Thrive ABA Therapy Runs an In-Network, BCBA-Only Care Model

A different labor model

KING COUNTY, WASHINGTON — Thrive ABA Therapy has built an in-network practice around a labor model that runs against the usual division of work in ABA. The King County, Washington, company does not employ RBTs. A BCBA delivers every direct-therapy hour, while founder Kristen Gainer handles insurance, billing, and prior authorizations so her clinicians can stay focused on care.

The approach places master’s-level, licensed clinicians in hours often assigned to technicians in a tiered model. It also places a different constraint on growth. Thrive has fewer than 10 clients, and Gainer said a full-time BCBA carries two families, or three at most. A part-time BCBA carries one.

That size is intentional. Gainer founded Thrive on July 3, 2023, without outside capital. She began with her own caseload, then hired a BCBA to take those clients and continued adding clinicians slowly. The company now has five clinicians.

The result is a founder-led practice that has chosen continuity and clinical depth over rapid expansion. Gainer said the model could grow, but she does not want growth to come at the expense of the work.

“I really think this business could be scalable, but I would never want to sacrifice the quality. Quality is most important to me, and I’m fine with having a small business,” she said.

“I want to have quality services over quantity.” — Kristen Gainer, owner, Thrive ABA Therapy.

From the classroom to a founder-led practice

Gainer’s path to ABA began in education. She has worked in the field since 2005 and first served as a special education teacher. She holds teaching certificates in special education and elementary education, completed post-master’s ABA coursework at the University of Washington, and is a Nationally Board Certified Teacher.

In the classroom, she ran an Extended Day program for preschoolers with autism. She said barriers in the classroom kept her from teaching as successfully as she wanted. When she began applying ABA, she saw a change in her students’ learning.

“I started applying it to the classroom, and it just made the biggest difference. I was seeing such great results in my teaching, and kids were learning so much more. And that’s when I fell in love with ABA,” Gainer said.

She also saw a gap between what students received in school and what families could obtain outside it. That experience became the foundation for Thrive, an in-home and in-school practice serving Seattle and communities across South and North King County.

What one tier changes clinically

Thrive’s one-tier structure assigns each family a single BCBA who provides direct care and makes clinical decisions. For Gainer, the value is not simply the clinician’s credential. It is what the clinician notices over time while working with a child and family.

She gave the example of a technician tracking the duration of tantrums. The data may record how long the behavior lasts, she said, but it may not show that the behavior begins when a sibling enters the room. A BCBA delivering the session can identify that relationship and decide that the team needs to collect ABC data.

“The data doesn’t show everything,” Gainer said. “So as the BCBA, you’re going to see a lot of things that your data might not show, and you’re going to know, oh, I need to be collecting ABC data.”

That continuity also matters inside a family’s home. Rather than rotating direct-care staff under a supervising clinician, Thrive assigns one BCBA to the family. “Families want to know who’s coming to their house every day, and it’s always going to be that one BCBA,” Gainer said.

The model still depends on the skills associated with direct implementation. Gainer described behavior technicians as doing the hardest job in the field and said a strong BCBA must first be a strong technician. Her distinction is about who holds the case and delivers the care, not whether technician-level work matters.

Thrive’s clinicians use a framework informed by Dr. Greg Hanley’s work, which Gainer calls “today’s ABA.” She described the approach as compassionate, child-centered, and neuroaffirming. According to Gainer, every BCBA at Thrive has completed Hanley’s training.

Making direct care work in network

The more difficult business question is how a BCBA-only practice works inside commercial insurance. Thrive is in-network with Premera Blue Cross, BCBS, LifeWise, Regence, and First Choice Health. Gainer said the practice works primarily with Premera, which recognizes direct-care models through a direct-care billing code.

The practice does not set its own rates. “Insurance companies set the rates. But we just work within that. We try to work with companies that provide a direct code,” Gainer said.

In a follow-up email, Gainer argued that direct care is not automatically more expensive for the payer. “In a tiered model, insurers pay for multiple levels of care and layers of supervision,” she wrote. “Our model simplifies care, ensuring families receive services directly from the clinician.”

The in-network status is central to her definition of access. Gainer said families have sometimes had to choose between using insurance and receiving direct care. Thrive is designed to provide both. She contrasted the practice with another local company, which she characterized as an all-direct provider that does not accept insurance.

Gainer also pointed to the CPT code revision currently under review and said she hopes it will formally recognize direct service delivery. Time will tell.

Because Thrive has no RBT workforce, the 2026 RBT credentialing changes had no operational effect on the practice. The company did not have to adjust its staffing model to revised training and professional development requirements.

A different BCBA job

The model changes the BCBA job as much as it changes the family experience. Gainer’s careers page requires five years of BCBA experience and a Washington behavior analyst license. She said experienced clinicians fit the independent structure because they are not working beside other BCBAs throughout the day as they might in a center.

Full-time clinicians receive medical benefits, a 401(k), flexible scheduling, mileage reimbursement, and accrued sick time. Gainer also takes on the administrative tasks that can pull clinicians away from care.

“I do all of the prior authorizations so that my BCBAs can just focus on providing the care, the quality ABA,” she said. “They can focus on the clinical side, and I deal with all the insurance, all the billing, all the prior authorizations.”

In her follow-up email, Gainer connected that focus to why many clinicians entered the field. “The direct model allows them to return to that core motivation, which is not always possible when supervising large caseloads of RBTs,” she wrote.

Thrive’s hiring process is therefore both selective and slow. Gainer looks for clinicians whose philosophy and mission align with the practice. Each new hire adds only a small number of families, which protects the caseload structure but also limits how quickly the company can expand. She has continued to operate as a solo founder, adding senior clinicians one at a time and keeping the business small enough to preserve its original model.

An option, not an indictment

That decision places Thrive apart from practices built for rapid scaling, but Gainer does not present it as a judgment on the rest of the field. She repeatedly made room for the tiered model and the RBT role.

“I do think that RBTs have a great place out there, and a lot of companies utilize RBTs, and I think that’s a great model,” she said. “I also think that families should have another option.”

That is the larger point of Thrive’s founder story. The practice is not trying to prove that one model should replace another. It is testing whether a BCBA-only structure can remain clinically focused, financially accessible through insurance, and intentionally small.

For Gainer, the answer comes back to choice. “I don’t have anything against the traditional model,” she said. “I also think there’s other ways of doing things, and that families should have the option to choose.”

“I also think that families should have another option.” — Kristen Gainer, owner, Thrive ABA Therapy.

AT A GLANCE

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