Jason Dana Costa 0:00

Hi, everybody, and welcome to Worth the Work with Jason Dana Costa. Today's guest is Alvi Wiskowski, who is the CEO and co-founder of Right Away ABA. He's an actuarial who has built his career solving complex business challenges across insurance, consulting, and in healthcare. And today we're going to explore his journey into leadership, which I share with him in many ways, and the lessons behind his career pivot and how he balances growth today, financial discipline, of course, where he worth the work like to have meaningful impact. So, Avi, welcome. Thanks, Jason. I appreciate you having me now. Excellent. We appreciate having you here. And given that you're a close neighbor in Connecticut, I'm here in Rhode Island. So that's fantastic to always have another New Englander here joining us. So here we worth the work. I always like to try to connect people's upbringing to those personal lessons that they now utilize in leadership. So I'll start off by asking, growing up, what values help shape the way you think about responsibility, success, and what work actually matters to you?

Avi Wisotsky 1:00

Yeah, I grew up in a family where my grandfather was a small-town pediatrician. And one of the things that he always talked about was doing things for others. And it's not just talked about it, I saw it. Where he had this little, do you remember back in the day that had these little offices attached to the house? And so I mean, I grew up watching someone who's just devoted to other people and really serving people and really just being there for the community, whether it's bedside manners, is something that he really emphasized. We can always make more money, but how do you actually provide value and really be there for other people? My mom's an OT as well. So that definitely from my great uncle's a pediatrician as well. So definitely familiar with the healthcare world.

Jason Dana Costa 1:53

So Avi, given that you've clearly got some strong clinical experience in your life, I'm an accountant by trade, and but you've brought up as being an actuarial. So how'd you land in being an actuarial when you were so surrounded with people that were in the medical field?

Avi Wisotsky 2:07

So it's funny because I was always a numbers person. So I had that head for basically business, numbers, entrepreneurial. Took me some time to kind of develop into what I felt, oh, okay, this is really where I see myself. But as I was growing up, I had a family friend who was an actuary. And it was just kind of one thing led to another. I was good at math. I liked that type of stuff. And it was just one thing like another, and decided I wanted to go into actuarial, went to school, got a degree in actuarial science, went through the whole exam process, worked as an actuary for 10 years, and worked in a variety of different settings as an actuary.

Jason Dana Costa 2:53

Got it. So clearly, you went from insurance and consulting to now being the CEO and co-founder of Right-Away ABA. That's a big pivot for you. And I should say your wife helped co-found this organization. So tell us a little bit about Right Away ABA and how you made that pivot. What made this an opportunity that you thought was worth taking?

Avi Wisotsky 3:14

Yeah. So one of the things that I learned was I was able to really have a great background work experience just from my experience working with different Fortune 500 companies, working for a Fortune 500 company, when I was working at the Hartford, working as a consultant for other Fortune 500 companies, and really being able to see operations, merge and acquisitions, capital allocation, and different things to really understand how companies, the big most successful companies, work. And obviously working alongside other very talented people throughout my career in the corporate world. So my wife is a BCBA, and she was working, BCBA is a board certified behavioral analyst. And that is, she is board certified as a supervising therapist, essentially, for ABA therapy. And she was working for a few different companies. And I noticed that I mean a bunch of people were reaching out to her and said, you know, hey, there were some operational challenges with her company that she was working for. Company got very big, and they asked her, hey, can you open up your own ABA agency? We really love working with you, but we're having some other issues working with some of the larger companies. So I did a deep dive to understand, well, what actually is happening in the ABA therapy industry? And what I found was that there essentially are two types of companies. There is the provider-led, BCBA-led organizations that focus on quality care. And that's great. They have quality care, they're making sure to put the therapy above profits and things like that. And they really are looking out for the patients. But the problem is that they can't scale. So it's great that you have a BCBA who has 10 kiddos under her caseload, but that's only impacting 10 kids. You can't really scale more than that. Once DCBAs start scaling, that's where they kind of lose things because operationally, there's a lot of things. There are a lot of things that go into running an ABA organization. Then on the flip side, you have these larger private equity-backed companies that have all those operations. They have their business done properly, they have everything running smoothly and efficiently. The problem is that they're running it just as a business. And it's very difficult for, I would say, parents and providers often have difficulties. There are difficulties where they're making rules that, yes, they work on paper, but in real life, they don't necessarily work, right? Having a reasonably high minimum hour requirements, kind of squeezing the orange for the pulp, if so to speak. So you're kind of not understanding what it's like to be in the trenches and actually working as a therapist or being a patient or being a parent of a child with autism.

