23:10):
Um, and, and yet also, havereally appreciated you know,
there are some things they seedifferently They were some of
the first people that, whenCOVID hit, were like, how do we
make sure BCBAs don't get hit bythis?
so it is, it is hard for me tosee the, a lot of the commentary
or the perception because I justthink it's really misguided in
the sense of, are there chancesthat there are some PE firms
(23:34):
that are driving poor businesspractices from a clinical
perspective?
I'm sure there are.
But in the same, as we'vediscussed, in the same light,
have I seen really poor ethicaland clinical practices by
privately owned, clinician ownedentities, 100%.
And so I think for me it's, justnot about the funding mechanism,
(23:58):
or financing mechanism.
It is about, the choices you'remaking every day around your
business.
And, all of us, whether you'renot for profit, private equity
backed, or, um, an individualowner, you still need to run
your business at, a reasonablelevel of sustainability, no
matter how you cut it, and atleast my experience is I'm not
(24:19):
being asked to run that at, atanything.
Beyond just what is appropriateto the reimbursement rates we're
getting and the cost to deliverthe care, and that we're not
going the wrong way, so I'mprobably oversimplifying it a
little bit, but I think from myperspective, I'm not really sure
who we're referencing when wetry to make it so, binary or
(24:40):
polarizing.
Jonathan (24:42):
Yeah, I mean, I couldn't agree more.
And I think one of the ways thatthis plays out, I could be
totally wrong on this, but letme throw it out there.
And I love your feedback.
One of the ways this plays outis, um, you know, our field
still operates, with thementality and mindset of cool.
We're in the medical model whenit comes to reimbursement.
But we don't have to be in themedical model when it comes to
compliance and all of the otherthings that every other health
(25:04):
care organization and everyother health care discipline has
to do.
So it's like, we're trying tohave our cake and eat it too.
And, you know, there's going tobe an office of inspector
general report that comes outlater in 2023 where they just
went and did an audit of allstate Medicaid, ABA programs.
And I think that's going to be acome to Jesus moment for our
field.
But, but this idea that, we'vebeen under indexing under
investing as a field oncompliance that, that.
(25:26):
Everywhere else in healthcare,you know, those investments have
to be made.
And, I do believe thatrealization, um, that we can't
have our cake and eat it too, isgoing to lead to more
consolidation.
It's going to lead to thoseorganizations that have invested
over time in compliance, andeverything from billing and
revenue cycle compliance toclinical compliance to, I mean,
(25:46):
you know, HIPAA compliance, youname it, right?
The entire complianceinfrastructure.
Those are the ones who are goingto make it through this next
leg.
and so I think that's one thingI, one thing I've learned about
private equity, they're actuallysuper conservative, right?
Cause you're dealing withinvestors money.
You're talking Californiapension funds and elsewhere.
So there's super conservativeand, and that conservatism
translates to dialed incompliance infrastructure.
(26:09):
But I don't know, what do youthink is a future of compliance
in our field?
And is there going to be a cometo Jesus moment for ABA
providers?
Dr. Gina Chang (26:16):
You know, it's, it's so interesting, right?
This is one of those momentswhere, like, again, I feel like
I keep saying this, but I, feellike I know my world.
Right?
but you're right, right?
One of the first things, when,our private equity team came in
was like, we have compliance,monthly calls we have, I mean,
so I definitely think that is ofabsolute value for them.
And also I think pushing usforward around outcomes, and,
(26:39):
data development, right?
obviously we've, always takendata on the patients we're
providing care for and, but,they understand what technology
can also do in a way that, as aclinician, that's not my natural
kind of wheelhouse, right, butwe're in the process, we've
built a data warehouse, we're inthe process of, Refreshing that
warehouse, but I just think thatto me is also what they bring,
(27:03):
but you're right, 100%.
So on the compliance side, butthen also just how levels of
accountability are going tochange.
So yes, we do spend a lot oftime on that I will be honest
when I hear that there's stillproviders that don't necessarily
take.
Data in every session, or, Imean that, that does kind of
blow my mind, but that, for me,has been an expectation, for a
(27:24):
long time.
I mean, in California we, wewere being audited a lot, even
at my prior company.
So, yeah, we have to beaccountable for what we do.
And, I, I think that reckoningis still, they're still
struggling with access.
And I think we have not yetdealt with the reckoning of the
quality of the care beingprovided.
Jonathan (27:45):
It's a good point.
Like there's, you know, we existin our environment, right?
And clearly with a 1 in 36diagnosing rate that just came
out from the CDC in April.
there's still true access issuesthat haven't been solved.
And that I think has been partof what the context of what's
pushed the can down the road on,on compliance.
But, um, But yeah, you know,there's a, um, I, I feel like,
(28:06):
um, all of this comes backaround to doing these things is
for the sake of our kiddos.
Right.
And then, yeah, it happens to begood business practices.
