Kaiser’s massive mental health care settlement sends a strong message to providers who ignore patient needs

Kaiser Permanentes $200 millionA settlement with the State of California for continued failures to provide patients with adequate and timely mental health care is a long way off.

Your own shortcomings? Kaiser employees say they were hiding in plain sight.

Years of banging your head against the wall have finally paid off, says Ilana Marcucci-Morris, a therapist at Kaiser Permanentes Oakland Medical Center. This could potentially position Kaiser as a leader in mental health care, rather than a serial violator of mental health care laws.

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Director Mary Watanabe said in a statement that the settlement, announced late Thursday by the state Department of Managed Health Care, includes a $50 million fine, the largest fine yet imposed. Department used to apply to a medical program. Kaiser also pledged to spend $150 million over five years to build out behavioral health services that critics say have been underdeveloped for years, leading to appointment wait times that violate state standards. state.

In a press release, the department said the settlement is the result of the department’s enforcement investigation and an occasional survey of Kaiser’s operations last year, which identified several deficiencies and violations in the plan to provide behavioral health services to the enrollee. Those problems included long delays for patients trying to make mental health appointments, not contracting with enough senior behavioral care facilities in its network, and Kaiser failure to make out-of-network referrals consistent with legal requirements when network providers operate. 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 complaints, and ensuring that patients receive the mental health care they need, regardless of the type of illness or severity of their condition.

“Today’s actions represent a tectonic shift in our accountability for delivering behavioral health services,” Governor Gavin Newsom said in a statement. . Newsom said the settlement is intended 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 deal was solely responsible for our performance during the survey period, including our shortcomings, admitting our efforts to improve mental health care and ensure that our ongoing investments not only help Kaiser Permanente members but also build a strong mental health foundation more in the communities we serve.

Critics say Kaiser patients have not received adequate care for years, despite previous enforcement measures. Kaiser paid a $4 million fine in 2013 for failing to provide its members with appropriate access to mental health care. Four years later, they agreed to overcome similar failures. Yet Kaiser has consistently left patients without mental health appointments for weeks, sometimes months, state officials and critics said.

The situation came to a head 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 over what they said were Kaiser refuses to address persistent staffing problems and long wait times. behavioral services. (Disclosure: NUHW is a financial backer of Capital & Main.)

Capital & Main reported in 2021 and again last year that Kaiser workers said wait times for mental health appointments were often four to eight weeks or more. Last August 14, my earliest follow-up appointment was mid-October for anyone, said Jenny Butera, a marriage and family therapist in Sacramento who left Kaiser. The American Psychological Association said in 2020 that it had never seen such a serious case of delayed follow-up appointments.

DMHC has taken notice of such stories, and a law that took effect last summer required providers like Kaiser to schedule follow-up appointments for mental health patients within 10 days since their last visit. After announcing the settlement on Thursday, the department said its survey continues and may produce a revised remediation plan.

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

In his statement, Adams said demand for Kaiser’s mental health services increased 33% during the COVID-19 pandemic and 20% more people sought care in 2023 than same time last year. He added that an ongoing shortage of qualified mental health professionals, coupled with clinician burnout and absenteeism as well as a 10-week strike last year, has led to Meeting this growing need for care becomes very difficult.

The union has disputed Kaiser’s characterization, saying qualified therapists have been leaving Kaiser for years because of unreasonable workloads and staffing shortages before the pandemic.

Kaiser Permanente is the largest health care provider in California, with 9.4 million residents using the system. The company is incorporated as a nonprofit, although its Permanente Medical Group operates as for-profit entities. Kaiser reported record net revenue of $8.1 billion in 2021 before posting a loss in 2022, the only year since 2007 the company had negative earnings.

Kaiser therapists have complained for years that Kaiser pays little attention to patients’ mental health care needs, a practice that is fairly common among medical providers, economists industry insiders said. Thursday’s settlement changes the math a bit.

“I feel hopeful knowing that they have to put money into this,” Marcucci-Morris said. We have been promoting for over a decade.

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