In Kaiser Program, Hospital Care Comes to the Patient's Home
Kaiser Permanente to Open a Medical School in Southern California
Strict Limits on Mental Health Care Still Common for California Patients
4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful'
Calif. Calls Kaiser Mental Health Services 'Inadequate' as Treatment Delays Persist
Kaiser Nurses Reach Agreement, Call Off Strike
Kaiser Mental Health Workers Launch 7-Day Strike
Study: Western States Eliminate Race Gap on Key Health Measures
Kaiser Mental Health Clinicians Authorize Strike
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Like the doctor said, 'Somebody is after you!' \" Stanton laughs.\u003c/p>\n\u003cp>And for his 81-year-old wife, Audrey, the nearly two-hour drive each way to Kaiser in Riverside from their home in Hemet was a tough haul.\u003c/p>\n\u003cp>\"I’m not a long-distance driver so I had to be real careful,\" she says. \"It was stressful.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242752789\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>But that stress dissipated last summer when John was admitted to the hospital -- without leaving home.\u003c/p>\n\u003cp>\"I thought, 'Wow! This is amazing. I love this!' \" John Stanton says. \"This is what people need!\"\u003c/p>\n\u003cp>\u003cstrong>Pneumonia, Cellulitis or Congestive Heart Failure\u003c/strong>\u003c/p>\n\u003cp>Stanton is one of about 125 patients who have been enrolled in an experimental \"hospital at home\" program run out of Kaiser’s Permanente’s Riverside Medical Center.\u003c/p>\n\u003cp>Launched two years ago, the program is designed for people who need treatment -- typically only given in the hospital -- for one of three conditions: pneumonia, cellulitis or congestive heart failure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/11/25/55860/kaiser-program-brings-hospital-care-to-the-patient/\" target=\"_blank\">Read the rest of the story at KPCC.org.\u003c/a>\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Hospital care at home is for patients with certain conditions who are not at risk for complications. ","status":"publish","parent":0,"modified":1453252342,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":253},"headData":{"title":"In Kaiser Program, Hospital Care Comes to the Patient's Home | KQED","description":"Hospital care at home is for patients with certain conditions who are not at risk for complications. 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Like the doctor said, 'Somebody is after you!' \" Stanton laughs.\u003c/p>\n\u003cp>And for his 81-year-old wife, Audrey, the nearly two-hour drive each way to Kaiser in Riverside from their home in Hemet was a tough haul.\u003c/p>\n\u003cp>\"I’m not a long-distance driver so I had to be real careful,\" she says. \"It was stressful.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/242752789&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/242752789'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But that stress dissipated last summer when John was admitted to the hospital -- without leaving home.\u003c/p>\n\u003cp>\"I thought, 'Wow! This is amazing. I love this!' \" John Stanton says. \"This is what people need!\"\u003c/p>\n\u003cp>\u003cstrong>Pneumonia, Cellulitis or Congestive Heart Failure\u003c/strong>\u003c/p>\n\u003cp>Stanton is one of about 125 patients who have been enrolled in an experimental \"hospital at home\" program run out of Kaiser’s Permanente’s Riverside Medical Center.\u003c/p>\n\u003cp>Launched two years ago, the program is designed for people who need treatment -- typically only given in the hospital -- for one of three conditions: pneumonia, cellulitis or congestive heart failure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/11/25/55860/kaiser-program-brings-hospital-care-to-the-patient/\" target=\"_blank\">Read the rest of the story at KPCC.org.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/140645/in-kaiser-program-hospital-care-comes-to-the-patients-home","authors":["byline_stateofhealth_140645"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_799","stateofhealth_803","stateofhealth_2519"],"featImg":"stateofhealth_140646","label":"source_stateofhealth_140645"},"stateofhealth_125242":{"type":"posts","id":"stateofhealth_125242","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"125242","score":null,"sort":[1450389275000]},"guestAuthors":[],"slug":"kaiser-permanente-to-open-a-medical-school-in-southern-california","title":"Kaiser Permanente to Open a Medical School in Southern California","publishDate":1450389275,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a medical school to its portfolio, the company announced Thursday.\u003c/p>\n\u003cp>The nonprofit HMO, based in Oakland, will open the Kaiser Permanente School of Medicine in Southern California in 2019. No specific site has yet been selected.\u003c/p>\n\u003cp>\"This is a natural evolution for us,\" Kaiser's CEO Bernard Tyson said in an interview. \"We are very motivated in being part of the transformation of the entire health care ecosystem.\"\u003c/p>\n\u003cp>Kaiser says it will base physician training on \"strategic pillars\" including providing care beyond traditional medical settings, emphasizing collaboration and teamwork, and addressing health disparities.\u003c/p>\n\u003cp>Kaiser has long been lauded by health care experts as delivering high quality care to its population of 10.2 million patients. Kaiser is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients about basic and complex medical needs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We now want to take all of our learnings and understanding of how to care for population and individuals and teach it more upstream for the future physicians of the 21st century,\" Tyson said.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/238062573\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Kaiser says it is committed to attracting a diverse pool of students \"to better reflect the communities we serve,\" said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group. \"We've been able successfully to move, not completely, to closing the care gaps in health disequities for different populations, ... and we see that type of work in informing the medical students and how we educate them.