It happens to be sound financialdiscipline, but it's for, it's
for the sake of our kids andthose we serve.
Well, do you know, what's onething every ABA business owner
should start doing?
And One thing to stop doing
Dr. Gina Chang (28:26):
I do think really, being transparent about
what it means to run thisbusiness I don't think that
means you have to give, Like,all the little details, but I, I
do think having folksunderstand, I really think you
will bring a lot of people withyou if they understand the
journey that you're on and whatyou're trying to accomplish and
(28:48):
what, what that would then alsogive access to if they helped
you accomplish it, the onlyother thing I'd say too is I
also think that invites, theymight have a better way of
solving it.
I mean, I just think a morecreative way of solving it than,
you know, I think I've talked tosome other CEOs or in my journey
where it seems like they'll lockin like, well, you know, this is
(29:08):
what it has to be.
and sometimes that's not true.
If you were just talking to moreof the people and letting them
know what the problem was.
that is just a way that I leadthat I think is really critical
to this, and especially in thisseason.
Um, and then what should theystop doing?
I just think we should stopfeeling badly that we're trying
(29:31):
to build sustainable businesses.
I mean, maybe that's just moreme, but I I think we want to
take care of everyone all thetime, and I don't think that's
possible.
And I think it's okay to drawlimits of what you can and can't
do.
And it's okay if that limitisn't losing money, but that
limit is like, I can,appropriately pay the interest
(29:53):
on my debt or whatever.
I mean, I just think, you know,it doesn't have to come at
personal cost to you.
Jonathan (29:59):
beautifully said, well, where can people find you
online?
Gina
Dr. Gina Chang (30:03):
Um, gosh, I'm not actually great online, but
LinkedIn, I'm definitely onLinkedIn, um, you know, our
website, autismlearningpartners.
com, those are probably the twobest places.
Jonathan (30:14):
Rock on, well, are you ready for the hot take
questions?
Dr. Gina Chang (30:17):
I, yes, yes.
Okay.
Okay, so
Jonathan (30:19):
Here we go.
Buckle up.
All right.
You know, you're on yourdeathbed.
What's the one thing you want tobe remembered for
Dr. Gina Chang (30:24):
Brene Brown, has this quote, strong back, soft
front, wild heart, and that isit.
Jonathan (30:31):
strong back, soft front wild heart,
Dr. Gina Chang (30:35):
Yes.
Jonathan (30:35):
well, as a fellow Brene.
Brown, Devote.
love that.
There's also like a mulletcontext somewhere in there.
Strong and like long
Dr. Gina Chang (30:43):
Oh, dear
Jonathan (30:45):
know.
That's what they came to buy.
This is like the 21st centurymullet.
That's beautiful.
I love it.
What's your most important selfcare practice, Chita?
Dr. Gina Chang (30:52):
Um, I would say walking and like, meditation and
prayer.
Are those, are those for me?
Jonathan (30:58):
What's your favorite song and or music genre?
Dr. Gina Chang (31:03):
I feel like this will just reveal my age.
One by U2.
I mean, there are quite a few U2songs that would make the top
list, but one, one is probablyup there.
Jonathan (31:11):
They're, they're absolute genius.
I got to ask you, I put you onthe spot.
I know you've got kids.
Have you seen the movie Sing 2?
Dr. Gina Chang (31:18):
Yes! Yes!
Jonathan (31:20):
Where, and no spoilers for the audience, but if you
haven't seen it, just gofreaking watch, it doesn't
matter if you've seen Sing 1,Bono plays, there's an animal I
should say, where Bono plays thevoice, it's a lion and it is
just, I was like in goosebumpsand tears through most of the
movie
Dr. Gina Chang (31:35):
Yes.
Jonathan (31:37):
like listening to all this stuff that I grew up with.
It was so good.
Dr. Gina Chang (31:40):
Yes.
Yes.
So great.
Jonathan (31:42):
You know, what's the one thing you'd tell your 18
year old self?
Dr. Gina Chang (31:45):
Oh, don't be so afraid.
Jonathan (31:50):
Well, you can only wear one style of footwear.
What would it be?
Dr. Gina Chang (31:53):
Running shoes.
Only because I really lovewalking.
Jonathan (31:55):
So highly functional.
Well, Gina, thank you so muchfor coming on the pod.
Thank you for sharing yourwisdom and all your experience.
I appreciate you.
Dr. Gina Chang (32:02):
Oh, appreciate it.
Thanks, Jonathan.
My guest today is Dr.
Gina Chang.
Gina is a BCBAD and licensedpsychologist and the CEO of
Autism Learning Partners.
She started her career as abehavior technician 22 years ago
and was captivated by thescience of ABA and seeing
children and family's livesforever improved by the science.
She's on a journey to ensureexcellence and access to care
(00:51):
for more and more families.
Gina, welcome to the pod.
Dr. Gina Chang (00:55):
Thank you.
