Kaiser’s Huge Mental Health Care Settlement Sends a Strong Message to Providers Who Ignore Patients’ Needs

Kaiser Permanentes $200 millionThe settlement with the State of California for its repeated failures to provide patients with adequate and timely mental health care was slow in coming.

The deficiencies themselves? Kaiser officials themselves say they are hiding in plain sight.

Years and years of banging your head against the wall finally paid off, said Ilana Marcucci-Morris, a therapist at Kaiser Permanentes 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 Thursday by the state 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 committed to spending $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 violate state standards.

The settlement resulted from the department’s oversight investigation and a non-routine survey of Kaiser’s practices last year, which identified several deficiencies and violations in plans for providing behavioral health services to enrollees, the department said in a news release. These included long delays for patients trying to schedule mental health appointments, a failure to staff sufficient high-level behavioral care facilities within its network, and Kaiser’s failure to make out-of-network referrals consistent with the requirements of the law when Network providers were unavailable, the department said.

Under the terms of the agreement, Kaiser must hire an outside consultant to focus on corrective actions related to access, referrals, resources and complaints 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 responsibility to provide behavioral health services, Governor Gavin Newsom said in a statement. Newsom said the agreement aims to provide Kaiser patients with the care they are entitled to in a timely manner.

In a statement, Kaiser CEO Greg A. Adams said the agreement assumes full responsibility for our performance during the research period, including our shortcomings, recognizes our work to improve mental health care, and ensures that our continued investments not only help Kaiser Permanente members but also build a stronger mental health foundation in the communities we serve.

Critics have argued that Kaiser patients have not received adequate care for years, despite past enforcement actions. Kaiser paid a $4 million fine in 2013 for failing to provide its members with adequate access to mental health care. Four years later, it agreed to correct similar flaws. Yet Kaiser has consistently left patients without mental health follow-up appointments for weeks, sometimes months, state officials and critics said.

The situation reached a boiling point last fall when more than 2,000 mental health professionals affiliated with the National Health Care Workers Union walked off the job, frustrated during contract negotiations by what they said was Kaiser’s refusal to resolve persistent staffing problems. and long wait times for behavioral services. (Disclosure: NUHW is a financial supporter of Capital & Main.)

Capital & Main reported in 2021 and again last year that 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 of last year: My next closest appointment (is) mid-October for anyone. The American Psychological Association said in 2020 that it had never seen such an egregious case of delayed access for follow-up appointments.

The DMHC paid attention to these stories, and legislation that took effect last summer required providers like Kaiser to schedule follow-up appointments for mental health care patients within 10 days of their last appointment. Following the settlement announced Thursday, the department said its research continues and could lead to a modified remedial plan.

This agreement is a monumental victory for Kaiser Permanente patients and their mental health therapists, who have waged multiple strikes over the past decade to force Kaiser to fix its broken behavioral health system, the union president said. Sal Rosselli. The DMHC report affirms everything Kaiser therapists said about their patients’ inability to receive adequate and timely mental health care.

In his statement, Adams said that demand for Kaisers mental health services has increased 33% during the COVID-19 pandemic and that 20% more people will seek care in 2023 than in the same period last year. She added that the ongoing shortage of qualified mental health professionals, coupled with physician burnout and turnover and the 10-week strike last year, have made it very difficult to meet this growing need for care.

The union disputed Kaiser’s characterization, arguing that qualified therapists fled Kaiser over the years due to excessive workloads and understaffing practices that predated the pandemic.

Kaiser Permanente is California’s largest health care provider, with 9.4 million residents using the system. The company was founded as a nonprofit organization, although its Permanent Medical Groups operate as for-profit entities. Kaiser reported record net income of $8.1 billion in 2021 before posting a loss in 2022, the only year since 2007 that the company posted a negative profit.

Kaiser therapists have complained for years that Kaiser pays little attention to the mental health care needs of its patients, a practice all too common among health care providers, industry economists say. Thursday’s deal will change the math a bit.

It makes me hopeful knowing they need to put money into this, Marcucci-Morris said. We’ve been pushing for more than a decade.

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