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/\" target=\"_blank\">major analysis\u003c/a> last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than caucasians.\u003c/p>\n\u003cp>The HMO has long been involved in medical education, but at the residency level, training more than 600 residents every year.\u003c/p>\n\u003cp>Kaiser's move is unusual. The nation's 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.\u003c/p>\n\u003cp>\"There are precedents, but this will be different,\" John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser's new school. \"It's an integrated health care system that's looking at developing a medical school. I think there will be some surprises as the school unfolds.\"\u003c/p>\n\u003cp>Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature \"innovative models,\" he said.\u003c/p>\n\u003cp>Still, building a new medical school is \"fraught with risk,\" said John Deane, president of Advisory Board Consulting and Management. He said it could be a \"huge waste of money\" if Kaiser were to replicate the existing model of specialty-focused academic medical centers.\u003c/p>\n\u003cp>\"On the other hand,\" he said, \"they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.\"\u003c/p>\n\u003cp>Tyson and Ellison both seemed focused on innovation as opposed to status quo.\u003c/p>\n\u003cp>\"We are excited to be on the frontier of creating a new medical school and thinking about how do we transform a medical education to meet the transformative needs of health care in this country, today, and into the future.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,\" Tyson said.\u003c/p>\n\n","blocks":[],"excerpt":"The HMO giant plans to open the school in 2019 and enroll 40-50 students from across the country in its first class.","status":"publish","parent":0,"modified":1450417557,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":649},"headData":{"title":"Kaiser Permanente to Open a Medical School in Southern California | KQED","description":"The HMO giant plans to open the school in 2019 and enroll 40-50 students from across the country in its first class.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"125242 http://ww2.kqed.org/stateofhealth/?p=125242","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/17/kaiser-permanente-to-open-a-medical-school-in-southern-california/","disqusTitle":"Kaiser Permanente to Open a Medical School in Southern California","path":"/stateofhealth/125242/kaiser-permanente-to-open-a-medical-school-in-southern-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a medical school to its portfolio, the company announced Thursday.\u003c/p>\n\u003cp>The nonprofit HMO, based in Oakland, will open the Kaiser Permanente School of Medicine in Southern California in 2019. No specific site has yet been selected.\u003c/p>\n\u003cp>\"This is a natural evolution for us,\" Kaiser's CEO Bernard Tyson said in an interview. \"We are very motivated in being part of the transformation of the entire health care ecosystem.\"\u003c/p>\n\u003cp>Kaiser says it will base physician training on \"strategic pillars\" including providing care beyond traditional medical settings, emphasizing collaboration and teamwork, and addressing health disparities.\u003c/p>\n\u003cp>Kaiser has long been lauded by health care experts as delivering high quality care to its population of 10.2 million patients. Kaiser is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients about basic and complex medical needs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We now want to take all of our learnings and understanding of how to care for population and individuals and teach it more upstream for the future physicians of the 21st century,\" Tyson said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/238062573&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/238062573'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kaiser says it is committed to attracting a diverse pool of students \"to better reflect the communities we serve,\" said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group. \"We've been able successfully to move, not completely, to closing the care gaps in health disequities for different populations, ... and we see that type of work in informing the medical students and how we educate them.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/\" target=\"_blank\">major analysis\u003c/a> last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than caucasians.\u003c/p>\n\u003cp>The HMO has long been involved in medical education, but at the residency level, training more than 600 residents every year.\u003c/p>\n\u003cp>Kaiser's move is unusual. The nation's 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.\u003c/p>\n\u003cp>\"There are precedents, but this will be different,\" John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser's new school. \"It's an integrated health care system that's looking at developing a medical school. I think there will be some surprises as the school unfolds.\"\u003c/p>\n\u003cp>Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature \"innovative models,\" he said.\u003c/p>\n\u003cp>Still, building a new medical school is \"fraught with risk,\" said John Deane, president of Advisory Board Consulting and Management. He said it could be a \"huge waste of money\" if Kaiser were to replicate the existing model of specialty-focused academic medical centers.\u003c/p>\n\u003cp>\"On the other hand,\" he said, \"they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.\"\u003c/p>\n\u003cp>Tyson and Ellison both seemed focused on innovation as opposed to status quo.\u003c/p>\n\u003cp>\"We are excited to be on the frontier of creating a new medical school and thinking about how do we transform a medical education to meet the transformative needs of health care in this country, today, and into the future.