Thank you for having me,Jonathan.
Jonathan (00:57):
Oh, it's so great to be here with you.
Well, tell me, I mean, 22 yearsin the field, so you are like
old school.
Um, you've been with, You'vebeen with ALP since 2015, I
think.
But when was the moment, Gina,that you realized you wanted to
make ABA your career?
Dr. Gina Chang (01:13):
I didn't, I didn't actually know anything
about ABA.
In college, I was a history andEnglish major and, really left
college, uh, not having any ideawhat to do with my life.
I think my parents were verynervous about me.
I'd always loved working withchildren.
Um, I'd actually thought I wasgoing to be a pediatrician
organic chem ensured that didn'twork out for me.
(01:35):
and, yeah.
And so a friend said she was apsych major and she said, well,
I'm, I'm going to be workingwith, autistic kids.
And I literally thought at firstshe said, artistic kids.
I really didn't know about thispopulation, but sure enough.
I needed a part time job andthey said well We'll hire you
for you know,$13 an hour.
(01:56):
And if you do a good job, we'llsort of do it on a trial period.
And I don't know there was justsomething about as I went
through training and learnedabout the science It made just a
lot of intuitive sense.
I think there were things thatjust resonated and then I still
remember walking up to the door,because it was all in home, of
my first client, and, I don'tknow, like, I literally, I can
(02:17):
picture it in my mind, knockingon the apartment door and going
in, and he and his family justchanged my life in so many ways,
because I think, you know, Ithink I'd always wanted to be of
sort of service and missionoriented work was really
important to me, but I thinkthat combination of then
watching change happen in frontof you, so seeing words come out
(02:41):
for the first time or thingsthat had really been hard for a
family.
you know, being able to go toTarget and him not throw a
tantrum because he didn't getaccess to a preferred item.
I mean...
I watched the family's lifechange and things that were so
painful become joyful.
And I think for me thatcombination of, the scientific
(03:02):
part, but then also the actualchange in a family's life part,
was just something that I hadn'texperienced before in any other
sort of, Part of the world thatI'd been dabbling in from a
educational career perspective.
So yeah, I mean it was thatmoment that I was just like how
do I do this?
And how do I do more of it?
(03:22):
And how do I become asupervisor?
So,
Jonathan (03:27):
I love that.
Gosh, the things that were sopainful become joyful.
I think that speaks to the powerof our science and our
treatment, right?
And what we, and the lifechanging impacts we make on
families.
part of what's so interesting tome about your story, you are a
classic, from mailroom toboardroom, a kind of journey.
And I want to hear more aboutyour journey to becoming Autism
Learning Partners CEO and ALPfor those who don't know, is one
(03:49):
of the largest ABA providers inthe country.
Tell me more about that.
Dr. Gina Chang (03:53):
Gosh, not, not something that felt very
intentional if I'm honest backwhen I was a behavior
technician, it became about howdo I become a supervisor because
I got married young.
We had very little money.
And it was like, okay, well, ifI can make, you know,$28 an hour
or whatever they were paying thesupervisor at the time, then
(04:13):
that meant my husband and Icould afford to live in Southern
California.
but then also just amazing doorswere opened it's always a bit
of, You know, luck, hard work,right?
That combination.
So I needed to get a master's tobecome a supervisor.
And, because I had been ahistory and English major, no
state school would take me if Ididn't redo my undergrad
(04:36):
coursework.
I had to get a certain number ofpsych units to be able to go to
Cal State LA, Cal StateNorthridge.
Right?
Great programs around me.
and I, that felt unfathomable.
And then, I was interviewedwith, Claremont graduate that
had a developmental psychprogram, but not really a BCBA
program.
And they said I could come inand sort of do that coursework
(04:58):
as a part of my program.
They would waive thatrequirement.
But then I got connected to awoman who was doing research in
ABA at Claremont McKenna, Dr.
Charlotte.
And I went to go meet with her.
And she just said, I don't takemaster's students, I only take
PhD students.
I was like, oh crap, go home.
I like, retake the GRE that Ihad not done well on.
(05:18):
change my application.
She took one student that year.
And it was me.
And to this day, I don't know...
how that worked.
but it really changed the courseof my journey because now not
only was I on path to get mymaster's, which was important to
get the the 28 an hour that Ineeded, but it just allowed me
(05:39):
to dive fully into the space.
I mean, and then I, able to getmy PhD, which really was not in
the cards, earlier, like thatwould not have been, um, Um, but
I loved it.
I actually really enjoyed theresearch.
and then I was able to do predoc hours with her so I could
get my license, which alsowasn't really that wasn't in the
cards necessarily.
Again, I was just trying to bethe supervisor.
(06:00):
so no, I think that, that wascertainly just a massive door
that got opened that, to thisday, I'm.
