The conversation about what makes an ABA company valuable tends to drift toward abstraction: scale, infrastructure, clinical quality. These words appear in pitch decks and investment memoranda, repeated until they lose whatever meaning they once possessed. But when a buyer actually sits down to evaluate a potential acquisition, the assessment becomes granular, specific, and unforgiving. There are numbers that matter and numbers that do not, metrics that signal a well-run operation and metrics that betray underlying dysfunction.
Scott Kremeier has spent years examining these numbers. As a managing director in the healthcare investment banking group at Piper Sandler, where he focuses on healthcare services, Kremeier advises companies navigating transactions and counsels buyers on what to scrutinize beneath the surface of a prospective deal. His perspective offers a window into how sophisticated acquirers think about ABA platforms—and, by extension, what operators might consider as they build their own businesses.
Utilization: The First Number They Check
When Kremeier evaluates an ABA company, utilization is among the first metrics he examines. The concept is straightforward: of the hours that behavior technicians are available to provide therapy, how many are actually being delivered? A high utilization rate suggests operational efficiency—sessions are being scheduled, clients are showing up, cancellations are being managed. A low rate suggests the opposite.
“What is the utilization that you’re getting out of your BTs?” Kremeier said, describing his initial line of inquiry. “If utilization is at a certain percent and that’s a good one, great. If it’s below that, you’ve probably got some room. If it’s materially below, that’s a big red flag.”
The metric captures something essential about how a clinic operates day to day. Cancellations are inevitable in any therapy practice, but what happens afterward reveals management capability. Can the company backfill those slots from a waiting list? Is there a system in place for rapid rescheduling? These operational details, often invisible in high-level financials, become visible through utilization figures.
“Do you have a lot of cancellations? Are you able to backfill from that? What does the waiting list look like?” Kremeier continued. “Those are the things that I would look at right out of the gate.”
Retention: The Metric That Compounds
Workforce stability has become a defining concern in ABA, and buyers have learned to pay close attention to retention data. The industry’s turnover problem is well documented, particularly among registered behavior technicians. The work is physically and emotionally demanding, wages are often uncompetitive with less strenuous alternatives, and burnout is endemic. But some companies manage these pressures better than others, and the differences show up in the numbers.
Kremeier spends considerable time examining retention rates for both BCBAs and RBTs, looking not just at annual turnover percentages but at average tenure. The distinction matters. A company might report acceptable turnover on an annualized basis while still losing technicians after only a few months, creating a constant cycle of recruitment and training that drains resources and disrupts care continuity.
“I think everyone knows that it’s a difficult job, especially for the RBTs,” Kremeier acknowledged. “The wages are not as good in that role, and so the turnover there is relatively high. But can you shrink your turnover, or more importantly, extend it? If your average BT is there for six months and you’re able to get it to eight months, that’s a material improvement.”
Two months may sound modest, but the compounding effects are significant. Each additional month of tenure means fewer resources devoted to recruiting and onboarding, more experienced technicians delivering care, and greater continuity for the children receiving services. For a buyer modeling future cash flows, these incremental improvements translate directly into operational leverage.
Caseload Ratios: Where Finance Meets Burnout
The number of children assigned to each BCBA represents one of the more revealing metrics in an ABA evaluation, in part because it sits at the intersection of financial performance and clinical sustainability. A company can boost short-term margins by loading supervisors with additional cases. The strategy tends to backfire.
“I’ll also look at overall staffing and caseload,” Kremeier said. “Is your BCBA supervising eight kiddos? Are they supervising fifteen? What does that look like? Because that’s where that feeds into poor outcomes, and it also feeds into turnover and burnout.”
The threshold appears to fall somewhere around eight to ten children per supervisor. Beyond that range, clinicians begin to feel stretched, quality of oversight declines, and the risk of departure increases. Kremeier noted that BCBAs generally recognize when they are unable to perform their jobs adequately, and that recognition often precipitates an exit.
“BCBAs, in general, don’t want to handle more than eight to ten kiddos,” he explained. “They get stretched too thin, and that drives them out of the industry.”
For a buyer, elevated caseload ratios represent a double liability. They suggest that current margins may be artificially inflated through unsustainable practices, and they signal future retention risk among the supervisory staff most critical to maintaining clinical quality. A company reporting strong EBITDA alongside BCBA caseloads of fourteen or fifteen children invites skepticism about whether those earnings can be maintained.
