The Investigation

Why ownership is worth tracing

Autism therapy is one of the most private-equity-concentrated corners of American health care. When the owner is a fund with a five-year horizon, the clinic your child attends is an asset on a balance sheet. Here is what the record shows, and what it does not.

Exhibit / A market bought in a decade

Concentration, not competition

Researchers at the Center for Economic and Policy Research found that between 2017 and 2022 private-equity firms completed roughly 85% of all mergers and acquisitions in autism services, a concentration they found in no other segment of health care.[1]

Our own record, built from the ground up out of public data, shows the same shape. Of the 1,755 clinics we have traced to an owner, 92% are held by private equity, and a handful of firms hold most of them. This is a market that was assembled, quickly, by financial buyers.

of autism M&A

~85%

private equity, 2017-2022 (CEPR)

of traced clinics

92%

PE-owned in our data

Exhibit / The warning already on the record

What happened to CARD

In 2018 Blackstone bought the Center for Autism and Related Disorders, then the largest ABA provider in the country at roughly 250 locations. The company took on debt it had not carried before. New-hire training was cut and moved online. Within five years more than a hundred centers had closed, and in 2023 CARD filed for bankruptcy.[2]

CARD is the reason a map like this matters. When a financial owner exits, the families relying on those clinics are the ones left without care. It appears in our dataset as a former holding, recorded for its history rather than shown as a live owner.

See it in the record: the owners index lists Blackstone as a former owner with a sourced timeline.

Exhibit / The honesty of the record

What we can and cannot say

We can say

For every clinic shown, the named owner is backed by a public document you can open. Non-PE institutional owners are labeled as what they are, not folded into “private equity.”

We cannot say

That a clinic not in this record is independent. Absence is a gap in our coverage, not a finding. We track ownership; we do not certify independence.

Still measuring

How complete the record is against the full set of PE-backed ABA platforms, and a published hand-verification rate. Both are in progress and will be stated as numbers, not implied.

Exhibit / Not a fringe worry

Washington is asking the same question

A bipartisan Senate Budget Committee investigation into private-equity ownership of hospitals found patient care deteriorated as owners took payouts.[3] The concern that drives this project is the same one now on the Senate floor: when finance owns care, whose interest wins.

Sources

[1] CEPR, “Pocketing Money Meant for Kids: Private Equity in Autism Services.”
[2] NBC News, on CARD, Blackstone, and the 2023 bankruptcy.
[3] U.S. Senate Budget Committee, private equity in health care.