Jason Dana Costa 6:32

And for our listeners, A A B A, can you tell them what that stands for?

Avi Wisotsky 6:36

ABA is applied behavioral analysis. And ABA therapy is it's an evidence-based, typically the number one therapy for children with autism, helping them prove their behaviors and setting them up for success.

Jason Dana Costa 6:54

And how about the VCBA you mentioned too, just for my listeners to make sure they know what those two things stand for?

Avi Wisotsky 7:00

Yeah, sure. So there are essentially two providers that are working with a child. There's something called a RBT or BT uh or behavior technician. That is the person who is working day in, day out with the child. A VCBA is a board-certified behavioral analyst. The field is called ABA behavioral analysis. And the BCBA is board certified, which means that they have their master's in ABA, they pass their boards, and they are fully qualified to be essentially a supervisor of these children. And they supervise, they design what we call a treatment plan, and they supervise the therapy. And they're the ones that are constantly implementing, tweaking different things to make sure that to really set up what the child is going to work on, what are the goals that the child needs to work on? How are we going to reach those goals? What are the methods that we're going to do? And then they are communicating with the behavior technician who is the one working day in, day out with a child.

Jason Dana Costa 8:10

Thank you, Avi. I appreciate that. So I hear you saying there was these sort of small shops that could really impact 10 kids well, but couldn't scale versus these larger shops that sort of had this strong operational efficiency, but yet didn't feel the right fit and really impacting there. So how did Right Way ABA find? I love the word by the way, because you're talking about these things and you're finding that middle. What made Right Way ABA special to kind of find its place there? So I like to say to scale with care.

Avi Wisotsky 8:43

Ah, nice. Scale with care. I love it. How do you scale with care? That's where my background really helped. So what I said is, okay, well, I've seen what these big companies have done. I've seen the inner workings. I have a good sense operationally and from a business perspective on kind of how to grow the company and how to run it operationally. And with my wife's clinical expertise and her background, we also have family with autism. So my first cousin has autism, so it's something that's personal for us. So with those two things, we felt okay, we put those together, we can build a successful company. I'll stay in my lane, my wife stays in her lane, and away we went.

Jason Dana Costa 9:34

Excellent. So it's kind of a good lead into one of the other questions I was really curious about. So actuarials and you're kind of like accountants like this, where I like to think of myself as sort of accountants are classically doctor no. I'd I like to think of myself as a little doctor maybe. You know, okay, what's the situation? How can we take your idea and potentially put it there? And ignorantly, perhaps, I think actuarials are really trained to see risk before it becomes a problem. So, how's that mindset helped you lead this healthcare organization?

Avi Wisotsky 10:05

It's helped a lot. It's helped a lot in a few different ways. More broadly, we've been able to scale it in sort of creative ways, but in a de-risked way. So, for example, we have four locations now. Instead of doing a full build-out for all of our locations, we've partnered up with existing sensory gyms that were already there. Excellent. And partnerships. They actually had pretty much no one there during the day because their busiest times are like the weekends. And we were able to partner with them. And this is sensory gym is specifically designed for children with autism. We partnered up with four of them to build out our full program. So what we're able to do is instead of investing hundreds of thousands of dollars of build-out to start in a location where we didn't know if it was going to be successful. And just to give you one more piece of background, we bootstrap this completely. So we did not take any investors. Congratulations. That's hard work. Yeah. It definitely forces you to be really efficient with your money and your time. So we couldn't just spend millions of dollars and just build out and just say, let's see what happens. We had to be more intentional about where we were starting. So we started in New Jersey, which is where I'm from. I'm from North Jersey and I'm familiar with the Jersey landscape. Yep. So we partnered up with existing spaces. We were able to be a little more cost-effective there. And we were able to kind of test out markets to figure out what works and what doesn't work. And I am more of a risk taker than most actuaries for sure. And also we basically stopped growth multiple times when we felt, hey, we really need to focus on the operations because ultimately it's about building that foundation, that strong foundation. And then when you build that strong foundation, you can scale on top of that.

Jason Dana Costa 12:14

Yeah, a great phrase. A former colleague used to tell me is he always wanted to make sure you didn't get out over your skis. You know, if you've ever skied before, it means sort of leaning too far forward. You got to set yours settle yourself in. Don't get too far over your skis. So that's great. I think you definitely deployed that opportunity to make sure the right way ABA didn't get out over their skis. I was curious considering clearly part of your business model was strategic partnerships. So how did that, how'd those conversations go? I mean, I'm assuming as a new CEO in this area, you know, you're kind of treading into some new water. So how did you build those partnerships? How did you show them value and they show you value?

