September 1, 2022

Setting the record straight on NUHW’s false claims

Addressing NUHW's false claims about Kaiser Permanente contract bargaining.

Staffing and hiring

Claim: Kaiser Permanente has not lived up to its promises to fix understaffing.

Fact: With more than 4,000 psychiatrists and therapists on staff, Kaiser Permanente is one of the largest mental health care providers in California, and we are continuing to hire new staff. Despite a national mental health workforce crisis in the midst of a global pandemic, we added nearly 200 net new clinicians in California between January 2021 and June 2022 and continue to hire mental health clinicians at a higher rate than membership growth. Long term we are working to address the shortage and inequitable distribution of trained mental health professionals that is affecting the nation by investing $30 million to build a pipeline of culturally diverse mental health professionals across California.
 

Turnover rate

Claim: Kaiser Permanente has a high turnover rate as clinicians leave due to worsening working conditions. The turnover rate for therapists has doubled at Kaiser Permanente in the last year.

Fact: Across health care and certainly within Kaiser Permanente we are seeing higher turnover rates than before the pandemic. We have seen increased turnover in voluntary departures and retirements over the last year, and while it is higher than we would like, it is below the national health care worker attrition rate of 30%. Retaining our talented professionals is critical to meeting the growing demand for mental health care, and we are very focused on working with our clinicians and the union to address this challenge.
 

Therapist shortage

Claim: Kaiser Permanente is understaffed not because of a therapist shortage but because therapists don’t want to work for Kaiser Permanente.

Fact: The increase in demand for mental health care in America and the national shortage of mental health clinicians is real and well documented. It was a crisis before the pandemic, and the pandemic has further strained the mental health care system and its limited number of caregivers. We have been taking action to address the shortage of mental health professionals, including making major investments to build the pipeline of new, culturally diverse professionals.

We hired nearly 200 net new therapists in California since the beginning of 2021 and we are committed to supporting all our therapists in their vitally important work. We provide our therapists with industry-leading compensation and benefits. In the San Francisco Bay Area, licensed marriage family therapists at Kaiser Permanente earn more than $126,000 annually on average, excluding benefits, and licensed clinical social workers make more than $128,000 per year excluding benefits.
 

Therapist diversity

Claim: Kaiser Permanente has failed to recruit more bilingual and minority therapists.

Fact: Kaiser Permanente knows that meeting our long-standing commitment to provide high-quality care, improve access to care, and address the inequities, structural racism, and injustices that have marginalized our most vulnerable populations starts with our commitment to our workforce, including those caring for the mental health needs of our members.

Among our California mental health staff, 50% are culturally diverse professionals. At Kaiser Permanente, more than 18% of our therapists identify as Hispanic or Latino, and more than 7% of our therapists identify as Black or African American. According to the American Psychological Association, only 7% of the U.S. psychologist workforce is Hispanic and 3% are Black.

We are investing $30 million to build a pipeline for new, culturally diverse mental health professionals across California.  Two-thirds of the fall 2022 class in our Mental Health Scholars Academy identify as people of color, Black, or Indigenous, and 46% are bilingual, speaking more than 20 different languages.

At Kaiser Permanente, we are building a highly inclusive, engaged, and psychologically safe workplace where everyone has an equal opportunity to reach their full potential and use their diverse perspectives and strengths to support our mission.
 

Timely access

Claim: Kaiser Permanente will not be able to meet California’s new timely access requirements outlined in SB 221.

Fact: Although the shortage of mental health clinicians continues to challenge every California health care organization, implementation of Senate Bill (SB) 221 to Kaiser Permanente’s model of mental health and addiction care and services is well underway.

Fact: We support the aim of SB 221, which took effect on July 1, 2022. The new law aligns with Kaiser Permanente’s long-standing commitment to provide timely, high-quality mental health care and substance use disorder treatment to our members.

The implementation of SB 221 is challenging for all health plans and providers given the overall demand for mental health care and substance use disorder services — exacerbated by the pandemic — and the shortage of trained professionals both nationally and in California. We are meeting regularly with the Department of Managed Health Care as they establish guidance for implementation of the new law to ensure we fully understand the requirements regarding documentation and reporting, so that we have appropriate processes and procedures in place.

Claim: Kaiser Permanente’s systems to document timely access are not valid and do not honor therapists’ judgment and negatively impact patients’ access to care.

Fact: We respect and honor our therapists’ clinical judgment and the individual care plans they create to meet each patient’s needs. To help support our clinicians’ professional practice we are creating easy tools for therapists to document their treatment plans in light of SB 221. Streamlined and more specific clinical documentation will benefit patients and clinicians and will also provide crucial information to help us monitor and evaluate how we are performing. Therapists continue to have the ability to add their own patient care documentation and treatment notes in the medical record.

