SAN FRANCISCO -- A report released earlier this week by the California Department of Managed Health Care slammed Kaiser Permanente, one of the state's largest health care providers, for numerous problems in the way it handles mental health coverage for more than 6.8 million plan members.
"These deficiencies are serious," Shelly Rouillard, the department's chief deputy director, told The Huffington Post. "We want to ensure that consumers are getting the care they need when they need it, and, in some cases, we found that wasn't happening."
Kaiser, the single largest HMO in California, offers a behavioral health plan that covers conditions ranging from anxiety and depression to bipolar disorder and schizophrenia. The state's report identified a number of problems with how the company's mental health system actually works, including long wait times, paper and electronic records that don't agree, "inaccurate educational materials" that pressure patients away from necessary procedures and failure to make appropriate corrections after the company learned it had broken state law.
The report came on the heels of a blistering set of allegations made by the National Union of Healthcare Workers that Kaiser's behavioral health services facilities are "sorely understaffed and frequently fail to provide timely and appropriate care."
Dr. Andris Skuja, a psychologist who has treated patients at a Kaiser facility in Oakland, Calif., for more than three decades, blames the problems largely on a management culture increasingly focused on the bottom line.
"At some point, the values of Kaiser changed from what some people called the 'socialist' ideals of its founding," said Skuja, who also serves as a lead steward for the health worker union's non-physician professionals group at Kaiser. "Now Kaiser has become just another corporate entity -- the Goldman Sachs of health care."
Due to understaffing, "we don't have the time to engage patients on a one-to-one level," he said, noting that he felt increasingly pressured to shift away from one-on-one counseling sessions and toward medication and group therapy, even in cases where individual attention would likely be more beneficial. "It's heartbreaking and it's wrong," he said.
The state's report said some Kaiser facilities used recordkeeping practices that obscured when patients initially called for an appointment. In California, HMO patients must be seen within 10 to 15 business days of their first request for non-urgent treatment.
Skuja charged that Kaiser "deliberately cooked the books" in order to make it appear that the company was complying with those regulations. He said that on multiple occasions when a patient called and asked to see a clinician, the patient would be told to come into a facility on a date beyond the two-week window, but the facility would not keep a record of that initial call. When the patient finally came in, say, three weeks later, it would appear on the books that the individual was able to see a doctor on the day of his or her first request.
In an open letter to its plan members, Kaiser said that the report "did not identify problems with the quality of the mental health care that our professionals provide to our members, nor with the ability of our members to obtain urgent or emergency mental health care." Additionally, the letter said that Kaiser had already started to make improvements to its mental health services, such as hiring more clinicians, working to improve wait times and revamping its informational system to more accurately measure the length of wait times.
Officials from Kaiser did not respond to multiple requests for comment.
State regulators have referred the matter to the Department of Managed Health Care's enforcement division, which could slap the company with sanctions ranging from fines to a cease-and-desist order.
"We're planning a follow-up survey in six months to check in on Kaiser's progress," said Rouillard. "Usually there's a follow-up after 18 months, but we wanted to check back in sooner because these violations were so serious."