[A California settlement compels the state’s largest health care
provider to spend $150 million on behavioral health services.]
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KAISER’S MASSIVE MENTAL HEALTH CARE SETTLEMENT SENDS STRONG MESSAGE
TO PROVIDERS THAT IGNORE PATIENT NEEDS
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Mark Kreidler
October 13, 2023
Capital & Main
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_ A California settlement compels the state’s largest health care
provider to spend $150 million on behavioral health services. _
The Kaiser Permanente Vallejo Medical Center in Vallejo, California.,
Justin Sullivan/Getty Images. Kaiser Permanente’s $200 million
settlement with the State of California for its repeated failures to
provide patients with adequate and timely mental health care was a
long while coming. The deficiencies themselves? Kaiser’
KAISER PERMANENTE’S $200 MILLION settlement with the State of
California
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its repeated failures to provide patients with adequate and timely
mental health care was a long while coming.
The deficiencies themselves? Kaiser’s own employees say they’ve
been hiding in plain sight.
“Years and years of banging our heads against the wall have finally
paid off,” said Ilana Marcucci-Morris, a therapist at Kaiser
Permanente’s Oakland Medical Center. “This has the potential to
make Kaiser a leader in mental health care, rather than a serial
violator of mental health care laws.”
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The settlement, announced late Thursday
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the state’s Department of Managed Health Care, includes a $50
million fine — the largest the department has ever levied against a
health plan, Director Mary Watanabe said in a statement. Kaiser also
pledged to spend $150 million over five years to build out behavioral
health services that critics say have been woefully underdeveloped for
years, leading to appointment wait times that violated state
standards.
The settlement resulted from the department’s enforcement
investigation and a nonroutine survey
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Kaiser’s practices last year, which identified “several
deficiencies and violations in the plan’s provision of behavioral
health care services to enrollees,” the department said in a news
release. Those included long delays for patients trying to schedule
mental health appointments, a failure to contract enough high-level
behavioral care facilities within its network, and Kaiser not making
out-of-network referrals consistent with requirements under the law
when in-network providers were not available, the department said.
Under the settlement, Kaiser must hire an outside consultant “to
focus on corrective actions” related to access, referrals, appeals
and grievances and to ensure that patients receive the mental health
care they need, regardless of the type or severity of their
conditions.
“Today’s actions represent a tectonic shift in terms of our
accountability on the delivery of behavioral health services,” Gov.
Gavin Newsom said
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a statement. Newsom said the settlement aims to “provide Kaiser
patients with the care they are entitled to in a timely manner.”
In a statement
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Kaiser CEO Greg A. Adams said the agreement “takes full
accountability for our performance during the survey period including
our shortcomings, acknowledges our work to improve mental health care,
and ensures that our ongoing investments not only help the members of
Kaiser Permanente but also build a stronger mental health foundation
in the communities we serve.”
Critics have argued that Kaiser patients haven’t received adequate
care for years, despite previous enforcement actions. Kaiser paid
a $4 million fine
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2013 for not providing its members proper access to mental health
care. Four years later
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it agreed to redress similar failures. Yet Kaiser has consistently
left patients without follow-up mental health appointments for weeks,
sometimes months, state officials and critics have said.
The situation reached a boiling point last fall, when more than 2,000
mental health professionals affiliated with the National Union of
Healthcare Workers walked off the job
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frustrated during contract negotiations by what they said was
Kaiser’s refusal to address persistent staffing issues and long wait
times for behavioral services. (Disclosure: NUHW is a financial
supporter of Capital & Main.)
Capital & Main reported in 2021
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last year
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Kaiser workers said wait times for mental health appointments often
stretched four to eight weeks or more. Jenny Butera, a marriage and
family therapist in Sacramento who has since left Kaiser, said on Aug.
14 last year, “My earliest next appointment (is) mid-October — for
anybody.” The American Psychological Association
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in 2020 that it had never “seen such an egregious case of delayed
access for follow-up appointments.”
The DMHC paid attention to such stories, and legislation
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took effect last summer required providers such as Kaiser to schedule
follow-up appointments for mental health care patients within 10 days
of their last visit. In the wake of Thursday’s announced settlement,
the department said its survey continues and could prompt a modified
corrective plan.
“This settlement is a monumental victory for Kaiser Permanente
patients and its mental health therapists who have waged multiple
strikes over the past decade to make Kaiser fix its broken behavioral
healthcare system,” said union President Sal Rosselli. “The
DMHC’s report affirms everything that Kaiser therapists have said
about their patients’ inability to receive timely, adequate mental
health care.”
In his statement, Adams said demand for Kaiser’s mental health care
services rose 33% during the COVID-19 pandemic and that 20% more
people have sought care in 2023 than at the same time last year. He
added that “an ongoing shortage of qualified mental health
professionals,” along with clinician burnout and turnover and the
10-week strike last year, made it “very difficult to meet this
growing need for care.”
The union has disputed Kaiser’s characterization, arguing that
qualified therapists fled Kaiser
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the years because of unreasonable workloads and short-staffing
practices that predated the pandemic.
Kaiser Permanente is the largest health care provider in California,
with 9.4 million residents
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the system. The company was founded as a nonprofit, though its
Permanente Medical Groups operate as for-profit entities. Kaiser
reported a record $8.1 billion
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net revenue in 2021 before showing a loss in 2022 — the only year
since 2007
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the company has posted negative income.
Kaiser therapists have complained for years that Kaiser paid scant
attention to the mental health care needs of its patients —
a fairly common practice
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health providers, industry economists say. Thursday’s settlement
will change the math a bit.
“It makes me feel hopeful, knowing they have to put money into
this,” Marcucci-Morris said. “We’ve been pushing for well over a
decade.”
_Copyright 2023 Capital & Main Reposted with permission._
_MARK KREIDLER is a California-based writer and broadcaster, and the
author of three books, including Four Days to Glory._
_CAPITAL & MAIN is an award-winning nonprofit publication that reports
on the most pressing economic, environmental and social issues of our
time. Winner of the Online Journalist of the Year and Best News
Website Exclusive to the Internet prizes at the 2020 Southern
California Journalism Awards, Capital & Main has had stories
co-published in more than 30 media outlets, from USA Today,
Newsweek, The Guardian and Fast Company to The American
Prospect, Grist, Slate and the Daily Beast. _
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