Outcomes: The New Table Stakes
For years, ABA providers could operate without rigorous systems for tracking clinical outcomes. The demand for services was so intense, and the supply so constrained, that questions about measurable progress took a back seat to questions about access. That dynamic has shifted. Buyers now expect to see outcomes data, and so do the payers whose reimbursement underpins the entire business model.
“Today, private equity—and candidly, payers—are focused on what outcomes you’re tracking.” Kremeier said. “I’m expecting to see improvement. If the kiddo was getting forty hours a week in the first six months, he should be showing some levels of progression and that utilization should start to come down.”
The expectation reflects a broader reckoning with how ABA services are authorized and delivered. Major insurers have begun scrutinizing whether intensive therapy schedules remain appropriate over extended periods, or whether hours should decrease as children make progress. Providers who can demonstrate that their patients improve—and that treatment intensity adjusts accordingly—position themselves favorably with payers and acquirers alike.
“If you’re not able to showcase that to payers and other constituents, I think it becomes a challenge for you to drive a premium valuation,” Kremeier added.
The specific metrics vary. Violence scores and other standardized assessments provide quantifiable benchmarks, though Kremeier, who is not a clinician, deferred on the particulars of clinical measurement. What matters from a transactional perspective is that some system exists, that data is being collected, and that the company can articulate a narrative connecting its services to demonstrable improvement.
Geography and Mix: The Context Around the Numbers
Raw KPIs do not exist in a vacuum. Buyers interpret them against the backdrop of where a company operates and how its service delivery is structured. A utilization rate that looks acceptable in one state might appear weak in another with more favorable reimbursement dynamics. Retention figures carry different weight depending on local labor market conditions.
Kremeier noted that geographic considerations have become increasingly central to due diligence. Buyers evaluate reimbursement environments, population density, and the availability of qualified clinicians. Rural markets present structural challenges that urban centers do not; recruiting a BCBA to rural Louisiana is a fundamentally different proposition than recruiting one to Dallas or Chicago.
“Folks are being very thoughtful about what the reimbursement dynamic looks like, what the recruiting environment looks like, and what the overall patient population looks like,” Kremeier said.
Service delivery model also factors into the evaluation. Center-based and school-based programs currently attract the strongest interest, though platforms offering a diversified mix of center and home-based services remain appealing. The preference reflects operational considerations: center-based models tend to offer greater control over scheduling, utilization, and supervision, even if they require more capital investment upfront.
Multi-state footprints command premiums over single-state operations, in part because they diversify regulatory and reimbursement risk. A company concentrated entirely in one state remains exposed to that state’s policy decisions; a platform spanning multiple jurisdictions can absorb localized headwinds more readily.
The Human Element
Beneath the spreadsheets and utilization reports, Kremeier’s framework reflects an awareness that ABA companies are built on people who entered the field for reasons that have little to do with financial engineering. BCBAs and RBTs chose demanding, often underpaid work because they wanted to help children with autism. When operational pressures undermine their ability to do that work well, they leave.
“BCBAs are caretakers,” Kremeier observed. “They got into the job because they really want to help children who suffer from autism. By and large, they just want to deliver quality care and help the kids move from being severely autistic to learning how to cope as they get older.”
The implication for operators is that sustainable businesses cannot be built by maximizing short-term extraction from clinical staff. The KPIs that buyers examine—retention, caseload ratios, utilization—are not merely financial indicators. They are proxies for whether a company has created an environment where clinicians can do meaningful work without burning out.
“When it becomes all about the bottom line and we see people shave corners to drive more profit, that becomes less appealing,” Kremeier said. “It increases the level of turnover because folks are like, look, I don’t want to be supervising fourteen kids. I know I’m not giving good care that way. I would rather go someplace where it’s less than that and I can feel like I’m actually having an impact.”
For buyers, this human reality translates into hard-nosed calculation. A company that treats its clinicians well will retain them longer, deliver more consistent care, and generate more predictable cash flows. A company that does not will face an endless cycle of recruitment costs, training expenses, and operational disruption. The numbers, in the end, tell a story about culture—and culture, in this industry, is inseparable from value.
