When asked about its access issues, Kaiser pointed to a nationwide shortage of mental health care practitioners. “The need for mental health care in America has never been greater and at the same time harder to provide,” a Kaiser representative said. Said in May. “In the United States, mental health experts have reported a 30% increase in demand for mental health services since the start of the pandemic.”
Kaiser says it has prioritized filling hundreds of therapist vacancies in California. “We recently launched a $500,000 recruitment initiative to source and hire clinicians to fill the more than 1,000 open mental health clinician positions at Kaiser Permanente, more than 400 of which are in California,” said Yanner Balan, Kaiser CEO. vice president of behavioral health and specialty services, told Capital & Maine in a March 29 statement.
“The challenge we face is that all mental health providers are drawing from the same, limited pool of talent.”
Kaiser, whose mental health care is deficient A well-documented, $8.1 billion profit in 2021, A company record. In 2021, the Fitch The credit rating agency rated Kaiser Bond AA- for the company’s “sound and consistent profitability track record.”
Susan Whitney attributes Kaiser’s understaffing to “a combination of greed and a long-standing stigma of treating mental health like physical health.”
“I can’t believe they treat physical health problems the same way,” she says.
Emily Ryan, a licensed clinical social worker, began working at Kaiser in Sacramento in 2005. The weight of her case on Kaiser was “terrible,” she says.
“I could believe that it was difficult for them [hiring today], that all kinds of workers are in short supply right now,” she says. “That was not the case in 2005. In 2008, when we had the economic crisis, there certainly wasn’t, and we had the same problems.
Therapist Mickey Fitzpatrick, who worked in the Bay Area town of Pleasanton, says he had caseloads in the hundreds at Kaiser before leaving for private practice. “If even a fraction of those new clients wanted to see as often as recommended, I didn’t have the availability to see people for weeks to months at a time,” he says.
In rural Kern County, Kaiser employs 35 mental health workers to serve about 100,000 Kaiser members, according to data from the National Union of Healthcare Workers. There is no limit on the number of cases a therapist can take, and they face a regular onslaught of new patients.
“I have co-workers who have worked when they were very sick, but felt that if they canceled a day, their patients would have to wait another six to eight weeks,” says Whitney. ,” says Whitney. “People wake up in the middle of the night worrying about patients.”‘
American health plans limit access Richard G., senior fellow at the Brookings Institution and director of the USC-Brookings Schaefer Initiative for Health Policy. for mental health care to keep costs down, according to Frank. Other health care organizations have been accused Undermining their mental health care by not hiring enough therapists—or paying them insufficiently for counseling sessions—to migrate to more lucrative private practices.
This is by design, says Frank. Mental health patients are more expensive than physical health patients—not because the cost of care is higher, but because mental health patients also come with substantial physical health needs.
A 2020 study Consulting Company Milliman Inc. by reviewed 21 million insurance holders and found that the cost of behavioral health patients was 3.5 times higher than that of patients with behavioral health needs. “Ever since mental health began to be covered by insurance in the ’60s and ’70s, the incentives have been to avoid enrolling people with mental illness in your plan,” Frank says.
Over time, parity laws mandating that health plans offer the same mental health care as their physical health care have become increasingly strict. On October 8, 2021, Governor Gavin Newsom signed it SB 221, which requires that follow-up appointments for mental health sessions be scheduled within 10 days of the previous session.
Asked about taking action against Kaiser under the new law, the California attorney general’s office declined to comment, citing a “potential or ongoing investigation.”
Regulation and enforcement of health plans in California falls under the Department of Managed Health Care, which fined Kaiser. $4 million in 2013 to overbook their therapists. Kaiser Contracted with DMHC 2017 followed a litany of millions of dollars in fines and enforcement actions against the company. The settlement established a six-point plan to address mental health access issues and forced Kaiser to hire a consultant to oversee the process.
After the settlement, Kaiser established Connect2Care, a system of call centers to reduce wait times for new mental health patients. Therapists interviewed by Capital & Main said Kaiser built its call centers just to satisfy regulators, and Connect2Care has been criticized by the American Psychiatric Association.
In May 2022, the agency notified Kaiser Check it out in the mental health services of the health care giant.
“We appreciate DMHC’s interest and accountability in understanding how we are working to provide medically appropriate care to people who rely on us for their mental health services,” Kaiser wrote in a statement. do,” Kaiser wrote in a statement.
“Kaiser Permanente is meeting California regulatory standards for initial visits for mental health and wellness more than 90% of the time, on average. We encourage therapists to document treatment recommendations, including initial visits and follow-up visit frequency, and to escalate any challenges in scheduling to their manager, according to the established process.