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,\" Tyson said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/125242/kaiser-permanente-to-open-a-medical-school-in-southern-california","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_803","stateofhealth_2616","stateofhealth_2519"],"featImg":"stateofhealth_118352","label":"stateofhealth"},"stateofhealth_60387":{"type":"posts","id":"stateofhealth_60387","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"60387","score":null,"sort":[1439363558000]},"guestAuthors":[],"slug":"despite-parity-laws-equal-access-to-mental-health-care-slow-going-in-california","title":"Strict Limits on Mental Health Care Still Common for California Patients","publishDate":1439363558,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>After the state of California \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">fined her employer $4 million\u003c/a> in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job -- and her patients’ lives -- to get better.\u003c/p>\n\u003cp>Instead, she said, things got worse.\u003c/p>\n\u003cp>Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care. Some patients might not live long enough to make the next available appointment, she said.\u003c/p>\n\u003cp>“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1ebnqoqYgtH13y2uhbXV4An8UIzspTvr\"]In February, two years after assessing the second largest fine in its history, \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\">the California Department of Managed Health Care stepped in again\u003c/a>, finding that Kaiser had improved somewhat but \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">still was short-changing patients\u003c/a> on mental health care. The state is considering another fine against the health maintenance organization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California has taken perhaps the \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\">most proactive stance in the nation\u003c/a> in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But even in this state\u003cstrong>, \u003c/strong>it’s proving difficult to ensure mental patients truly have equal access to treatment.\u003c/p>\n\u003cp>Parity laws, including a sweeping measure passed by the federal government in 2008 and an older California law, require insurers to provide mental health and substance abuse benefits on par with the coverage they offer for other medical care. And a \u003ca href=\"https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx#.VckfjvlVhBd\" target=\"_blank\">separate state law requires\u003c/a> insurers to provide patients with access to mental treatment within a specific timeframe – 48 hours for an urgent visit and 10 business days for a non-urgent one.\u003c/p>\n\u003cp>After the 2013 fine, Kaiser patients continued to face not just ongoing delays – they also faced arbitrary limits on treatment in direct violation of the state’s parity statute, officials found. The law was intended to prevent such things as annual caps on patient visits that would not typically be faced, for instance, by patient with another chronic illness such as diabetes or heart disease. Yet, according to the 2015 report, some Kaiser staffers told mental health patients that they were not entitled to long-term individual therapy -- ever.\u003c/p>\n\u003cp>“No one ever sees a therapist once a week in the Kaiser Health Plan,” according to a 2014 email a Kaiser psychologist sent to a patient, which was cited in the state’s most recent report. “Not a covered benefit for the past 20-something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Dr. Mason Turner, Kaiser Permanente’s Associate Director of Regional Mental Health for Northern California, said that the organization has fixed the problems identified by the state.\u003c/p>\n\u003cp>“Between the time the DMHC made their [initial] findings and now, we've made substantial improvements, hired many more staff, and really put into place a lot of mechanisms to address the initial concerns that were brought up,” Turner said in April.\u003c/p>\n\u003cp>The access problems, he said, were caused by an increase in demand, which rose in part because of the influx of new enrollees under the Affordable Care Act. In response, he said, Kaiser increased the ranks of therapists by 25 percent and arranged to contract with outside therapists when necessary.\u003c/p>\n\u003cp>The actions against Kaiser highlight both how far California has come in ensuring equal treatment for mental health patients and how far it has yet to go.\u003c/p>\n\u003cp>On one hand, after many years of “abysmal” enforcement, “now we have regulators who seem to be enthusiastic,” said Randall Hagar, director of government relations for the California Psychiatric Association.\u003c/p>\n\u003cp>Hagar gives credit to managed health care department director Shelley Rouillard, who spent 20 years in consumer advocacy before joining the department in 2011 and becoming director in 2013. On the other hand, critics say, Rouillard and her staff are making slow progress at best.\u003c/p>\n\u003cp>“This is one of the ‘pace car’ states, and it's still slow going,” said Carol McDaid, who runs the Parity Implementation Coalition, an advocacy group made up of addiction and mental health consumer and provider organizations.\u003c/p>\n\u003cp>\u003cstrong>Holding Insurers Accountable \u003c/strong>\u003c/p>\n\u003cp>Soon after they fined Kaiser in 2013, California officials realized the problems with unequal coverage of mental health were much broader.\u003c/p>\n\u003cp>For years, California, like most states and the federal government, relied on consumers to bring complaints alleging that their rights had been violated under parity laws. State regulators grew concerned that the approach was too passive -- few consumers were complaining, perhaps because of the stigma attached to mental illness.\u003c/p>\n\u003cp>So as a first step, the department of managed health care last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law.\u003c/p>\n\u003cp>The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said.\u003c/p>\n\u003cp>“It is rather shocking,” Rouillard said.\u003c/p>\n\u003cp>Part of the problem, Rouillard said, is that the federal government did not release the final regulations dictating how its parity law should be enforced until November 2013 – five years after the law was passed.