How Will Kaiser Permanente Make Up for Its Shortage of Therapists?

Kaiser Permanente’s long-standing deficiencies in providing mental health care to its patients led to a $200 million settlement with the state of California that was labeled historic. The settlement included a $50 million fine, the largest ever levied against a health plan by the state’s Department of Managed Health Care (DMHC). But that was largely a numbers game.

Considering that Kaiser drove a record $8.1 billion in net revenue as recently as 2021, the health care behemoth can handle the fine. But what happens next? And how will anyone know whether Kaiser is actually planning the buildout of its mental health programs, as the DMHC settlement calls for?
 

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Watching closely for answers to those questions are not only the health care workers’ unions that negotiate with Kaiser, but also the individual therapists within those groups who’ve known for years that the provider was lagging badly in delivering much needed mental health care.

“We’ve really been under the gun in terms of being able to provide care to so many patients,” said Ken Rogers, a psychotherapist who has worked at Kaiser for more than a decade. “We’re talking about people’s lives here.”

Rogers was among the more than 2,000 mental health professionals affiliated with the National Union of Healthcare Workers who walked off the job last fall, frustrated during contract negotiations by what they said was Kaiser’s refusal to address persistent staffing issues and long wait times for behavioral health services. (Disclosure: NUHW is a financial supporter of Capital & Main.)

Since the strike’s settlement, Rogers said, “I feel like Kaiser has taken some issues seriously and taken some strides in positive directions. But I’ve spent the past 13, 14 years or so in negotiations with this employer (as part of NUHW’s negotiating team), so my optimism is going to be guarded.”

NUHW President Sal Rosselli said that over the past few months, Kaiser has hired “a couple hundred more people” in mental health care, and in some places in California patients are receiving follow-up appointments within 10 days of care, as mandated by law. But Rosselli noted that the union can’t know how many new hires it would take for Kaiser to provide adequate care statewide.

Kaiser officials did not immediately respond to questions posed by Capital & Main. In a statement announcing the plan’s settlement with DMHC in October, Kaiser CEO Greg A. Adams said Kaiser “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.”

If Kaiser is taking seriously its deficiencies in providing access to mental health care, it is in part because the provider has been called out repeatedly — and, now, has been forced into a settlement with the state. That settlement makes explicit how poorly Kaiser responded to its mental health care patients’ needs for years, but especially during the NUHW strike.

According to the settlement document, Kaiser canceled more than 111,000 mental health care appointments during the 10-week strike. “What they did to patients during that time was terrible,” Rogers said. “They just kept pushing back the appointments. I had quite a few patients when I came back who I could see from the charting had not received any kind of care at all.”

Kaiser patients’ difficulty in getting mental health care appointments is not new, and it predates the settlement itself by many years. Kaiser paid a $4 million fine in 2013 for not providing its members proper access to mental health care. Four years later, it agreed to address similar failures. Yet Kaiser has consistently left patients without follow-up appointments for weeks, sometimes months, state officials and critics have said.

In January of 2020, an official with the American Psychological Association sent a letter to the DMHC calling Kaiser’s ongoing delays in providing mental healthcare access “egregious.” And last year, Jenny Butera, a marriage and family therapist for Kaiser in Sacramento who has since left the provider, told Capital & Main that by August, “My earliest next appointment [was in] mid-October — for anybody.” 

Industry experts say that Kaiser isn’t alone. Many plans in California have historically failed to deliver timely mental health care, in part because it was often cheaper to pay the fines levied by the state than to build and maintain adequate care programs.

That calculation was altered a bit by the passage of two bills in the California Legislature. One mandated timely appointments for mental health patients, while the other increased by tenfold the possible civil penalties for providers not doing so, from $2,500 to $25,000 per violation.

“It’s impossible for Kaiser to obey the law today, because they don’t have enough staff to do it,” Rosselli said. “That makes me optimistic that Kaiser leadership will sit down with us and collaborate in a real way to overhaul their mental health system.”

Part of Kaiser’s settlement with the state is a $150 million spending commitment over the next five years, but that will largely go to support things such as school outreach and partnerships, prevention programs and the like. According to the settlement document, Kaiser has increased its spending to provide mental health care by $1.1 billion just since 2020, which provides a more sober notion of the kind of money involved in a real buildout.

There are early signs of that process beginning. As part of their contract settlement, the NUHW and Kaiser have formed several committees in Northern California “that are making progress on access to care issues,” Rosselli said. That sort of organizational setup, in which therapists themselves have a seat at the table and can voice their concerns, is reminiscent of an older Kaiser model of collaboration with its individual health care providers.

In the meantime, the DMHC will be looking on. Spokesperson Rachel Arrezola said the department will be monitoring the terms of its settlement with Kaiser, including a requirement for Kaiser to hire an outside consultant “to focus on corrective actions” to help ensure that patients receive the timely care they need.

The DMHC is also continuing what it calls a nonroutine survey of Kaiser’s practices regarding mental health care that it began in 2022. Further recommendations or requirements from that survey could yet result, and Kaiser’s ultimate Corrective Action Work Plan is subject to the state department’s approval, Arrezola said.

Here and now, Kaiser therapists are trying to keep up with their caseloads while dealing with a pandemic-altered landscape that includes more virtual interaction. The rise of telehealth services has encouraged many therapists to leave Kaiser and go into private practice, Ken Rogers said, since they can do so from their own homes.

“Kaiser’s challenge going forward is to make these jobs appealing to workers in every way they can,” Rogers said. “I don’t think Kaiser historically was as concerned about that.” Both the union’s workers and the state itself are watching — and waiting — for change.

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