So grateful for.
and then I think I just, Ireally fell in love with
operations, which I think notnecessarily all clinicians are
really into, but, I spent, uh,almost a decade at it at Autism
Spectrum Therapies, which wasacquired by Learn just before I
(06:21):
left.
but there I really learned, Ithink a few things like one,
just operations have to betight.
To do what we do, especially inhome, right?
I mean, it is literally like UPSmeets clinical care.
I what you're trying toaccomplish.
So I think that work, andreally, a woman named Dr.
(06:42):
Andrea Ridgway was bothincredibly instrumental for me,
both in operations and inclinical development.
she taught me so much about whatI understand about clinical care
I did a lot of work with brieffunctional analyses when I was
there, but then also opened upservices for areas of California
that didn't really have greataccess to care and loved that.
(07:03):
Like loved the idea that I wasgoing to build infrastructure
around training and access thathadn't existed.
That really was a spark for me,in that time.
Those 10 years were really bigfor me as far as things that I'm
deeply passionate about.
Jonathan (07:17):
Is that so crazy how X post factor looking back, it can
feel like everything like fellinto place to make it happen.
But like the reality of so manyof our journeys, it's wow, this
little moment changed where thetrajectory went, but you know, I
want to probe more on, onoperations and you cannot be
more correct Gina that,particularly for in home, but
for any type of ABA services.
(07:38):
If you don't have the tightestoperations,
Dr. Gina Chang (07:41):
Yeah.
Jonathan (07:41):
you cannot be successful.
And especially in this time ofcompressed margins and
increasing wage rates.
And, we've known each other for,I think almost a couple of years
now, but when we chatted at theCasp CEO event, I was just blown
away for how you brought thisoperational mindset just to
describe the work that, that youdo and ALP was doing, but that
doesn't get taught in schools.
(08:01):
Doesn't even get taught reallyin an MBA program.
So how did you build your reallykeen operational skill sets and
the mindsets that you knew youneeded to be a successful
leader?
Dr. Gina Chang (08:11):
Yeah.
Um.
Man, and it is, it's, it's thesame thing where you just have
different people come into yourlife at sort of different key
moments.
So again, I think Dr.
Ridgeway was like, I think whatwas so clear in our work
together was you have to managethe relationship between your
sort of supervisor costs andyour behavior technician costs
(08:32):
one piece of advice I would giveto anybody, it's that
relationship and the caseloaddynamics that will, from my
perspective, with how we arepaid today, right, the context
you're in, is really drives theability to build sustainable
businesses.
So I think that was probably abig nugget of truth I had that I
(08:54):
took when I came in as Chief ofClinical Operations at ALP.
But, I would say the next bigpiece was I worked then really
closely with the CEO thatbrought me in to ALP, who was
just really great one of thefirst things we did was put in
place a balanced scorecard.
And so for us that has, youknow, a people column, an
operations column, a clinicalquality column, and a growth
(09:16):
column.
So those for us, at the time,again, all your context, right?
At the time I was landing atALP, the business was in not a
good spot, we needed, some realgrowth to balance overhead
costs, and we needed to reallyroot the team in clinical
excellence and operationalexcellence.
And so that scorecard, was socritical to that.
(09:36):
And then it was just everymonth, I mean, that, routinized
focus on execution.
and they were toughconversations, so you know, you
don't transform a business byall good stuff, right?
There's going to be hard momentswhere there are honest
conversations about where theperformance of the business is
going, and I think that, thosethings for me were so
(09:57):
instrumental, in what hasbecome, a toolkit that I really
depend on in how we lead thebusiness.
Jonathan (10:07):
Hmm.
Tell me some more about, thebalanced scorecard is this
concept that's been around, Ithink for at least a couple of
decades, right?
But it's much newer to ourfield.
I want you to tell me a littlebit more about that.
And also, this idea that theimportance of managing that
relationship between yoursupervisor costs and your
frontline workers and what, whatdoes that actually look like day
to day?
60
Dr. Gina Chang (10:27):
So I think as far as the balanced scorecard, I
think for us it set the tone fora monthly review of the business
at the regional level.
So I mean, I'd say that's a bigpart of it.
Um, but you're right.
That other question you asked,Those metrics all float onto the
balanced scorecard.
So, just to dive more into that,what we really focus on I mean,
(10:48):
we call it gross margin, otherpeople will call it lots of
different things, but it'sreally how, you know, you can
look at a BCBA's product call itproductivity, hours they bill,
care they provide, all of thatgood vernacular.
But honestly, that, for most ofus, given the landscape of the
reimbursement rate, because, atleast in our organization,
(11:10):
they're typically only about 6070 percent billable, right?
So, there are other things theydo, um, that depending on how
you're being reimbursed, that'sthe level of Productivity or
reimbursed time we get from themand because of that typically
what they're doing is reallypaying for their costs they're
not generating anything thatSupports the rest of the
(11:34):
functioning of the business Ifyou were to have that position
say bill at 90 95 percent time,so If there is someone out there
getting 35, 37 hours out ofproductivity a week out of their
BCBAs, God bless you, we arenot, then that probably could
work as far as that being yourfocus.
