Kaiser Permanente is now responsible in paying $50 million in a settlement for improperly managing services within their behavioral health department and will soon have to provide better support for that that form of care.
The Department of Managed Health Care in the state of California has mandated the largest health care provider in the state that looks over 9.4 million individuals, in being financially responsible to redo the system with tens of millions of dollars. They also will be giving $150 million in the span of the next five years to improve behavioral health programs.
Last Thursday, the state gave out a response that Kaiser has been called out by them for many issues when reviewed completely since 2006 by the state department. So basically, this isn't a recent problem; it's a foundational disaster within the healthcare provider.
An investigation was started last year by the department that found Kaiser and associated medical groups to not have a great relationship with clarity and poor compliance regarding the law. According to Courthouse News, “Kaiser often cancels behavioral health appointments and often does not provide enrollees with timely behavioral health appointments, and did not meet clinical standards required during a mental health clinicians strike in August 2022.”
Legal violations in Kaiser's BH system were also discovered including a worksforce shortage within their facilities, the inability to make adequate referrals when in-network providers were not available, and badly made enrollee grievances.
Mary Watanbe from the Department of Managed Health Care called the agreement “historic” to enforce Kaiser to change their BH system both financially and structurally.
“In addition to paying the highest fine the DMHC has ever levied against a health plan, Kaiser Permanente has agreed to make significant improvements to the plan's operations, processes and procedures and business model to better assist enrollees with accessing care," Watanabe said in a statement. "The DMHC is committed to using its full authority to hold Kaiser accountable and ensure enrollees have access to behavioral health care when they need it.”
Greg Adams, Kaiser's chair and chief executive officer, had put fault for responsibility of Kaiser's lack of accountability on the COVID-19 pandemic, claiming that the healthcare provider has a 33 percent increase of need from members during this pandemic.
According to Courthouse News, “Adams said that since 2020, Kaiser has invested $1.1 billion to boost mental health care treatment, hired 600 therapists and spent $195 million on 329 mental health provider offices.”
This settlement also adds on that Kaiser has programs coming out with the $150 million giving services that focus on adolescents and workforce development. A consultant from the outside will be hired to ensure that enrollees will get the best assistance possible as well as seeing how the deficiencies can be resolved within the behavioral health system.
According to Courthouse News, “The company must also improve enrollees' access to all providers, including out-of-network providers for behavioral health services when Kaiser's network cannot offer timely care. It is also required to improve its grievance and appeals policies and procedures, and develop processes to ensure compliance with all behavioral health parity laws.”
“While we have made many enhancements to our mental health care delivery system, there is still work to be done to ensure our interventions and therapies are aligned with our members' expectations and to ensure we achieve the best patient outcomes,” Adams said.
Much backlash on Kaiser has came from state officials on their BH services for decades. That is why the Department of Managed Health Care has started a yearly oversight review on the provider starting last year due to the complaints.
Newsom had also came out with a statement regarding how California law requires patients to mental health or substance use disorder treatment or support appointments within 10 business days, and if necessary, a follow-up appointment within another 10 business days, according to Courthouse News.
"Today's actions represent a tectonic shift in terms of our accountability on the delivery of behavioral health services," Newsom said. "Accountability of the private sector is foundational to ensuring our entire system of behavioral health care works for all Californians.”
Sal Rosselli, president of the National Union of Healthcare Workers representing more than 4,000 behavioral health workers, responded to the settlement as a victory for patients and therapists that have wanted and even in some strikes in the past decade “to make Kaiser fix its broken behavioral healthcare system.”
“We are thrilled that Kaiser has now agreed 'to undertake a systemic overhaul' of its behavioral healthcare system, but caution that the success of any overhaul depends on Kaiser agreeing to work in tandem with therapists to build a better model for delivering care,” Rosselli said in a statement.