Former Lighthouse Autism Center executive Katie Meyer on ABA staff retention, payer mix, clinical quality, and training clinicians for new states.
Key Takeaways
- ABA staff retention can mask complacency. Katie Meyer, who rose from therapist to Vice President of Clinical Operations at Lighthouse Autism Center, says staff often stay because other employers could be worse, which keeps headcount steady without moving a business forward.
- Her response was financial transparency. She trained clinical leaders on payer mix and billable hours, and paired quality metrics with KPIs and financial reviews in a monthly clinical town hall.
- Lighthouse’s Iowa expansion tested the model. Roughly half of the BCBAs Lighthouse initially hired in Iowa did not stay, she said, which led the company to train new center leaders in Indiana before each opening.
- The path forward runs through clinicians. Meyer, now Director of Clinical Solutions at Passage Health, says providers should define quality before they grow and train clinicians into operations rather than the reverse.
Katie Meyer has a word for the know-how that carried Lighthouse Autism Center through most of its growth: folklore. Clinical standards passed from one longtime employee to the next, learned on the floor more than from a manual, and for years that was enough, because the people opening new centers had come up through the company. Then Lighthouse expanded into Iowa, and the folklore, she said, did not make the trip.
Meyer spent nearly 14 years at Lighthouse, which Gregg and Sandy Maggioli, the parents of a child with autism, founded in Mishawaka, Indiana, in 2012. She joined as one of its first therapists, before the Behavior Analyst Certification Board introduced the Registered Behavior Technician credential in 2014, and left as Vice President of Clinical Operations. In September, she joined Passage Health, which sells clinical and practice management software to ABA providers, as Director of Clinical Solutions, a move Acuity noted in its third-quarter appointments roundup.
By October 2025, Lighthouse reported serving more than 1,100 learners across 44 centers in Indiana, Michigan, Illinois, Iowa, Nebraska, and North Carolina. In two video interviews with Acuity this month, Meyer described what scaling an ABA organization asked of the company’s clinical side, and why she thinks most of the answer lies with clinicians who understand the business.
An ABA Career Path From Therapist to Acquisition Due Diligence
Lighthouse took its first private equity investment, from Abry Partners, in 2018. In 2021, Abry sold the company to Cerberus Capital Management in a deal PE Hub valued at more than $400 million. During the Abry years, Meyer took on acquisition due diligence. She told Acuity she reviewed scores of ABA providers as potential acquisitions, then led the integration of the companies Lighthouse bought.
“It’s a bit of a unique career path, I would say, going from a BCBA to doing business development like that,” she said. The work took her into billing, credentialing, payroll, hiring, and intake. “To truly become an expert at ABA and operations, I think you almost have to know that side of the business.”
Measured against the providers she reviewed, she said, Lighthouse’s profitability, growth, retention, and client satisfaction held up well, and the comparison showed her which operating habits kept companies afloat and which tended to break a deal.
ABA Staff Retention: Why Loyalty Can Turn Into Complacency
As Vice President of Clinical Operations under Cerberus, Meyer led about 10 Regional Directors, none of whom left during her tenure, she said. Of the more than 200 BCBAs on staff when she departed, roughly 60 percent had started at Lighthouse as therapists, by her count.
She is careful about what she counts as retention. “In ABA, their loyalty doesn’t always just look like staying with a company,” she said. “Retention isn’t just ‘I still work here.’ It’s that ‘I still go to bat for you, too.’”
Staying, in her view, can be a default rather than a commitment. “If everything is decent in terms of getting paid and they’re ethical for the most part, people will stay long-term in places just because they know other ABA companies could be wildly worse,” she said. “And so staying almost becomes complacent, but doesn’t move the business forward.”
Others in the field have framed the workforce shortage as a retention problem, and research ties the front line to the layer above it: a 2022 study in the Journal of Organizational Behavior Management, using Behavioral Health Center of Excellence data, found that turnover among technicians and among their supervisors tended to move together.
Payer Mix and Financial Transparency for ABA Clinical Leaders
Meyer’s remedy for complacency is transparency, aimed especially at the clinicians who end up running things. “There are usually clinicians that end up at the helm, just like myself, and that comes because they obviously understand the industry, but they have absolutely no training in business,” she said. She sees two camps in ABA leadership: people who treat the work as something like a hobby, a description she offers “with a lot of love,” and “those that aren’t scared to talk about things like profitability.”
The metric that finally clicked for the clinicians at Lighthouse, she said, was their payer mix (the blend of plans covering a center’s children, each reimbursing at its own negotiated rate) and what it meant for the company’s average reimbursement rate. In her illustration, if a center averaging about $65 an hour loses five of its 20 children to school in the fall and replaces them with clients whose payers have lower rates, the center’s average reimbursement rate can move by more than $10 an hour. Nobody on the floor chose that. In the example she walked her team through, the shift cost hundreds of thousands of dollars in revenue, “by no decision that we made as a company.”