(11:56):
but for us, because that isn't,we give them time for other
things, most of the margin ofthe business is made off of the
behavior technician hour.
Um, in this season, that'sobviously been, compressed a
lot.
And so there's, you know, workwe're doing there.
but that for us has been sort ofthat understanding.
(12:17):
So we want to pay our behaviortechnicians well.
And so in order to do that, youhave to really watch how many
behavior technician hours youcan have per BCBA.
That relationship becomes moreand more important in being
sustainable.
I think in a world where wecould imagine really great
(12:37):
reimbursement rates, then thatcan be less, like someone,
actually a guy at AST, Rob Haut,once said to me, when the, when
the tide is high, you don't knowhow much shit is at the bottom
of the ocean.
and I think that's just reallytrue, right?
I think about that statement alot, like when, you know, those
of us, and I wasn't inoperations at this time, but I
mean, there was a day when wewere regularly being paid 90,
(13:01):
100 bucks an hour.
For BT work, right?
That's not the world we live in.
This is not going back, 15years, 20 years.
And so yeah, then I think youcan do all sorts of things,
right?
Your BCBAs don't have to bill,it doesn't matter what the
caseload looks like.
you can have a lot of fun.
Um, but that's, that's not ourreality.
And if people have the same sortof reimbursement profile that we
(13:23):
do, which I think is not thelowest, but not the greatest,
you have to watch those.
To be able to then provide otherreally amazing things to your
team members, to your families,right?
To afford, um, the technologyyou need.
To afford, somebody else to doyour scheduling, and
contracting, and credentialingall those things that no
clinician wants to do.
(13:45):
you've gotta watch thosedynamics to have the resources
left over to invest in thosethings.
Jonathan (13:50):
This is so true.
from when we started Ascend fiveand a half, six years ago, we
said the same thing.
Like the true measures ofproductivity around caseload
size defined specifically as thenumber of direct therapy hours
in this pyramid.
under a BCBA.
and so I, I love that, your mindworks that way.
And like we're a human servicesbusiness, right?
we don't make widgets.
(14:10):
So unlike a UPS or some of theseothers where we could like
Dr. Gina Chang (14:12):
tweak some levers I know,
Jonathan (14:13):
levers and so this is the, I believe, hardest thing.
That organizations have to do tobe successful, even harder than
like the hard clinical deliveryof treatment.
So what feedback do you have forABA providers when it comes to
increasing utilization and justmaking sure the providers are
working as efficiently andeffectively as possible and in a
supportive environment?
Dr. Gina Chang (14:34):
Yeah.
Um.
Look, first, I'm not gonna lie,like, I think it's really hard.
You know, I think for us, and Idon't know that we do it well,
or always do it well, but Ithink it's been about, Also,
just, Just trying to be astransparent about this reality.
I actually read this great SimonSinek quote that said like
transparency isn't tellingeverybody all the details, but
it's telling them sort of whythe context for why the decision
(14:58):
is being made.
And I think that, you know,there is feedback I would give
is I just, I think giving yourteam levels of transparency.
I actually think.
A lot of humans, if they had thesame information you had, would
actually make a lot of the samedecisions.
It's, it's not that people, likemost of the supervisors we have,
(15:18):
or when I talk to them, they getit.
do we always do a good job ofmaking sure they understand the
why?
And that includes the financialwhy.
You know, I think sometimesthose of us who are clinicians,
would much rather talk about ourwhy clinically and, um, the
amazing clinical work and we doa lot of that, but it's also
about explaining the financialcomponent or making sure they
(15:40):
understand how the businessworks.
And so that was a part of thatscorecard.
That was a lot of what we weredoing month over month was
actually equipping the directorso that they could communicate
with their supervisors like,this is how the business works.
It's not like we need you tobuild 25 hours just, or 27 hours
just to do it.
(16:00):
yes, that maps onto clinicalcare, right?
If you're doing the 10 to 20percent, I mean, it lines up.
But we do monitor it alsobecause that supports the
sustainability of the business.
and that, that is our reality.
And let me then walk you throughthat, you know?
So I think for me it's, I wouldsay it's trying to bring people
(16:22):
along.
with understanding the businessand not trying to hide that from
them.
I do think sometimes asclinicians, we don't want our
BCBAs to have to get caught upin that stuff, right?
Or we, we don't want to feellike they need to worry
themselves and they shouldn't,but I do think if they don't
know the why behind the fullstory.
(16:46):
You know, you can share theclinical, but the full story of
the why, I think we do ourselvesa disservice in, in their
willingness to come along.
but again, I don't know that wealways do that well, but that's
our intent.
Jonathan (16:57):
But you've pointed something really critical.
and I think I had a mentor tellme once, this is the hard
leadership work that we get todo.
