Private equity firms acquired more than 500 autism centers in past decade, study shows
By Juan Siliezar, Associate Director of Media Relations
and Leadership Communications, School of Public Health,
.jpg)
That’s according to a new study from researchers at Brown
University’s Center for Advancing
Health Policy through Research.
Study author Yashaswini Singh, a health economist at Brown’s
School of Public Health, said the work highlights how financial firms are
rapidly moving into a sensitive area of health care with little public scrutiny
or data on where this is happening or why.
“The big takeaway is that there is yet another segment of
health care that has emerged as potentially profitable to private equity
investors, and it is very distinct from where we have traditionally known
investors to go, so the potential for harm can be a lot more serious,” Singh
said. “We're also dealing with children who are largely insured by Medicaid
programs, so if private equity increases the intensity of care, what we're
looking at are impacts to state Medicaid budgets down the road.”
The findings were published in JAMA Pediatrics and offer one of the first national assessments of private equity’s growing role in autism therapies and services. Autism diagnoses among U.S. children have risen sharply in recent years, nearly tripling between 2011 and 2022, and autism has been in the national spotlight amid political debate claiming links between autism and childhood vaccines.
The findings suggest that investment has been concentrated
in states with higher rates of autism diagnoses among children and states that
have fewer limits on insurance coverage.
The researchers identified a total of 574 autism therapy
centers owned by private equity firms as of 2024, spanning 42 states. Most of
those centers were acquired between 2018 and 2022, the result of 142 separate
deals. The largest concentrations of centers were in California (97), Texas
(81), Colorado (38), Illinois (36) and Florida (36). Sixteen states had one or
no private equity-owned clinics at the end of 2024.
States in the top third for childhood autism prevalence were
24% more likely to have private equity–owned clinics than others, according to
the study.
The scale and speed of acquisitions underscore the growing
trend of private equity’s entry into the market, the researchers say. According
to Singh, the team was prompted to investigate that trend after hearing
anecdotal reports from families and health providers about changes following
private equity takeovers.
The primary concern is that private equity firms may
prioritize financial gains over families, said Daniel Arnold, a senior research
scientist at the School of Public Health.
“It's all about the financial incentives,” Arnold said. “I
worry about the same types of revenue-generating strategies seen in other
private equity-backed settings. I worry about children receiving more than the
clinically appropriate amount of services and worsening disparities in terms of
which children have access to services.”
To establish a baseline of where private equity firms are
investing and why, the team used a mix of proprietary databases, public press
releases and manual verification of archived websites to track changes in
ownership. Unlike public companies, private equity firms and private practices
are not required to disclose acquisitions, making data collection challenging
and labor-intensive.
The team is now seeking federal funding to examine how
private equity ownership affects outcomes, including changes in therapy
intensity, medication use, diagnosis age or how long children stay in
treatment. They seek to determine whether these investments are helping to meet
real needs or are primarily a way to make money.
“Private investors making a little bit of money while
expanding access is not a bad thing, per se,” Singh said. “But we need to
understand how much of a bad thing this is and how much of a good thing this
is. This is a first step in that direction.”
This study received funding from the National Institute on
Aging (R01AG073286) and the National Institute on Mental Health (R01MH132128).