Avi Wisotsky 12:52

You know, in sales, a lot of people think it's about finding that like that pickup line, so to speak, right? It's like, what am I gonna do to get them? What's that catch, right? That hook that our my big thing is provide value. That's it. So when I approach them, the first thing is about credibility. How do you gain credibility? Well, that's where our mission comes in. My wife is a BCBA, you know, we are a BCBA owned and led organization. And a lot of people really like that because what happens is that they can feel good about partnering with us because they can trust us to represent their brand in a good way as well. So it's also about finding out what everyone wants. And again, that's where providing value is. So I've asked the question if there are two things that would make you say, let's do this. What would those two things be? And sometimes it's money, sometimes it's values, sometimes it's something else, sometimes it's communication. But what are those two things that would make you say, Yeah, I'm in. And when you figure that out, and sometimes I'll ask it directly in the conversation. Oh, yeah. What are those two things? And then once I understand that, I can speak to oh, if it's a price, okay, let's figure out a price that works for both of us. That makes sense, right? If it's quality clinical care, we can speak to that on how we do that on our team. But that's really how we've been able to do it. And then once we kind of got one, then the other ones came because it did give us some credibility. Once we kind of, you know, had one or two, then other, you know, others came and were continuing to expand.

Jason Dana Costa 14:57

Yeah, credibility is absolutely probably one of the most important things you can do in a business partnership. Be forthright, be credible, and do what you say you're gonna do.

Avi Wisotsky 15:08

Yeah, and I I think also it's really important to be honest. Like I don't BS people, I just and we're also very flexible. That's the other thing. Whenever you're having some sort of partnership, everyone has to understand that there are gonna be pains in the beginning. There are gonna be growing pains, and not just in the beginning, throughout, there are gonna be different things. Education is really important. Staying, if there is an issue, let us know. If there is a frustration, you need to tell us before it bottles up inside, and then all of a sudden, so it's about maintaining that communication, and you have to put your ego at the door. That's what it is, also. So put your ego at the door and you're thinking about other people, not just about how this can help me, but how this can help you, then that's where you're able to make partnerships, build relationships.

Jason Dana Costa 16:02

Give me a sense of scale op because I think you said four locations. How many people are working for your organization currently? We have almost 170 people.

Avi Wisotsky 16:12

And we started a year and a half ago.

Jason Dana Costa 16:13

So that's a tremendous amount of growth in a short period of time.

Avi Wisotsky 16:17

Yeah, we're trying to hit the uh 10 million of ARR by year end and continue to grow after that.

Jason Dana Costa 16:26

So and it's multi-state. So I heard New Jersey, Connecticut, those are the only two states you're in, or is there others?

Avi Wisotsky 16:32

We're actually just in New Jersey. Connecticut, we live in Connecticut, but we are not operating in Connecticut. Yeah.

Jason Dana Costa 16:37

Oh wow. So that's interesting. I mean, I've always wanted to probe into when I've learned about you, I wanted to probe into how your transition to leadership has been from being an actuarial, you know, becoming that person who is ultimately responsible for those decisions. But that's going to be interesting, not only to have that new role, but in some respects doing it from a virtual distance. So maybe share with us how that experience has been, leading an organization from four to five hundred miles away. Yeah.

Avi Wisotsky 17:05

So it's not that far. It's about two hours or two to three hours to our locations each way. But it is far, but it's not the hop, skip, and jump. Part of the great part about working through COVID in the corporate world and really most of my working time, at least the last few years in the bulk of my experience. I was working remotely for years. I was managing teams remotely. I was managing many things remotely. I really learned how to manage things, manage teams remotely, and manage a business remotely. And it just goes back to that communication piece. Our admin team stays really closely connected. We are talking all the time. Ultimately, the reason why I actually like it is because it forces you to delegate, as opposed to just saying, I will take this myself. I'll just go here, I'll just go there, I'll just meet that person. It really forces you to be more intentional about the things that you're going in for, about really understanding the value of whatever that thing is. Is there going to be a value? Is this worth my time? And then it's allowed us. I mean, we hired a BCBA to run our outreach essentially, and run our event marketing, and run our events and go to other events and reach out to providers and things like that. I can come in when needed, but it's allowed me to then say, okay, how do I just continue working on the business, not in the business? And ultimately on a scale, you need to be able to work on the business, not in the business.

Jason Dana Costa 18:46

Oh, I say that to colleagues all the time. It's one of the biggest mental pivots I can say in taking on a CEO's role is to recognize that you have to work on the business rather than in it. I agree 100% with that phrase. I was also curious because you've had so much growth in 18 months. That puts a lot of pressure on quality and on culture. I mean, so I think you said 180 employees in 18 months. Is that fair? So that that's literally 10 employees every month. So how are you managing quality and culture? Because that's a bit of a break next speed. So I wouldn't even call like yes, we did grow quickly.