That is the teaching.
Not like just telling aclinician, one of our team
members, this is what you do,but like, give them that
context, teach them the why.
Being a teacher to help themunderstand, how certain
decisions have to be made.
this is so critical.
Why do you think as a fieldthat, we've shied away from
(17:19):
that?
Is it because we haven't wantedto expose, clinicians to the,
harder financial realities,right?
Or, what drives that?
Dr. Gina Chang (17:28):
I don't know.
I know my own journey, you know,and I know that even for me at
times, like, I have my ownstruggles with overextending
myself to care for people,right, whether that's in my
personal life or in my worklife, I will give a lot to, to
do right by somebody, to get itright, right?
And I think sometimes that cansort of overgeneralize to like
(17:51):
financials and budgets And Idon't doubt that there are
amazing clinicians runningbusinesses today that are either
running at a loss or bleedingtheir personal finances because
they are trying to do right, andbecause they will give of
themselves to that.
(18:11):
And I think, you know, that,that whole notion of boundaries
allow you to Give appropriately.
I actually think that's true, insort of your own emotional and
cognitive and sort ofpsychological development.
And it's sort of truefinancially.
to me that almost feels like abit of a universal truth.
And I think that's been my ownjourney it's actually really
(18:32):
appropriate to not Give outsideof what is sustainable so that
you can keep giving and you cankeep doing it.
and so I, think sometimes, youknow, we feel badly saying, no,
we're not going to do that.
You know, because you could sayit's in, best interest of client
(18:52):
care.
It's the best interest of thestaff, so I think then we try,
but it's like, no, we just, wehave to live.
within the reality and give theright feedback loop.
I think sometimes we almostabsorb, like we get squeezed
rather than no, payers need topay us more for this work.
I mean, I think I've been, it'sbeen really hard, we've made
some tough decisions to leavemarkets and I never will do that
(19:14):
flippantly, but at the sametime, how do you send a message?
To a payer or to a state thatdoesn't want to fund services.
When you just keep taking.
When you just make yourself,your team members squeeze
because they won't show up.
(19:36):
I just, I don't know.
And so it's painful becauseobviously then there's a client
or a patient but I do feelstrongly that we've got to
figure out a feedback loop thatputs the accountability on.
payers and states to show up forthese patients, not just on the
provider being squeezed in themiddle.
Jonathan (19:53):
it's so brilliantly said, you know, the universal
truth I'm hearing quality costsmore, right?
and if payers and states arewilling to put up with a low
reimbursement rate, then like,what are they going to get?
You're going to get servicesprovided essentially by like
staffing agencies, right?
And just.
Sort of like home health care,but you send someone in and not
trained and not well supervisedquality costs more full stop.
(20:16):
You know, one of the things Ithink I've always been reluctant
in my 11 years in the field, I'mnot a clinician.
And so when I approach thesekinds of conversations about,
utilization and productivity andmargins, like this worry in the
back of my head is shoot, like,They're just going to see me as
this MBA that only wants like tomake money.
And so I've had to over indexand a lot of times like way too
(20:37):
over index on not having thoseconversations, which taken me
away from that.
but I love this sense of like,Hey, we can't overgive, right.
quality costs more and we needto be upfront and transparent
with our team members about thedynamics of our business.
Like they deserve that.
one of the things you and Ireally agree on, um, well, I
don't want to put words in yourmouth.
Dr. Gina Chang (20:57):
No, go
Jonathan (20:57):
is like, there's this debate in our field these days
about like private equity versusnon private.
I don't know.
I, I think it's sad and, and atbest, it's just distracting, but
at worst, it's actuallydangerously destructive and I
love you told me at one point,Gina, like that it's.
It's about the choices you makeand how you run the business.
Like, that's what counts.
(21:18):
Can you tell me more, like, whatyou mean by that?
Dr. Gina Chang (21:20):
sure.
Um, yeah, and I, again, right,you, you only can speak from the
context you've, like, lived,right?
so, when I joined ALP, there wasanother private equity firm.
that held the organization.
and then there was a transfer ofownership.
and then the current team I'vebeen with since 2018.
So for, I know them very well.
and I, I stepped into the CEOrole in 20.
(21:43):
So, so really have gone throughthe journey of COVID and all of
it.
Right.
The great resignation.
so I've, I've walked with these,humans through just really tough
times.
And I think.
for me and my experience is thatthey are looking for as much
expertise and leadership fromthe management team, um, more
(22:05):
than anything.
So my experience has been thembeing highly supportive of
decisions and approaches butalso requiring.
a level of transparency withthem, right?
So, in the same way I need to betransparent with my supervisors
to bring them along, it'srequired transparency with them
to bring them along.
(22:26):
And sometimes that means hardconversations with them about,
no, you can't just do that.
You don't, you don't understandwhat we do.
but then also trust, right?