\u003c/p>\n\u003cp>In addition to the flawed and incomplete paperwork, her department found insurers trying to control costs in ways that could be discriminatory -- for example, by limiting the number of days a patient could receive inpatient care for a mental health condition.\u003c/p>\n\u003cp>“Mental health services are still sort of a second class benefit as far as the health plans are concerned,” Rouillard said.\u003c/p>\n\u003cp>At this point, Rouillard says the managed care plans she regulates are in varying stages of compliance with the federal parity law. Just one plan, Health Net, has so far been able to prove on paper that its benefits fully comply. Rouillard says she expects the other plans to follow suit by the end of the year, and in 2016, the department plans a more intensive review.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, disputed that insurers see mental health a second-tier benefit. “We're committed to providing this coverage for our enrollees. It's very important, and it's something that we're working hard to do,” he said.\u003c/p>\n\u003cp>But the law poses a huge challenge for health plans, he said, in part because the science underpinning diagnosis and treatment of mental illness is constantly evolving. In addition, health plans are trying to adapt not just to parity law but to the implementation of the Affordable Care Act, which has transformed the national insurance landscape.\u003c/p>\n\u003cp>Even so, he said, “I think by the end of this year, all the plans will have filed the right documents and will have approval from the department, and this will be something that's in the rearview mirror.”\u003c/p>\n\u003cp>\u003cstrong>‘A Societal Problem’\u003c/strong>\u003c/p>\n\u003cp>[contextly_sidebar id=\"ibzkpzZhksO1dURcjHzt07C3hHpl7QzN\"]Finding that her situation did not improve even after the first investigation of Kaiser in 2015, psychologist Ginne made a request of her managers -- copied to Rouillard -- that December. She asked that six of her sickest patients be transferred to other providers who could see them more frequently.\u003c/p>\n\u003cp>One of them, an elderly man with dementia and depression, was hallucinating “fully-formed humans,” Ginne said in an interview. One day, he wandered down the block at 5 am in his pajamas, panicked, and flagged down a truck driver who called the police.\u003c/p>\n\u003cp>“He was a danger to himself,” Ginne said.\u003c/p>\n\u003cp>According to Ginne, the backup in appointments meant she could see him for individual therapy only once every few months. The man had been assigned to regular group therapy for depression, which Ginne felt was inappropriate for his condition.\u003c/p>\n\u003cp>When her supervisors did not transfer the man to another individual therapy provider, Ginne reported the case to Adult Protective Services, because she said she believed him to be imminent danger.\u003c/p>\n\u003cp>“That's such a bad solution,” she said, shaking her head. Ultimately, he and his wife decided to quit therapy entirely.\u003c/p>\n\u003cp>Rouillard said that many managed care plans have a long way to go to ensure fair and equal access to mental health care for Californians. But she also said there’s only so much her department can do.\u003c/p>\n\u003cp>Access to care at companies like Kaiser is also an issue of capacity – and that’s not within the department’s purview, she said.\u003c/p>\n\u003cp>“There just aren't enough therapists to see everyone who needs help,” she said. “It isn't just a plan problem; it's a societal problem. And that is really the crux of the matter. We're trying to address a problem that is beyond our ability to fix, and that is a challenge.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cstrong>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a> \u003c/em>\u003c/strong>\u003cem>and\u003c/em>\u003cem> not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Long waits for care and a shortage of therapists thwart California's efforts to make state and federal parity laws work.","status":"publish","parent":0,"modified":1439488895,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":42,"wordCount":1558},"headData":{"title":"Strict Limits on Mental Health Care Still Common for California Patients | KQED","description":"Long waits for care and a shortage of therapists thwart California's efforts to make state and federal parity laws work.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"60387 http://ww2.kqed.org/stateofhealth/?p=60387","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/08/12/despite-parity-laws-equal-access-to-mental-health-care-slow-going-in-california/","disqusTitle":"Strict Limits on Mental Health Care Still Common for California Patients","nprByline":"Jenny Gold","path":"/stateofhealth/60387/despite-parity-laws-equal-access-to-mental-health-care-slow-going-in-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After the state of California \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">fined her employer $4 million\u003c/a> in 2013 for violating the legal rights of mental health patients, Oakland psychologist Melinda Ginne expected her job -- and her patients’ lives -- to get better.\u003c/p>\n\u003cp>Instead, she said, things got worse.\u003c/p>\n\u003cp>Within months, Ginne, a whistleblower in the 2013 case, was back to writing her supervisors at Kaiser Permanente about what she considered unconscionable delays in care. Some patients might not live long enough to make the next available appointment, she said.\u003c/p>\n\u003cp>“I can’t tell a family whose elderly mother is declining that I can’t provide treatment until 2014,” she wrote to her managers at the Kaiser Medical Center in Oakland in September 2013.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In February, two years after assessing the second largest fine in its history, \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\">the California Department of Managed Health Care stepped in again\u003c/a>, finding that Kaiser had improved somewhat but \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">still was short-changing patients\u003c/a> on mental health care. The state is considering another fine against the health maintenance organization.