Hawaii residents enrolled in Kaiser Permanente health plans are facing major delays in getting help for mental health and substance use disorders due to provider shortages, according to a complaint filed Wednesday by the union representing 51 Kaiser clinicians — including psychologists, social workers, psychiatric nurses and chemical dependency counselors — with the Hawaii Department of Commerce and Consumer Affairs.
Union members say that Kaiser needs to increase pay and benefits in order to retain and attract more providers and have voted in favor of authorizing a strike if current contract negotiations continue to deteriorate.
Rachel Kaya, a psychologist at Kaiser Permanente Maui Lani clinic, says she has more than 150 patients, a caseload that she says would be better handled by five full-time therapists.
“The access problem causes repeated, shameful, horrifying violations of my professional code of ethics,” she said in a news release announcing the complaint and strike authorization.
Kaiser’s mental health clinicians in Hawaii unionized in 2018 and they are negotiating their first contract with Kaiser. The clinicians are represented by the National Union of Healthcare Workers.
Arlene Peasnall, Kaiser’s senior vice president of human resources, said in response that shortages in mental health clinicians, both in Hawaii and on the mainland, have been exacerbated by the COVID-19 pandemic as demand for care has increased. She said that Kaiser has expanded its ability to provide patients with virtual care, in spite of initial protests from the union, and that it has hired more mental health clinicians across the country in the past five years.
“We have the greatest respect and gratitude for our mental health professionals, and we are dedicated to supporting them in their important work,” she said in a statement.
The 57-page complaint field with DCCA provides detailed allegations about long wait times throughout Kaiser’s system of care, from booking appointments to obtaining follow-up therapy sessions. The union says 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.
The challenges in obtaining care begin with Kaiser’s call center, which the complaint says is staffed by just five full-time clinicians tasked with conducting triage assessments for mental health and substance abuse problems. Kaiser members are often on hold for as long as 30 to 60 minutes before they can speak to a clinician, resulting in 20% to 45% of callers hanging up, according to the complaint. Callers can request that a clinician return their call, but the complaint says that typically takes one to four weeks.
Kaiser members are waiting between six to seven weeks for both initial and return appointments to treat conditions ranging from depression, panic attacks, eating disorders and post- traumatic stress disorder, according to the complaint. Kaiser enlists out-of-network mental health therapists to augment care, but only 28% of those providers are actually accepting Kaiser members, the union says.
The findings are based on records provided by whistleblowers from within Kaiser, according to Fred Seavey, the union’s research director.
“They need to grow the number of providers. So how do you grow it? You have to recruit and retain mental health care professionals that deliver this care, and at this point they aren’t doing that,” said Seavey.
The complaint was filed with Hawaii’s insurance commissioner, Colin Hayashida, who said he was unable to comment on open investigations. “Generally speaking, when investigating any complaint, the respondent has 15 working days to respond to the Insurance Division’s questions,” Hayashida said through a spokesman.
Kaiser was fined $4 million in 2013 for a similar complaint about access to mental health services that was filed with regulators in California.
The Hawaii complaint includes an Aug. 13 letter that Kaiser clinicians sent to company executives detailing the “horrendous state of affairs” of mental health and substance abuse services. The letter alleges that the shortage of providers has been so bad that Kaiser implemented an e-visit program, where a computer using an algorithm instructs “almost all patients” suffering from depression or anxiety to use a mindfulness app, such as Calm, or enroll in a health education class.
“These patients are discouraged from seeking an appointment until they have tried the app and/or the class and found them to be not helpful,” according to the letter signed by Andrea Kumura, a licensed clinical social worker, and about two dozen other clinicians.
The providers said that patients seeking treatment of substance abuse “fare no better,” having to jump through multiple hoops to get treatment.
“By the time an appointment is available, the patient lacks any support they may need to climb out of their personal rabbit hole and often fall backwards, ending up in the emergency department or simply losing the motivation they had when they first sought help,” according to the letter.
Kaiser decries union tactics
Kaiser didn’t address the detailed wait times alleged in the complaint. But in a statement to the Honolulu Star- Advertiser, Peasnall said that clinicians’ pay was already competitive in Hawaii.
“While the union is issuing press statements about staffing, the real issue at the table is how much therapists are paid,” she said. “At the heart of the challenge is this: Health care is increasingly unaffordable, and escalating wages are half of our costs.”
Peasnall said that Kaiser is “indisputably one of the most labor-friendly organizations in the United States.”
“We are committed to remaining an employer of choice for mental health professionals, and to continuing to offer our employees market-leading wages and benefits. But we cannot continue to allow costs to grow beyond what our members can afford,” she said.
Kaiser’s psychologists get paid, on average, more than $120,000, which is more than $17,000 higher than the market average, said Peasnall. She said licensed clinical social workers get paid more than than $91,000, on average, which is more than $10,000 higher than the market average.
“The challenge we are trying to address is that if we continue to increase costs so high above the marketplace, our members will not be able to afford to get the care they need,” said Peasnall.
The union, in contrast, says that Kaiser’s 4,000 mental health clinicians in California are paid on average 10% to 15% more than their Hawaii counterparts, even though Hawaii has a higher cost of living.