I'm a big believer that when wetalk about integrity or trust,
it's all about say do.
Like, you say something, thenyou do it.
And I think on both sides, youhave to demonstrate that.
(22:48):
And so I think they've seen ussay what we think needs to be
done, do it, and then see theright result.
Right?
Whether that's improvedretention.
I mean, it's not always justfinancial, but it is also that.
Um, and so...
So, I think from my perspective,I have been really respected
when I've, sort of when I'vedisagreed.
(23:10):
Um, and, and yet also, havereally appreciated you know,
there are some things they seedifferently They were some of
the first people that, whenCOVID hit, were like, how do we
make sure BCBAs don't get hit bythis?
so it is, it is hard for me tosee the, a lot of the commentary
or the perception because I justthink it's really misguided in
the sense of, are there chancesthat there are some PE firms
(23:34):
that are driving poor businesspractices from a clinical
perspective?
I'm sure there are.
But in the same, as we'vediscussed, in the same light,
have I seen really poor ethicaland clinical practices by
privately owned, clinician ownedentities, 100%.
And so I think for me it's, justnot about the funding mechanism,
(23:58):
or financing mechanism.
It is about, the choices you'remaking every day around your
business.
And, all of us, whether you'renot for profit, private equity
backed, or, um, an individualowner, you still need to run
your business at, a reasonablelevel of sustainability, no
matter how you cut it, and atleast my experience is I'm not
(24:19):
being asked to run that at, atanything.
Beyond just what is appropriateto the reimbursement rates we're
getting and the cost to deliverthe care, and that we're not
going the wrong way, so I'mprobably oversimplifying it a
little bit, but I think from myperspective, I'm not really sure
who we're referencing when wetry to make it so, binary or
(24:40):
polarizing.
Jonathan (24:42):
Yeah, I mean, I couldn't agree more.
And I think one of the ways thatthis plays out, I could be
totally wrong on this, but letme throw it out there.
And I love your feedback.
One of the ways this plays outis, um, you know, our field
still operates, with thementality and mindset of cool.
We're in the medical model whenit comes to reimbursement.
But we don't have to be in themedical model when it comes to
compliance and all of the otherthings that every other health
(25:04):
care organization and everyother health care discipline has
to do.
So it's like, we're trying tohave our cake and eat it too.
And, you know, there's going tobe an office of inspector
general report that comes outlater in 2023 where they just
went and did an audit of allstate Medicaid, ABA programs.
And I think that's going to be acome to Jesus moment for our
field.
But, but this idea that, we'vebeen under indexing under
investing as a field oncompliance that, that.
(25:26):
Everywhere else in healthcare,you know, those investments have
to be made.
And, I do believe thatrealization, um, that we can't
have our cake and eat it too, isgoing to lead to more
consolidation.
It's going to lead to thoseorganizations that have invested
over time in compliance, andeverything from billing and
revenue cycle compliance toclinical compliance to, I mean,
(25:46):
you know, HIPAA compliance, youname it, right?
The entire complianceinfrastructure.
Those are the ones who are goingto make it through this next
leg.
and so I think that's one thingI, one thing I've learned about
private equity, they're actuallysuper conservative, right?
Cause you're dealing withinvestors money.
You're talking Californiapension funds and elsewhere.
So there's super conservativeand, and that conservatism
translates to dialed incompliance infrastructure.
(26:09):
But I don't know, what do youthink is a future of compliance
in our field?
And is there going to be a cometo Jesus moment for ABA
providers?
Dr. Gina Chang (26:16):
You know, it's, it's so interesting, right?
This is one of those momentswhere, like, again, I feel like
I keep saying this, but I, feellike I know my world.
Right?
but you're right, right?
One of the first things, when,our private equity team came in
was like, we have compliance,monthly calls we have, I mean,
so I definitely think that is ofabsolute value for them.
And also I think pushing usforward around outcomes, and,
(26:39):
data development, right?
obviously we've, always takendata on the patients we're
providing care for and, but,they understand what technology
can also do in a way that, as aclinician, that's not my natural
kind of wheelhouse, right, butwe're in the process, we've
built a data warehouse, we're inthe process of, Refreshing that
warehouse, but I just think thatto me is also what they bring,
(27:03):
but you're right, 100%.
So on the compliance side, butthen also just how levels of
accountability are going tochange.
So yes, we do spend a lot oftime on that I will be honest
when I hear that there's stillproviders that don't necessarily
take.
Data in every session, or, Imean that, that does kind of
blow my mind, but that, for me,has been an expectation, for a
(27:24):
long time.
I mean, in California we, wewere being audited a lot, even
at my prior company.
So, yeah, we have to beaccountable for what we do.
And, I, I think that reckoningis still, they're still
struggling with access.
And I think we have not yetdealt with the reckoning of the
quality of the care beingprovided.
Jonathan (27:45):
It's a good point.
Like there's, you know, we existin our environment, right?
