Timothy A. Zercher (00:00)
So Joe, you've had decades in ABA and multiple leadership roles. What inspired you to launch Compass ABA?

Joseph O’Keefe (00:07)
Thanks for asking. Yeah, I had been working in the kind of ABA field and related fields for quite some time and really got to know the ins and outs of providing ABA therapy to children to adults. Really gained a lot of experience along the way through my journey and thought 2020 — in the middle of a pandemic — seemed like a good time to start your own business.
No, but asking around and talking to a lot of families in the New Jersey community, a lot of the services that they had been receiving had either gone away or never started, unfortunately, because of the pandemic.
As a sole practitioner, as a BCBA, I had kind of the business operations background too. I decided to kind of throw myself out there to see if I could help these families — most notably families that were Medicaid beneficiaries in New Jersey. As of 2020, it was just made available to them. And it was kind of terrible timing that a lot of the services had gone away at the time.
So I wanted to make what I believed were high-quality services, high-quality ABA therapy, available to those families.

Timothy A. Zercher (01:24)
You’ve led both clinical and operations teams, and Compass has grown rapidly in the last five years. How do you balance quality of care with scaling and growth? Sometimes those two seem to be opponents.

Joseph O’Keefe (01:59)
Yeah, no, exactly. You hit it on the head. I have to take off one hat and put on another one sometimes. It can be quite dichotomous. But in an effort towards that, I have brought on a clinical team separate from me. I'm not on it. And I've really given them the clinical keys to the company.
Had to be someone that I really trusted. That was our Clinical Director, Danielle Misera, trained under Vince Carbone — very strong with behavior skills and training. I just have the ultimate confidence in her, which helps.
And I decided to do that just because I wanted to maintain the business side, even though I have no business training. I don't consider myself a business person, but I wanted to make sure that I was in a position to be able to make the business decisions to ensure clinical quality, if that makes sense.

Timothy A. Zercher (02:50)
Tell me something you've learned with authorizations and payer relationships over the last few years. What do new service providers often get wrong?

Joseph O’Keefe (03:48)
Yes. Just a word of advice — I know I'm maybe not supposed to give advice here — but to people looking to either start their own practice or be a sole practitioner like how I started: make sure that you know the ins and outs of your payers first.
It's a big piece that I think a lot of clinicians are missing. They don’t teach you about this stuff in grad school.
This being said, if your funding source is insurance reimbursement, like with Compass ABA — I know there are other funding models — but if you're going insurance-based, you have to know who you're partnering with.
And then make sure your authorizations process, assessment templates, data collection, and all related documentation meet the medical necessity criteria for these payers.

Timothy A. Zercher (04:50)
So many providers in ABA are struggling with staffing and turnover. What are some tips and how do you manage that ongoing challenge?

Joseph O’Keefe (05:05)
Yeah, it is a constant struggle, and I would have hoped after almost five years of being operational that we would have figured it out by now.
But to be brutally honest, we still haven’t. Hiring and retention is still the number one challenge facing an ABA company.
The main reason is just too much demand — for better or worse. But we also have to ensure that we are putting people in positions where they can succeed.
Over the years, as we’ve scaled, we’ve done a good job providing the tools, resources, and supervision to help our employees succeed.
But you have to make sure you’re hiring the right people, too. Rather than just throwing human equity at it, we’ve built a process that ensures we’re hiring the right individuals to work with children with developmental disabilities.
Even if it means having difficult conversations with families about waiting, it’s more important to find the right match with a trained professional.

Timothy A. Zercher (07:16)
If you could change one thing about the ABA business model overnight, what would it be and why?

Joseph O’Keefe (07:27)
My answer to that is quite simple. Maybe not earth-shattering — or maybe even controversial — but I think the prevailing business model doesn’t focus on providing high-quality clinical services.
As the field has grown into a full-blown industry, it’s strange even to call it that. I’ve been working with people with developmental disabilities for over 15 years, but it’s now a large part of the healthcare economy.
The focus has unfortunately shifted. That’s why I appreciate movements and groups pushing for higher-quality care.
I want Compass ABA to be a case study — proof that if you do it right, you can be successful without cutting corners. Your ROI comes from helping people. That’s how you grow.

Timothy A. Zercher (08:36)
Absolutely. By actually helping them progress and achieve their goals — not just servicing hours.

Joseph O’Keefe (08:42)
Exactly. Helping them achieve their own targets and acquiring skills that they want to develop.
At least from our perspective, the funding source will still be there if you do all those things. You don't need to cut corners. It'll grow on its own if you do it right.