Avi Wisotsky 19:25

I'm not saying this, just say it. We stopped at marketing for months, multiple months throughout the process. That's where my wife and the rest of the admin team, everyone on our admin team are either therapists with clinical experience and also have family with autism.

Jason Dana Costa 19:46

Ah, so really committed to the condition.

Avi Wisotsky 19:48

They have a lot of care and they really want to make sure that we're providing quality care. AI has definitely been helpful in this. How so? I built out a lot of systems to sort of track where things are kind of falling through the cracks. So there are a couple things that we've done. One of them is my wife does not have a caseload. So she is in charge of all of the BCBAs. So if you think about an org chart, it's actually a fairly clean org chart because you have all of these behavior technicians that are pretty much working one-to-one. They pretty much have like one kid out. And sometimes they have two, but it's pretty much, let's just say an average caseload is for a BCBA is 10, 10 kids. And let's say each one has one behavior technician. So you have org chart is behavior technicians report up to the BCBA. And then you have all the BCBAs report up to my wife, the clinical director. So it keeps it a pretty nice, clean structure. And my wife has constant touch points with the BCBAs, where she actually reviews all their goals, progress, things like that.

Jason Dana Costa 20:57

So she really runs the clinical supervision for each one of your clinicians who are actually touching the patients. Exactly.

Avi Wisotsky 21:04

So she's basically making sure that the BCBAs, that the kids that are under their care are actually improving, getting the quality care that they need. And then where AI comes in, and we are working on developing some more things to kind of track progress and things like that with the use of AI. But some of the breakdowns that happen, which is staff turnover, cancellations, a lot of these other things that are indirectly related to quality care, but absolutely impact quality care if there are a lot of, if there, the more cancellations. Obviously, you can't have the consistency. And ABA is it's really about consistency. So track we so we've built systems to get ahead of issues, track things where catch those early flags, basically, and then go back to go back to our admin team and and alert them hey, we're seeing something. Here, high cancellation rates for these people. And that's really helped us identify issues before they snowball out of control.

Jason Dana Costa 22:09

Is Right Way ABA accredited already with either CARF or joint commission or anything like that?

Avi Wisotsky 22:15

I'm not familiar with what that is, so I would say no. Okay.

Jason Dana Costa 22:18

There, I know in some behavioral health organization, I don't know if that's true in an IDB where autism would sit. Sometimes there is accreditation organizations that are part of licensure. So I was curious if if you've done that because it's so quick and the strength in which you've grown.

Avi Wisotsky 22:33

Yeah, we haven't done it yet. There's something called BHCOE or something for AVA agencies.

Jason Dana Costa 22:38

Got it. That's probably what your accrediting agency is. That would make sense. Yeah.

Avi Wisotsky 22:42

We haven't done that yet.

Jason Dana Costa 22:43

Avia, I have to know your co-founder and wife sounds like an incredible person. Let's name her who she is, not just your wife. Who is this wonderful person?

Avi Wisotsky 22:52

Rochelle Wisatsky.

Jason Dana Costa 22:54

She is a Michelle, you're doing amazing work from what Avia is selling us.

Avi Wisotsky 22:59

Yep. She's doing great work. And we really could not be doing this without her. You know, ultimately, it comes down to the clinicians. That's just what it is. So any decision that I make, she will override me. If there's a basically business versus a clinical decision, the way that we are built is that clinical comes first. And there are gonna be business constraints oftentimes. There are things that are gonna happen where we can't always do something or whatever, but we have that lens, and then the business has to kind of work around that essentially.

Jason Dana Costa 23:41

So that's a great segue to ask a question here about leadership because clearly you guys are sort of co-leading as well as co-founding. So what's the hardest leadership lesson that you've learned so far since moving into this CEO role? 18 months is sort of breakneck pace. Any hard lessons that you've learned that you're willing to share?

Avi Wisotsky 23:59

It is not fun making difficult decisions. You are constantly making difficult decisions all the time, whether it's terminating employees. I do not like it. It's something that I learned pretty quickly, which is basically you'll know within probably a week of working with someone whether they're gonna be her long term. And in the beginning, I would try to stretch it out, make excuses, whatever. Now it's pretty understood. Your first 30, 60, 90 days is essentially a trial period, right? Oh, yeah. Obviously, you're hired, but the way I work is that if I see within a week, like you have it, ooh, like people on our team that came on, they just take it and run with it.