And clearly with a 1 in 36diagnosing rate that just came
out from the CDC in April.
there's still true access issuesthat haven't been solved.
And that I think has been partof what the context of what's
pushed the can down the road on,on compliance.
But, um, But yeah, you know,there's a, um, I, I feel like,
(28:06):
um, all of this comes backaround to doing these things is
for the sake of our kiddos.
Right.
And then, yeah, it happens to begood business practices.
It happens to be sound financialdiscipline, but it's for, it's
for the sake of our kids andthose we serve.
Well, do you know, what's onething every ABA business owner
should start doing?
And One thing to stop doing
Dr. Gina Chang (28:26):
I do think really, being transparent about
what it means to run thisbusiness I don't think that
means you have to give, Like,all the little details, but I, I
do think having folksunderstand, I really think you
will bring a lot of people withyou if they understand the
journey that you're on and whatyou're trying to accomplish and
(28:48):
what, what that would then alsogive access to if they helped
you accomplish it, the onlyother thing I'd say too is I
also think that invites, theymight have a better way of
solving it.
I mean, I just think a morecreative way of solving it than,
you know, I think I've talked tosome other CEOs or in my journey
where it seems like they'll lockin like, well, you know, this is
(29:08):
what it has to be.
and sometimes that's not true.
If you were just talking to moreof the people and letting them
know what the problem was.
that is just a way that I leadthat I think is really critical
to this, and especially in thisseason.
Um, and then what should theystop doing?
I just think we should stopfeeling badly that we're trying
(29:31):
to build sustainable businesses.
I mean, maybe that's just moreme, but I I think we want to
take care of everyone all thetime, and I don't think that's
possible.
And I think it's okay to drawlimits of what you can and can't
do.
And it's okay if that limitisn't losing money, but that
limit is like, I can,appropriately pay the interest
(29:53):
on my debt or whatever.
I mean, I just think, you know,it doesn't have to come at
personal cost to you.
Jonathan (29:59):
beautifully said, well, where can people find you
online?
Gina
Dr. Gina Chang (30:03):
Um, gosh, I'm not actually great online, but
LinkedIn, I'm definitely onLinkedIn, um, you know, our
website, autismlearningpartners.
com, those are probably the twobest places.
Jonathan (30:14):
Rock on, well, are you ready for the hot take
questions?
Dr. Gina Chang (30:17):
I, yes, yes.
Okay.
Okay, so
Jonathan (30:19):
Here we go.
Buckle up.
All right.
You know, you're on yourdeathbed.
What's the one thing you want tobe remembered for
Dr. Gina Chang (30:24):
Brene Brown, has this quote, strong back, soft
front, wild heart, and that isit.
Jonathan (30:31):
strong back, soft front wild heart,
Dr. Gina Chang (30:35):
Yes.
Jonathan (30:35):
well, as a fellow Brene.
Brown, Devote.
love that.
There's also like a mulletcontext somewhere in there.
Strong and like long
Dr. Gina Chang (30:43):
Oh, dear
Jonathan (30:45):
know.
That's what they came to buy.
This is like the 21st centurymullet.
That's beautiful.
I love it.
What's your most important selfcare practice, Chita?
Dr. Gina Chang (30:52):
Um, I would say walking and like, meditation and
prayer.
Are those, are those for me?
Jonathan (30:58):
What's your favorite song and or music genre?
Dr. Gina Chang (31:03):
I feel like this will just reveal my age.
One by U2.
I mean, there are quite a few U2songs that would make the top
list, but one, one is probablyup there.
Jonathan (31:11):
They're, they're absolute genius.
I got to ask you, I put you onthe spot.
I know you've got kids.
Have you seen the movie Sing 2?
Dr. Gina Chang (31:18):
Yes! Yes!
Jonathan (31:20):
Where, and no spoilers for the audience, but if you
haven't seen it, just gofreaking watch, it doesn't
matter if you've seen Sing 1,Bono plays, there's an animal I
should say, where Bono plays thevoice, it's a lion and it is
just, I was like in goosebumpsand tears through most of the
movie
Dr. Gina Chang (31:35):
Yes.
Jonathan (31:37):
like listening to all this stuff that I grew up with.
It was so good.
Dr. Gina Chang (31:40):
Yes.
Yes.
So great.
Jonathan (31:42):
You know, what's the one thing you'd tell your 18
year old self?
Dr. Gina Chang (31:45):
Oh, don't be so afraid.
Jonathan (31:50):
Well, you can only wear one style of footwear.
What would it be?
Dr. Gina Chang (31:53):
Running shoes.
Only because I really lovewalking.
Jonathan (31:55):
So highly functional.
Well, Gina, thank you so muchfor coming on the pod.
Thank you for sharing yourwisdom and all your experience.
I appreciate you.
Dr. Gina Chang (32:02):
Oh, appreciate it.
Thanks, Jonathan.
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