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California has taken perhaps the \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\">most proactive stance in the nation\u003c/a> in enforcing laws to ensure people with mental illnesses have fair and timely access to care. But even in this state\u003cstrong>, \u003c/strong>it’s proving difficult to ensure mental patients truly have equal access to treatment.\u003c/p>\n\u003cp>Parity laws, including a sweeping measure passed by the federal government in 2008 and an older California law, require insurers to provide mental health and substance abuse benefits on par with the coverage they offer for other medical care. And a \u003ca href=\"https://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx#.VckfjvlVhBd\" target=\"_blank\">separate state law requires\u003c/a> insurers to provide patients with access to mental treatment within a specific timeframe – 48 hours for an urgent visit and 10 business days for a non-urgent one.\u003c/p>\n\u003cp>After the 2013 fine, Kaiser patients continued to face not just ongoing delays – they also faced arbitrary limits on treatment in direct violation of the state’s parity statute, officials found. The law was intended to prevent such things as annual caps on patient visits that would not typically be faced, for instance, by patient with another chronic illness such as diabetes or heart disease. Yet, according to the 2015 report, some Kaiser staffers told mental health patients that they were not entitled to long-term individual therapy -- ever.\u003c/p>\n\u003cp>“No one ever sees a therapist once a week in the Kaiser Health Plan,” according to a 2014 email a Kaiser psychologist sent to a patient, which was cited in the state’s most recent report. “Not a covered benefit for the past 20-something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Dr. Mason Turner, Kaiser Permanente’s Associate Director of Regional Mental Health for Northern California, said that the organization has fixed the problems identified by the state.\u003c/p>\n\u003cp>“Between the time the DMHC made their [initial] findings and now, we've made substantial improvements, hired many more staff, and really put into place a lot of mechanisms to address the initial concerns that were brought up,” Turner said in April.\u003c/p>\n\u003cp>The access problems, he said, were caused by an increase in demand, which rose in part because of the influx of new enrollees under the Affordable Care Act. In response, he said, Kaiser increased the ranks of therapists by 25 percent and arranged to contract with outside therapists when necessary.\u003c/p>\n\u003cp>The actions against Kaiser highlight both how far California has come in ensuring equal treatment for mental health patients and how far it has yet to go.\u003c/p>\n\u003cp>On one hand, after many years of “abysmal” enforcement, “now we have regulators who seem to be enthusiastic,” said Randall Hagar, director of government relations for the California Psychiatric Association.\u003c/p>\n\u003cp>Hagar gives credit to managed health care department director Shelley Rouillard, who spent 20 years in consumer advocacy before joining the department in 2011 and becoming director in 2013. On the other hand, critics say, Rouillard and her staff are making slow progress at best.\u003c/p>\n\u003cp>“This is one of the ‘pace car’ states, and it's still slow going,” said Carol McDaid, who runs the Parity Implementation Coalition, an advocacy group made up of addiction and mental health consumer and provider organizations.\u003c/p>\n\u003cp>\u003cstrong>Holding Insurers Accountable \u003c/strong>\u003c/p>\n\u003cp>Soon after they fined Kaiser in 2013, California officials realized the problems with unequal coverage of mental health were much broader.\u003c/p>\n\u003cp>For years, California, like most states and the federal government, relied on consumers to bring complaints alleging that their rights had been violated under parity laws. State regulators grew concerned that the approach was too passive -- few consumers were complaining, perhaps because of the stigma attached to mental illness.\u003c/p>\n\u003cp>So as a first step, the department of managed health care last year began requiring insurers under its watch to show -- at least on paper -- that they were complying with federal parity law.\u003c/p>\n\u003cp>The results were not encouraging: Of 26 managed care insurers, from Aetna to Western Health Advantage, zero were able to prove that they were fully in compliance. Most filed incomplete or flawed documents, state officials said.\u003c/p>\n\u003cp>“It is rather shocking,” Rouillard said.\u003c/p>\n\u003cp>Part of the problem, Rouillard said, is that the federal government did not release the final regulations dictating how its parity law should be enforced until November 2013 – five years after the law was passed.\u003c/p>\n\u003cp>In addition to the flawed and incomplete paperwork, her department found insurers trying to control costs in ways that could be discriminatory -- for example, by limiting the number of days a patient could receive inpatient care for a mental health condition.\u003c/p>\n\u003cp>“Mental health services are still sort of a second class benefit as far as the health plans are concerned,” Rouillard said.\u003c/p>\n\u003cp>At this point, Rouillard says the managed care plans she regulates are in varying stages of compliance with the federal parity law. Just one plan, Health Net, has so far been able to prove on paper that its benefits fully comply. Rouillard says she expects the other plans to follow suit by the end of the year, and in 2016, the department plans a more intensive review.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, disputed that insurers see mental health a second-tier benefit. “We're committed to providing this coverage for our enrollees. It's very important, and it's something that we're working hard to do,” he said.