Jason Dana Costa 24:46

Awesome.

Avi Wisotsky 24:47

But if I see you don't have it, you're not doing anyone any favors if there's just a complete mismatch. And what I've done is I've been extremely clear about expectations ahead of time now. So I say, I'll tell them what it's like. I'll tell them we're a really fast-paced team. We're working fast, we're working quickly, we communicate. If that's not for you, that's okay. But I'm letting you know that now. So you're not, oh my gosh, this is too fast. No, we're moving quickly. And you have to be able to keep up mentally, physically, like there's gonna be there be things. Attitude is extremely important. We are constantly doing different things. You have to be able to pick up anything, you know what I mean? Like just contribute where you can. If I ask you to do this or if someone else asks you to do that, don't say, oh, that's beneath me, or something like that. So it's attitude, skill set. And then ultimately, money cash flow is a constant difficulty, especially in this. You have the insurance delay, building is a separate issue.

Jason Dana Costa 25:49

That's a whole nother podcast.

Avi Wisotsky 25:51

Yeah. And you know, I thought that, oh, like, because I'm a spreadsheet person. If I'm have X amount of clients, I'd be making this amount of money. And I will tell you, at this stage of business, I thought I'd be making bottom line, certainly more, significantly more than we're actually making right now. But that's okay because you know what? We've been intentional for certain things to pay our therapists a little more than industry. And even if it's gonna hurt our bottom line a bit, that's okay because we want that quality care. But also, it's forced me to be extremely intentional of where I jump in. So I've been jumping into billing significantly. I've learned billing just because we need to. And it's not, you don't just trust people. You have to be on top of the process as the CEO. You have to understand the ins and outs. And then when everything is running smoothly, then you know, let it go into the wind with your blessing, right? Of periods.

Jason Dana Costa 26:52

I call it trust but verify.

Avi Wisotsky 26:55

Yeah. And I think it's even more than trust but verify because usually verify you have to be even more the weeds, I think, than verify. And that's another mistake that I made, which was like, yeah, I'll review something and I'll take a look at it. Yeah, that looks good. No, no, no. One of the things I learned as an actuary was reconcile, reconcile. Oh, yes, I agree. I'm an accountant, you reconcile everything. Exactly. So, you know, some of those things have helped us where we've really been able to identify a lot of issues just because I went into something, this doesn't make sense. There's a reason why this doesn't make sense, it's not adding up. And then you're able to uncover a bigger issue because of that.

Jason Dana Costa 27:40

Got it. So if I heard correctly, one of the first lessons was when you have something that's new, fail fast, particularly in some hires. You know who that's going to fit the culture, you know who's not, and be courageous to take that on. That's been a great lesson recently. Is that fair? From the 18 months from beginning to now.

Avi Wisotsky 27:58

Oh, yeah. Absolutely.

Jason Dana Costa 28:00

Absolutely. And the second thing I'm hearing you say is trust, verify, but reconcile. Make sure you're interrogating, asking those questions about your business.

Avi Wisotsky 28:09

Look for the issues. Look for the my father would always tell him when he was teaching me how to drive, he would say, you know, look for the baby. Look for the baby, you know, when you're pulling out. Look for the car behind you. Not like, oh, see if there's no, you have to actively look for the issues and then it's all about speed. It's about speed, not sitting on anything, boom, finding out where it needs to go, who needs to go, giving them a timeline, right? Being having it specific instructions, things like that. Yeah.

Jason Dana Costa 28:36

That makes a hundred percent sense. So I got one more question for you, Avi, before we wrap up here. It's been so quick this growth. 18 months right away, ABA has grown so much. So give me your vision. What's five and 10 years from now? What do you want me to say if it's true that it's been worth all this work? If I we get together in five, 10 years from now, what's that vision? What are you looking like?

Avi Wisotsky 29:00

Ultimately, it's about impacting as many families as we can and providing quality therapy to as many families as we can. So what those numbers will look like? I have numbers in my head. But to me, I think about how many families are we impacting? What's the quality of therapy? And when in 10 years from now, when those kids who are in our program are that much more successful in whatever they're doing, and everyone's at their own stage, autism is a fairly wide range. But the more that we can provide value, the more that we can impact people, that's what it's about.

Jason Dana Costa 29:34

That's a fantastic vision for the future. So, Avi, I want to thank you for joining us today. We really hope you right away ABA all the success in the world. Thank you so much for coming on Worth the Work with Jason Dan Acosta. We appreciate you and the work you do.

Avi Wisotsky 29:49

Thanks, and thanks for having me. Thanks, Well.