By Consumers For Quality Care, on January 9, 2020
California’s Largest health insurer, Kaiser Permanente, claims it is making progress on mental health care after sanctions and fines were levied against the company over its practices. But according to a new report by the Los Angeles Times, Kaiser is still falling short.
The Times interviewed dozens of Kaiser Permanente therapists, patients and industry experts. What they found painted a “troubling” picture of superficial gains in mental health coverage.
Kaiser, as the Times reports, has already come under intense scrutiny in California, leading to fines and settlements over several years.
In 2013, the state Department of Managed Health Care found Kaiser was systematically shortchanging patients seeking mental health treatment in violation of the state’s parity law and levied a $4-million fine. In 2015, regulators again cited Kaiser, finding that some patients were waiting months to see a psychiatrist or therapist. In 2017, the state cited Kaiser a third time for persistent problems. This time, the parties reached a settlement requiring Kaiser to hire an outside consultant for three years to improve access and oversight.
But Kaiser’s strategy in dealing with the shortcomings has itself come under scrutiny and been criticized by mental health professionals. The strategy has been described by a health care union official as “teaching to the test” rather than making genuine strides in mental health. In other words, Kaiser is simply attempting to do the minimum to satisfy the new regulations that have been imposed on them.
One area of concern for Kaiser therapists is a new Kaiser “telehealth” program, where patients who call in are offered a same-day appointment for an intake assessment conducted by phone with a therapist. While these calls fulfill a state regulation, therapists say they are inadequate at providing any actual care, as patients usually have to wait months for a follow-up appointment after their initial “intake.”
Michael Torres, a pediatric psychologist in the San Leandro clinic, said that when it comes to ongoing therapy, little has changed in the 17 years he’s worked at Kaiser. His schedule is so packed that he is able to see his patients only every four to six weeks, even when a child is experiencing major depression and should be seen weekly.
“It’s heartbreaking,” he said. “It only exacerbates conditions, prolongs symptoms, and professionally it’s just unethical.”
According to a union survey of Kaiser therapists, just 4% said individual weekly appointments were available to patients who needed them.
The consequences of Kaiser’s policies are felt acutely with patients who need care. Matthew Wasserman, a Kaiser member with anxiety, had to call dozens of therapists to try and get an appointment.
Wasserman waited more than a week, but no one called. He started contacting therapists on Beacon’s online directory. Of the 30 to 40 he called, five called back. Three had no openings. The other two had time midday, but he couldn’t miss work.
So he called Beacon and waited nearly two hours on hold. Two weeks later, he got an email listing three additional providers. None returned his calls.
In a more extreme case, Kaiser patient Kevin Dickens was suffering from anxiety and depression to the point of being suicidal. He experienced the same rejection as many Kaiser patients after calling dozens of doctors. Dickens’ situation was so dire that he was hospitalized after a suicide attempt.
After his release, Kaiser connected him with a therapist who could see him every six weeks. “I felt I needed every two weeks,” he said. “But there was nothing I could do.”