\u003c/p>\n\u003cp>But the law poses a huge challenge for health plans, he said, in part because the science underpinning diagnosis and treatment of mental illness is constantly evolving. In addition, health plans are trying to adapt not just to parity law but to the implementation of the Affordable Care Act, which has transformed the national insurance landscape.\u003c/p>\n\u003cp>Even so, he said, “I think by the end of this year, all the plans will have filed the right documents and will have approval from the department, and this will be something that's in the rearview mirror.”\u003c/p>\n\u003cp>\u003cstrong>‘A Societal Problem’\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Finding that her situation did not improve even after the first investigation of Kaiser in 2015, psychologist Ginne made a request of her managers -- copied to Rouillard -- that December. She asked that six of her sickest patients be transferred to other providers who could see them more frequently.\u003c/p>\n\u003cp>One of them, an elderly man with dementia and depression, was hallucinating “fully-formed humans,” Ginne said in an interview. One day, he wandered down the block at 5 am in his pajamas, panicked, and flagged down a truck driver who called the police.\u003c/p>\n\u003cp>“He was a danger to himself,” Ginne said.\u003c/p>\n\u003cp>According to Ginne, the backup in appointments meant she could see him for individual therapy only once every few months. The man had been assigned to regular group therapy for depression, which Ginne felt was inappropriate for his condition.\u003c/p>\n\u003cp>When her supervisors did not transfer the man to another individual therapy provider, Ginne reported the case to Adult Protective Services, because she said she believed him to be imminent danger.\u003c/p>\n\u003cp>“That's such a bad solution,” she said, shaking her head. Ultimately, he and his wife decided to quit therapy entirely.\u003c/p>\n\u003cp>Rouillard said that many managed care plans have a long way to go to ensure fair and equal access to mental health care for Californians. But she also said there’s only so much her department can do.\u003c/p>\n\u003cp>Access to care at companies like Kaiser is also an issue of capacity – and that’s not within the department’s purview, she said.\u003c/p>\n\u003cp>“There just aren't enough therapists to see everyone who needs help,” she said. “It isn't just a plan problem; it's a societal problem. And that is really the crux of the matter. We're trying to address a problem that is beyond our ability to fix, and that is a challenge.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cstrong>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a> \u003c/em>\u003c/strong>\u003cem>and\u003c/em>\u003cem> not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/60387/despite-parity-laws-equal-access-to-mental-health-care-slow-going-in-california","authors":["byline_stateofhealth_60387"],"categories":["stateofhealth_11","stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_803","stateofhealth_68"],"featImg":"stateofhealth_60409","label":"stateofhealth"},"stateofhealth_24020":{"type":"posts","id":"stateofhealth_24020","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"24020","score":null,"sort":[1424973503000]},"guestAuthors":[],"slug":"4-year-contract-dispute-between-kaiser-nuhw-thaws-union-hopeful","title":"4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful'","publishDate":1424973503,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-e1424973125499.jpg\">\u003cimg class=\"size-large wp-image-19926\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-640x358.jpg\" alt=\"(Ted Eytan/Flickr)\" width=\"640\" height=\"358\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ted Eytan/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.\u003c/p>\n\u003cp>NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.\u003c/p>\n\u003cp>In 2011, the union filed a \u003ca href=\"//nuhw.org/wp-content/uploads/2014/01/CareDelayedCareDenied.pdf%E2%80%9D\" target=\"_blank\">34-page complaint\u003c/a> with the California Department of Managed Health Care alleging Kaiser's mental health services were \"sorely understaffed and frequently fail to provide timely and appropriate care.”\u003c!--more-->\u003c/p>\n\u003cp>Individually, union members have been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">scathing in their assessments\u003c/a> of Kaiser's mental health services, at times implying or outright stating that the company was unethical in the way it rationed patient appointments.\u003c/p>\n\u003cp>Kaiser, for its part, has frequently brushed aside such complaints as a negotiating tactic designed to win a new contract. As recently as January, just before a weeklong strike by mental health workers, the HMO took direct aim at the union. John Nelson, vice president of government relations for Kaiser Permanente, released \u003ca href=\"http://share.kaiserpermanente.org/article/statement-on-nuhw-strike-from-john-nelson-vice-president-of-government-relations-kaiser-permanente/\" target=\"_blank\">a statement\u003c/a> that read in part:\u003c/p>\n\u003cblockquote>\u003cp>“NUHW is a small California union representing fewer than 5,000 of Kaiser Permanente¹s 175,000 employees. Since its creation in 2009, it has never negotiated a contract with Kaiser Permanente. In fact, NUHW stands alone as the only union that has been unwilling or unable to reach a fair agreement concerning a contract covering our employees during that time.”\u003c/p>\u003c/blockquote>\n\u003cp>For weeks since, the two had not been at the bargaining table.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But now, in the midst of a second DMHC report finding \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">significant deficiencies in Kaiser’s mental health care\u003c/a>, the relationship appears to be thawing.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hRElI21H21RuhFYYJOkkigsM02jlA9UM\"]\u003c/p>\n\u003cp>“There are multiple meetings scheduled through next week where Kaiser management is seriously listening to their clinicians, getting their ideas how to fix the DMHC's findings,” said NUHW President Sal Roselli. \"I'm hopeful -- I'm not saying this is going to happen -- but I'm hopeful\" that a contract that \"formalizes change in how Kaiser provides care and engages with clinicians\" could be forthcoming.