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Families Changed Microsoft's View of Autism

By Spake

May 8, 2007

BRIAN ROSENBERG SUFFERS from autism. And while that term can describe a wide

range of developmental problems, says Jon Rosenberg, 's father, " My son

is at the severe end of the spectrum. " At that level of severity, he

explains, " Kids don't know how to imitate, and that's how most kids learn.

It took weeks to teach my son to get himself a glass of water, months to

teach him how to use a fork and spoon. "

has learned these skills by working one on one with a behavioral

therapist, day in and day out, since his diagnosis. Behavioral therapy for

autism can cost as much as $60,000 per year, a serious financial challenge

for a family whose insurance won't cover it. Indeed, many families have no

coverage for the services that autistic children need most. The Rosenbergs

are lucky: Jon's employer, the software giant Microsoft (MSFT1), covers

behavioral therapy as part of its health-benefits package. But that wasn't

always the case - and the story of how the policies changed at the Redmond

Empire is instructive for any family facing a costly medical problem.

Statistics collected yearly by the Department of Education show that the

number of children between ages 6 and 21 with autism or autism-like

developmental disabilities has increased by 500% in the last decade. A

recent report by the federal Centers for Disease Control and Prevention

shows that as many as one child in 150 is now diagnosed with an autism-type

disorder. While doctors have been unable to explain the reasons behind this

startling increase, research on how best to treat and teach autistic

children has confirmed the value of an early intervention program that

relies on intensive behavioral therapy. More than 500 medical studies

published in the last two decades support the idea that behavioral

techniques, focused on teaching everything from language and academics, to

basic life skills, can help substantial numbers of preschool-age children

with autism achieve intellectual, academic, communication, and social skills

that approach normal range.

Yet, too often health insurers do not cover such treatment, and few

corporate benefit managers are aware of the significant problems this gap in

coverage creates for their employees who struggle to pay for their autistic

children's therapy.

Jon Rosenberg was determined to change all that, if not in the world as a

whole, at least in the world of Microsoft. " About eight of us parents got

together in 1999 and were comparing notes on how behavioral therapy was

effective for our autistic children, " he recalls. They decided that each

would send an email to the president of human resources at Microsoft. " Each

of us told him about autism, how it affected our children, about behavioral

therapy and what a great, positive impact it was having on our children and

our families. "

The company immediately promised to look into the issue - but it probably

wouldn't have done so without prompting. " That started the dialogue, "

recalls Mark Stoppler, program manager for U.S. benefits at Microsoft. At

the time, Stoppler says, very little was understood in the insurance and

benefits world about autism or autism treatment. Coverage of speech therapy,

physical, and occupational therapy was typically denied because insurers

assumed that speech would eventually come to all children, and that

occupational and physical therapy were appropriate treatments only for

adults.

To its credit, Microsoft did not take those assumptions for granted. " We

worked extensively with the University of Washington's autism center to get

an understanding of the condition, the types of treatment available, which

showed the most promise, " explains Stoppler. The university provided

background on Applied Behavioral Analysis, a type of behavior therapy for

autism that has proven successful in many clinical studies. Once Microsoft

decided ABA would be worth covering, the school helped the company design a

benefit plan around the treatment.

Microsoft, a self-insured health-care provider, pays 80% of the cost of ABA.

Because research suggests that the type of early intervention needed by most

autistic kids required three years of intensive behavioral therapy,

Microsoft imposes yearly and lifetime limits based on those assumptions.

Microsoft recognizes and compensates for two levels of care: The benefit

provides for a program manager who oversees each child's entire treatment

program, as well as for the therapy assistants, who are the day-to-day

providers of the therapy. Speech, occupational, and physical therapy

recommended by the program manager are also covered at 80%.

To employees of Microsoft who have autistic children, the value of these

benefits is almost incalculable. " This therapy is literally 's lifeline

to the world the rest of us live in, " says Jon Rosenberg. " It gives him a

sense of control in his life. is 14 now, and I can see by 20 or 25 he

will have learned enough to have independence in his life. " Better still,

" Now, the world is not just a place making all of these demands on him that

he doesn't understand, it's a place he can have fun, too. "

Microsoft's approach to autism benefits remains more the exception than the

rule. But a few other corporations have taken similar steps. Home Depot

(HD2), for example, began covering the full range of treatment for childhood

autism as part of its health insurance benefits for the company's 365,000

employees about eight years ago. Roughly a year and a half before autism

coverage was added, employees who had been denied behavioral, speech,

physical and occupational therapies for their autistic children had to

appeal the denials, first to the company's insurance carriers, then to the

company's benefits managers. And often, even the appeals were denied.

According to Illeana Connally, the company's vice-president for benefits,

Home Depot eventually was persuaded by unhappy employees to look more deeply

into the issue of autism. Connally and her staff consulted various research

centers that specialize in the treatment of children and adolescents with

developmental disabilities, including one that was particularly close to

home: the Marcus Institute in Atlanta, which was originally founded through

a gift from Bernard Marcus, the founder of Home Depot, and his wife. Home

Depot eventually fashioned a package of autism benefits that was essentially

written by medical experts from the Marcus Institute and the Kennedy Krieger

Institute, a treatment and research center in Baltimore. The policy covers

cognitive behavioral therapy, occupational therapy, speech therapy and

physical therapy for children with autism, as well as for kids with Down

Syndrome, cerebral palsy or a severe neurological or genetic disability.

Connally is hopeful that a wider array of companies will institute autism

coverage in the future. Indeed, advocates of such care may have numbers on

their side: The one major cost-benefit analysis of behavioral therapy for

autism, a study published in 1998 in the journal Behavioral Interventions,

suggested that the savings in unneeded social services could be substantial

if every autistic child was offered these services. Using a model that

assumed preschool children with autism would receive three years of early

intensive behavioral intervention from age 2 until they entered school at

age 5, the study concluded that by investing about $50,000 per child yearly

for three years, more than $1 million per person would be saved by the time

these children became 55-year-old adults. Since as many as 500,000 kids may

be diagnosed with autism by 2010, early behavioral therapy looks like it

could be a good investment.

Links in this article:

1http://www.smartmoney.com/cfscripts/Director.cfm?searchString=MSFT

2http://www.smartmoney.com/cfscripts/Director.cfm?searchString=HD

URL for this article:

http://www.smartmoney.com/mag/index.cfm?story=june2007-autism