A national organization
focused on improving the quality of health care has determined that Kaiser Permanente’s health plans in Hawaii need to improve and has put them under “corrective action” for failing to meet national quality standards.
The National Committee for Quality Assurance, based in Washington, D.C., would not say why it flagged Kaiser’s health plans, but
Kaiser said it relates to shortcomings in its behavioral health services.
Kaiser said that it is actively working to increase its psychiatrists, therapists and support staff, and in 2022 added 11 new behavioral health clinical positions as well as support staff. The health plan says that it plans to boost its staffing by the same amount over the next three years.
Kaiser said that overall it performed well during its latest accreditation by NCQA and that it has submitted a corrective action plan to the agency with the expectation that the designation will be removed by December.
Kaiser offers four health plans in Hawaii, including a commercial, Medicaid and Medicare plan, and an individual plan created under the 2010 Affordable Care Act.
NCQA’s action comes five months after the union representing Kaiser’s mental health clinicians submitted a 60-page complaint to NCQA detailing long wait times for Kaiser’s behavioral health services, from booking appointments to obtaining
follow-up therapy sessions.
“It’s important because consumers should know that the second-largest health plan in Hawaii has suffered this sanctioning by the national ratings agency,” said Fred Seavey, research director for the National Union of Healthcare Workers, the union representing about 50 Kaiser psychologists, clinical social workers, psychiatric nurses and addiction counselors in Hawaii.
The union has been in protracted negotiations with Kaiser for its first contract after unionizing four years ago. Those negotiations have spilled out into the media as unionized employees push for higher wages and benefits, which they say are critical to attracting more behavioral professionals to Kaiser’s network.
Andrea Kumura, a licensed clinical social worker who works in Kaiser’s Waipio clinic, said NCQA’s action underscores the struggles she and her colleagues face in trying to meet patients’ needs. Kumura, who treats kids struggling with mental health problems, such as depression, anxiety and eating disorders, said that her first available appointment for new or returning patients isn’t until Sept. 14. Many
parents prefer to schedule appointments in the afternoon so their child’s school day isn’t disrupted. But Kumura said her first available afternoon appointment isn’t until Oct. 4.
“The impact on our patients is really severe,” said Kumura.
Kaiser said NCQA’s focus on behavioral health access during its survey was partially in response to the union complaint.
“Although we do not agree with NUHW’s frequent reliance on using regulatory complaints as a bargaining tactic, we continue to work with NUHW in good faith to address the union’s concerns as well as to finalize contract negotiations,” Kaiser said in written responses to questions.
The union submitted the same complaint to the state Department of Commerce and Consumer Affairs in
November, which the union said was in part based on
records provided by whistleblowers within Kaiser. In addition to long wait times to book appointments, the complaint alleged that Kaiser’s call center was understaffed, resulting in callers often hanging up before they reached someone. The union argued that the delays appear to violate state and federal laws, including Hawaii’s provider network adequacy rules, the Patients’ Bill of Rights and Responsibilities Act and the federal Mental Health
Parity and Addiction Equity Act.
On Monday the union sent a letter to DCCA Director Catherine Awakuni Colón expressing disappointment that the state wasn’t acting faster on its complaint, especially in light of the recent action taken by NCQA.
“As you know, we have
repeatedly raised our concerns about the DCCA’s investigatory failures,” the union wrote. “We have asked both you and the Insurance Division to provide an estimated date by which you plan to complete an investigation. Neither has provided such a date. We have asked whether it is possible that your investigation will remain uncompleted one year from now, and neither you nor the Insurance Division has responded. These circumstances are extremely troubling given the risk of harm to KFHP’s enrollees as well as the important duties your tax-payer funded agency owes to
Hawai‘i consumers.”
DCCA, in response, said it’s “extremely important for Hawaii’s health plans to function optimally and in compliance with the law.”
“We can confirm that the subject complaint was received,” DCCA said in a statement. “Because complaints to our Insurance
Division are confidential,
we are unable to provide
further comment on the complaint or on the investigations.”