When cuts follow, she wants clinicians to understand why rather than simply be persuaded. “What does that get you? It’s just blind loyalty, and you truly do want loyalty that is substantiated behind action.”
How to Measure ABA Clinical Quality Before a Provider Scales
Her advice on protecting quality through growth begins before a provider is large. “A lot of people will say we have high quality services, but my next question for them is, how do you know that?” she said. Lighthouse invested in having its data analyzed, she said, an investment private equity’s resources made possible. Smaller providers can start with simpler proxies, she said, such as first-attempt pass rates on RBT and BCBA exams, which affect how quickly new learners can be enrolled.
The point is to settle on what counts as quality early enough that every later decision can be checked against it. Meyer held a monthly clinical town hall where quality metrics were shared alongside KPIs and financial reviews. “These aren’t silos for operations and clinical,” she said.
She is reluctant to treat ownership as the deciding variable. Growth limits how much a company can individualize for each employee, she said, and private equity tends to absorb the blame, but clinicians and families can ask the right questions before they sign on. “Whether you are a one center company or a 55 center private equity, there’s good ABA in both places,” she said.
Clinical Versus Operations: Why Clinicians Should Run ABA Operations
When clinical and operations teams fall out, Meyer usually traces the problem to requests made without clinical knowledge. Her example is a large organization that sets a blanket rule requiring 10 percent supervision for every client without first asking whether it has enough BCBAs to deliver it. “If the answer is no, you really just made a big mistake with your team,” she said. “You’ve lost a lot of trust, and those sorts of things are really hard to get back.”
Acuity has reported on the blind spots a split between clinical and operations managers can create. Meyer’s answer is to put clinicians in operating roles. “I have found it too hard to train ops into clinical, and have found much more success clinical into ops,” she said, because “there’s a better manual for management with people and administrative tasks than there is a manual for ABA.” The field, as Acuity has reported, has few formal programs for developing those leaders.
The clinician she wants in that seat can work in the gray. She described a recent debate with a colleague who would discharge a client whose family was not completing parent training, about an hour and a half a month. Meyer would first ask whether the child is still progressing and whether the family is engaging in some form of training, while keeping the company in documented compliance. “There is a gray area here, and the perfect operator is a clinician who understands that there are multiple facets to this decision we’re about to make,” she said. Rigidity from either side, she added, is the real risk: “Black and white on either side of the fence of operations and clinical, and this business just doesn’t work.”
Expanding an ABA Provider Into a New State: Lighthouse’s Iowa Lesson
Lighthouse opened its first Iowa center, in Davenport, in 2023. Until then, Meyer said, centers in Indiana, Michigan, and Illinois had been opened by longtime Lighthouse employees; Iowa was the first state without one. Roughly half of the BCBAs Lighthouse initially hired when it moved into the state did not stay, she said.
“Moving into Iowa was like a year of hell, if you will,” she said. “We had a lot of what I called folklore.” What veterans passed down “wasn’t documented well enough for people six hours away from us to be able to pick up that training and culturally implement the standards that Lighthouse holds their clinicians to.” Lighthouse’s retention record, she concluded, had rested less on its training procedures than on the tenure of people who started as therapists and worked their way up.
Lighthouse rebuilt its clinical training department. Leaders for each new center were hired well before opening and trained inside Lighthouse’s established Indiana centers, so they could see a fully operating center before building their own, and the company followed the same approach as Iowa, Nebraska, and North Carolina opened. “That was the turning point for us,” she said. Design matters as much as hours: Acuity has reported on one multi-site provider that cut technician onboarding nearly in half, to 66.5 hours against the BACB’s 40-hour training minimum for new technicians, and saw early turnover fall.
Measured against what the company already spent on recruiting and sign-on bonuses, she said, it was worth the money. As each state matured, its own centers became the training sites, within a few hours’ drive. It is a working version of a rule other operators have described in Acuity’s reporting on multi-site growth: never outgrow your talent.
From Lighthouse Autism Center to Passage Health
Rate cuts and staff reductions at Lighthouse, she said, convinced her that systems have to carry more of the load when a provider cannot afford a full headcount. “I want businesses in this new kind of payer compliance hell that we’re in to feel confident that not only are they going to be paid, but they’ll be able to keep their money come audits,” she said. She chose Passage, she said, for what it offers the industry: “clarity and simplicity where it matters most.”
She describes a field in disarray. Providers have promised high-quality services to children with autism for a decade, she said, and the open question is how they will deliver them. “Everyone’s saying the same thing, and everyone’s also saying that it’s broken,” she said. “So something’s got to change.”
