Kaiser mental health workers in Northern California went on strike on August 15th.
This strike by the National Union of Healthcare Workers (NUWH) isn’t your run-of-the mill dispute about wages. Kaiser mental health physicians have been leaving in significant numbers. Many Kaiser psychologists, including multiple personal friends of mine, are disheartened by their inability to schedule appointments and followups for their patients within an appropriate time. And they are seeking additional time under their contract to handle the administrative tasks documenting patient charts.
The California Department of Managed Care (the DMHC) has opened several investigations into the quality of Kaiser mental health services and the long patient waits.
All of this isn’t rocket science. Kaiser has failed to adequately staff mental health services for years. In the past Kaiser was able to skate by after an occasional slap on the wrist.
Kaiser’s efforts to offload some of the patient load onto services such as Beacon have by most accounts had mediocre results at best. Patients trying to access care through those services often encounter long waits.
The demand for mental heath services has spiked during the pandemic, so the access situation has deteriorated.
But you may be thinking, why is all this of concern to workers’ comp stakeholders?
As a major group health provider, Kaiser is where many California injured workers turn for services. While the 2004 and 2012 California workers’ comp reforms have not eliminated psychiatric claims, they have discouraged them and raised the bar on such claims. So many California injured workers turn to group health coverage to seek treatment for depression, anxiety and various behavioral problems that arise after their injuries. If they receive poor care or can’t get timely care, it has implications workers’ comp.
By failing to prioritize mental health coverage earlier, Kaiser may have painted itself into a corner. Politicians are jumping aboard the bandwagon to support the strike. And with the DMHC breathing down Kaiser’s neck, Kaiser is under pressure to solve the problem. The stakes could be even higher if Governor Newsom signs SB 858, a bill that would provide a ten-fold increase in potential fines by DMHC against a health plan. Instead of a maximum $2500 fine per violation which harms a plan enrollee, the maximum fine could be as high as $25,000 per enrollee.
Kaiser claims that it is trying to hire mental health professionals, and touts a $500,000 commitment to recruiting. That is probably true, but they will need to make a much larger commitment to mental health services to solve this problem.
Kaiser’s motto may have been “Thrive”. Perhaps management needs a bit less branding hype and more commitment to patients.
Several years ago the California legislature enacted California Health and Safety Code Section 1367.03 out of concern that mental heath service access was inadequate. The strike will give the Department of Managed Health Care even more incentive to enforce Section 1367.03.
Section 1367.03 of the California Health and Safety Code states that a health care service plan such as Kaiser Permanente “shall ensure that its contracted provider network has the capacity and availability of licensed health care providers to offer enrollees appointments” within:
48 hours of the request for appointment for urgent care appointments that do not require prior authorization;
96 hours of the request for appointment for urgent care appointments that require prior authorization;
15 business days of the request for appointment for nonurgent appointments with specialist physicians (e.g., psychiatrists); and
10 business days of the request for appointment with a nonphysician MH/SUD provider.
Here is a link to the NUHW site that details day by day strike events:
And here is a letter from healthcare advocacy organizations that outlines many of the reasons for the strike:
Here is a link to the text of SB 858 (Wiener):