\u003c/p>\n\u003cp>Kaiser confirmed that \u003ca href=\"http://fortherecord.kp.org/kaiser-permanente-and-nuhw-ibhs-bargaining-february-19-and-20-2015/\" target=\"_blank\">bargaining resumed last week\u003c/a> in Northern California. It said that bargaining in Southern California is scheduled for the second week in March.\u003c/p>\n\u003cp>“As we have said all along, we need the union representing mental health care providers to work with us cooperatively,\" said John Nelson in a statement sent to KQED. \"Delays, roadblocks, and other challenges to continued improvement do nothing to help our members and patients. We all deliver our best when we work constructively together to remove obstacles and solve problems more quickly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He said that Kaiser \"remain(s) committed to resolving our differences.\"\u003c/p>\n\n","blocks":[],"excerpt":"The contract negotiations take place as state regulators cited Kaiser for deficiencies in mental health services.","status":"publish","parent":0,"modified":1425059359,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":470},"headData":{"title":"4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful' | KQED","description":"The contract negotiations take place as state regulators cited Kaiser for deficiencies in mental health services.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"24020 http://blogs.kqed.org/stateofhealth/?p=24020","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/02/26/4-year-contract-dispute-between-kaiser-nuhw-thaws-union-hopeful/","disqusTitle":"4-Year Contract Dispute Between Kaiser, NUHW Thaws; Union 'Hopeful'","path":"/stateofhealth/24020/4-year-contract-dispute-between-kaiser-nuhw-thaws-union-hopeful","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19926\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-e1424973125499.jpg\">\u003cimg class=\"size-large wp-image-19926\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/07/6980198171_a6cbed3bdf_k-640x358.jpg\" alt=\"(Ted Eytan/Flickr)\" width=\"640\" height=\"358\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Ted Eytan/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>For more than four years, the National Union of Healthcare Workers, representing 2,600 Kaiser mental health clinicians in California, has been in a small war with the health care giant.\u003c/p>\n\u003cp>NUHW members have gone on strikes of varying lengths three times over what it says are lengthy delays in providing care to mental health patients.\u003c/p>\n\u003cp>In 2011, the union filed a \u003ca href=\"//nuhw.org/wp-content/uploads/2014/01/CareDelayedCareDenied.pdf%E2%80%9D\" target=\"_blank\">34-page complaint\u003c/a> with the California Department of Managed Health Care alleging Kaiser's mental health services were \"sorely understaffed and frequently fail to provide timely and appropriate care.”\u003c!--more-->\u003c/p>\n\u003cp>Individually, union members have been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">scathing in their assessments\u003c/a> of Kaiser's mental health services, at times implying or outright stating that the company was unethical in the way it rationed patient appointments.\u003c/p>\n\u003cp>Kaiser, for its part, has frequently brushed aside such complaints as a negotiating tactic designed to win a new contract. As recently as January, just before a weeklong strike by mental health workers, the HMO took direct aim at the union. John Nelson, vice president of government relations for Kaiser Permanente, released \u003ca href=\"http://share.kaiserpermanente.org/article/statement-on-nuhw-strike-from-john-nelson-vice-president-of-government-relations-kaiser-permanente/\" target=\"_blank\">a statement\u003c/a> that read in part:\u003c/p>\n\u003cblockquote>\u003cp>“NUHW is a small California union representing fewer than 5,000 of Kaiser Permanente¹s 175,000 employees. Since its creation in 2009, it has never negotiated a contract with Kaiser Permanente. In fact, NUHW stands alone as the only union that has been unwilling or unable to reach a fair agreement concerning a contract covering our employees during that time.”\u003c/p>\u003c/blockquote>\n\u003cp>For weeks since, the two had not been at the bargaining table.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But now, in the midst of a second DMHC report finding \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/\" target=\"_blank\">significant deficiencies in Kaiser’s mental health care\u003c/a>, the relationship appears to be thawing.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“There are multiple meetings scheduled through next week where Kaiser management is seriously listening to their clinicians, getting their ideas how to fix the DMHC's findings,” said NUHW President Sal Roselli. \"I'm hopeful -- I'm not saying this is going to happen -- but I'm hopeful\" that a contract that \"formalizes change in how Kaiser provides care and engages with clinicians\" could be forthcoming.\u003c/p>\n\u003cp>Kaiser confirmed that \u003ca href=\"http://fortherecord.kp.org/kaiser-permanente-and-nuhw-ibhs-bargaining-february-19-and-20-2015/\" target=\"_blank\">bargaining resumed last week\u003c/a> in Northern California. It said that bargaining in Southern California is scheduled for the second week in March.\u003c/p>\n\u003cp>“As we have said all along, we need the union representing mental health care providers to work with us cooperatively,\" said John Nelson in a statement sent to KQED. \"Delays, roadblocks, and other challenges to continued improvement do nothing to help our members and patients. We all deliver our best when we work constructively together to remove obstacles and solve problems more quickly.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>He said that Kaiser \"remain(s) committed to resolving our differences.