Claim: Kaiser Permanente is not able to meet patients’ mental health needs during NUHW's open-ended strike.

Fact: We have been working to ensure that we are able to meet our members’ mental health needs and meet state requirements for access during the strike, using every resource available. Care is being provided by:

  • Hundreds of Kaiser Permanente mental health professionals who have been choosing to come to work for their patients. More than 2 weeks into this action, nearly 45% of them are caring for members instead of striking.
  • Kaiser Permanente psychiatrists, clinical managers, and other licensed clinicians who have stepped in to meet with people needing care.
  • Dozens of skilled clinicians that we have brought in on a temporary basis to help.

We are also on our way to reaching agreements with hundreds of community-based mental health providers to open their schedules — for at least 2 months — to be able to treat more of our patients.

Together, these compassionate professionals have helped ensure we have trusted, professional resources available for any patient who has had their care disrupted due to the strike. 

For those patients who choose to cancel their own appointment or choose not to reschedule, we have a clinical quality review process in place to ensure they receive the care they need.

Urgent and emergency care continues to be prioritized. Some nonurgent appointments may need to be rescheduled for another day or with another clinician. Any patient whose appointment may be affected will be contacted directly prior to the date of the appointment to ensure they receive the care needed.
 

Return appointments

Claim: Kaiser Permanente forces mental health patients to wait weeks, even months, for appointments.

Fact: Recognizing that every person’s needs are unique, our clinicians work with each patient to independently develop a care plan that is clinically appropriate and tailored specifically for them without requiring health plan approval.

When appointments are not readily available, we have escalation procedures to support our therapists if they are unable to schedule a needed follow-up appointment for a patient, and we have a dedicated phone line for our members if they have challenges getting mental health appointments. This is also part of our effort to work strategically to ensure compliance with SB 221.

For members who need more immediate assistance, we have escalation procedures and a dedicated phone line.

Follow-up appointments scheduled outside of the 10-day window are done so based on either clinical judgment or patient preference — which is a decision that is fully documented in the patient’s record.
 

Mental health parity

Claim: Kaiser Permanente is not meeting the parity requirements of SB 855.

Fact: Kaiser Permanente has the operational and clinical expertise to support the new mental health parity requirements defined by SB 855. Long before parity laws were first passed, Kaiser Permanente committed to providing comprehensive, evidence-based care for our members in need of mental health care. Through our unparalleled experience and capability, we have applied the updated parity provisions of SB 855, which requires plans to cover “medically necessary treatment” for all mental health and substance use disorders, to our model of mental health and addiction care and services.

Workload and burnout

Claim: Therapists see 7 to 12 patients per day and maintain unsustainable workloads under tremendous circumstances, which has led to employee burnout and clinicians leaving for other jobs.

Fact: The pandemic has strained our front-line care teams, including nurses, health care workers, physicians, and of course our mental health clinicians. We have the greatest respect and gratitude for our mental health professionals, and we are dedicated to supporting them in their important work.

Our therapists in adult and child mental health clinics who provide individual psychotherapy see an average of 5 to 7 patients per day. In addition, we have an administrative structure in place to ensure an appropriate amount of preparation time and time to support ongoing education.

We have invested in psychological support teams that can help all employees and physicians who are dealing with burnout-related issues. And we are actively collaborating with our mental health clinicians on other ways to care for themselves while they help us serve the unprecedented demand for care.
 

Evaluating care

Claim: The Department of Managed Health Care, or DMHC, is investigating Kaiser Permanente to determine if Kaiser Permanente has or is violating state laws for timely access to mental health care.

Fact: The DMHC has announced a non-routine survey of Kaiser Permanente’s mental health services, which we welcome. We appreciate the DMHC’s interest and accountability in understanding how we are working to deliver clinically appropriate care to people who rely on us for their mental health services. 

We see the survey as an opportunity to review our performance and collaborate on new areas for improvement. We believe that a thoughtful, impartial review can help us and other health plans in California address challenges we are all facing. We know that we cannot solve the challenges of the national mental health crisis on our own and look forward to collaboration from across the mental health community.

Claim: The Office of Patient Advocate, or OPA, rating system is flawed and based on a very narrow criteria that doesn’t measure wait times for routine behavioral health appointments.

Fact: Across California, Kaiser Permanente’s ratings for behavioral and mental health care are among the highest in the state, according to the California Office of the Patient Advocate’s 2021-22 report card.

The OPA’s Quality of Medical Care rating, derived from independent sources (HEDIS, CAHPS, NCQA), tells an important story of how well a health plan and its doctors meet national standards for good care. The OPA’s 5-star public rating system shows how successful each plan is at helping its members get the behavioral and mental health care they need. We are very proud of our 5-star rating, the highest in the state.