Kaiser’s network of mental health practitioners may be less robust than the numbers suggest. A 2021 trial Allegations filed against Kaiser by the San Diego City Attorney’s Office allege that more than 30% of therapists listed in Kaiser’s directory were not actually available to patients: some were listed with incorrect contact information, some had retired. , some were not practicing in Kaiser’s network. , and some were not practicing at all.
The city of San Diego asserted in its lawsuit, “Kaiser’s grossly inaccurate provider directories harm the personal health of its customers as well as their pocketbooks, while illegally and unfairly restricting the company’s market share.” enable competitors to exclude more expensive subscriptions to their detriment.” .
San Diego has filed lawsuits against two other major providers, California’s Molina Healthcare and Health Net, for maintaining false directories of mental health care practitioners.
Data from the National Union of Healthcare Workers, which represents Kaiser therapists, found that practitioners have left Kaiser in steadily increasing numbers over the past three years: From June 2019 to November 2020, 469 practitioners left Kaiser. Given, the annual turnover rate is about 8% per year in Northern California and 5% per year in Southern California. From December 2020 to May 2022, 850 practitioners left Kaiser, and the average annual turnover rate was more than 12% in Northern California and 10% in Southern California. (Disclosure: NUHW is a financial supporter of this website.)
Kaiser mental health practitioners and experts told Capital & Main that working conditions are responsible for the exodus of therapists from the company. Former Kaiser therapist Mickey Fitzpatrick easily beat his old hourly rate, he says, which was $73.73 in April 2021, 10 years into the plan. In the Bay Area, therapists charge regularly $250 or more For 50-minute sessions.
Vice president of academic affairs at the Wright Institute, a private graduate school for psychology in California, Dr. “My graduates want to go to Kaiser for work, and they do,” said Gilbert Newman. “They often leave Kaiser because they don’t like the work they do. They don’t like being told you can’t see the people you need to help them.”
Kaiser therapists can get into trouble with their managers when they recommend clients for regular follow-up visits. In November 2021, marriage and family therapist Tanya Veluz was called into a meeting with three of her superiors after she recommended patients for withdrawal sessions. Managers went through a list of those clients, questioning their need for care.
“They went through each case, and for one couple where the trouble was too much, they said, ‘Understood, we understand why you want more support for this case,'” Veluz recalls. In every other case, they challenged my clinical judgments. ‘Well…the questionnaire doesn’t reflect the level of distress you’re asking for.'”
Veluz says managers also questioned his estimates for his patients’ treatment durations. Trauma patients, Veluz realized, would need sessions for two to six months.
According to Veluz, his manager told him it was impossible to know how long a patient would need treatment. Veluz disagreed, citing his clinical experience as well as “numerous findings” supporting his diagnoses. She says a manager threatened her license.
When asked about the incident, Kaiser representatives did not directly comment. On July 19, the company said it is on a “multi-year journey to improve the way mental health care is delivered in America today” and is expanding its virtual care and mental health professionals in medical settings. is keeping The company has “escalation procedures to support our therapists if they are unable to schedule the required follow-up appointment” and a “dedicated phone line”.
Ken Harlander, a licensed marriage and family therapist, practiced with Susan Whitney at Kaiser’s Bakersfield clinic, and left for private practice last year. Harlander avoided delays between appointments at Kaiser by booking returning clients into slots reserved for new patients, which led to her being summoned to the “principal’s office.”
“That’s what happened if you tried to push back,” he says. “When you ask, ‘Why are we selling a product that we can’t actually deliver?’ You won’t get an answer.”
Richard G. Frank agrees that post-pandemic The demand bolsters Kaiser’s shortage argument, but says insurance plans’ refusal to compete with private practice is the real culprit behind the practitioner shortage.
“I think there’s a grain of truth here, but I think it’s an exaggeration,” he says. “Health plans typically claim that they cannot hire all the people they want to hire at the current pay rate. It’s not like saying, ‘Gee, there’s nobody available.’
But for Ken Harlander, it wasn’t the salary that drove him to private practice—the company’s excellent benefits made up for the low hourly pay. Harlander says he left because Kaiser booked him too much and prevented him from doing his job effectively.
“It’s been great not working there anymore,” he says. “I practice really good therapy.”
Because of its benefits, Kaiser always has willing applicants, according to Harlander. “People would rather work at Kaiser than work for the county or Medi-Cal,” he says. “They can open slots and hire people if they want. They will not have to change their pay structure either. If they said we are hiring five therapists, they would get five candidates right now.
Copyright 2022 Capital & Main.
Correction: An earlier version of this story identified Susan Whitney as a current Kaiser Permanente employee. Whitney left Kaiser in late 2021.