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/24020/4-year-contract-dispute-between-kaiser-nuhw-thaws-union-hopeful","authors":["80"],"categories":["stateofhealth_13"],"tags":["stateofhealth_803","stateofhealth_68"],"featImg":"stateofhealth_19926","label":"stateofhealth"},"stateofhealth_23993":{"type":"posts","id":"stateofhealth_23993","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23993","score":null,"sort":[1424901834000]},"guestAuthors":[],"slug":"calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist","title":"Calif. Calls Kaiser Mental Health Services 'Inadequate' as Treatment Delays Persist","publishDate":1424901834,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_23433\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\">\u003cimg class=\"size-full wp-image-23433\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.\u003c/p>\n\u003cp>A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Following up on a survey that resulted in a $4 million fine against the HMO in 2013. \u003c/aside>\n\u003cp>A patient deemed high-risk for domestic abuse doesn't show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can't get one.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>These are just a few of the cases documented in the California Department of Managed Health Care’s\u003ca title=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\"> latest report of Kaiser’s mental health services,\u003c/a> released to the public Tuesday. The report, a follow-up to the survey that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">resulted in a $4 million fine against Kaiser in 2013,\u003c/a> says that while the health care giant has made progress in providing mental health services to its enrollees, it still has a long way to go in adequately serving patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Despite the very significant strides made by the Plan in monitoring and assessing corrective action related to timely access to behavioral health services,\" the report reads, \"the Plan’s monthly access reports suggest that the Plan’s current behavioral health provider network remains inadequate to serve the needs of its enrollee population.\u003c/p>\n\u003cp>\"(T)he Plan’s own monthly access reports continue to show a lack of stability or a lack of available providers within the Plan’s behavioral health provider network,\" the DMHC writes in its conclusion to the 32-page report.\u003c/p>\n\u003cp>\"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services,\" Shelley Rouillard, director of the Department of Managed Health Care, \u003ca title=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" href=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" target=\"_blank\">told the Los Angeles Times\u003c/a>. \"I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need.\"\u003c/p>\n\u003cp>Kaiser, which serves nearly 7.7 million members statewide, agreed to pay the $4 million fine last September after an initial appeal. That penalty resulted from a routine DMHC \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">survey\u003c/a> finding four basic deficiencies related to plan members experiencing excessive wait times for initial appointments.\u003c/p>\n\u003col>\n\u003cli>Kaiser measured wait times for initial appointments in ways that minimized their length. For instance, it used paper waiting lists, not counting the days patients languished there. Or it logged the interval between a canceled appointment and a new appointment instead of from the original appointment, thus decreasing its wait times statistically.\u003c/li>\n\u003cli>Kaiser's methodology for measuring timely access -- averaging all reported enrollee wait times for a given month -- obscured the lengthy wait times of some individuals. \"Such an approach could prevent effective treatment of an enrollee’s condition or fail to prevent further deterioration of an enrollee’s health,\" the DMHC said in its follow-up report.\u003c/li>\n\u003cli>Long wait times for an initial appointment and the failure of the plan's quality assurance program to address these delays violated department regulations.\u003c/li>\n\u003cli>By focusing on limitations and exclusions of mental health benefits, some Kaiser mental health personnel, as well as printed and online materials, disseminated \"inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.\" Some materials, for instance, failed to inform enrollees that coverage for severe mental illness or serious emotional disturbances of a child is required.\u003c/li>\n\u003c/ol>\n\u003cp>The current report designates deficiencies 1 and 2 as \"corrected\" and numbers 3 and 4 as \"not corrected.\" The new report has been referred to the DMHC's Office of Enforcement \"for further investigation and possible disciplinary action, based on the Plan’s failure to correct Deficiencies #3 and #4.\"\u003c/p>\n\u003cp>\"Financial penalties are an option available to the DMHC,\" said DMHC information officer Rodger Butler, \"but it's too early to say if that will be the course of action.\"\u003c/p>\n\u003cp>\u003cstrong>Focusing on the Positive\u003c/strong>\u003c/p>\n\u003cp>In a lengthy \u003ca href=\"http://share.kaiserpermanente.org/article/kaiser-permanente-comments-on-the-department-of-managed-health-care-follow-up-mental-health-survey/\" target=\"_blank\">statement\u003c/a>, Kaiser focused on the progress the DMHC said Kaiser had made in correcting problems:\u003c/p>\n\u003cblockquote>\u003cp>\"We are proud of the progress we have made to improve access to mental health care. The DMHC’s initial survey was conducted in 2012. This follow-up survey was conducted in 2013-14, including the case review portion. Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. We have engaged with high quality community-based mental health care providers, including ValueOptions, a network of community providers with which we began successfully partnering in 2014, to ensure our patients receive timely access to mental health care, especially in locations where there are increases in appointment requests.\"\u003c/p>\u003c/blockquote>\n\u003cp>In its statement, Kaiser acknowledged that DMHC had found some Kaiser health centers experienced significant fluctuations in providing timely access. The report cited four unnamed medical centers in Northern California at which access rates plummeted over several months or more.\u003c/p>\n\u003cp>Last year, the National Union of Healthcare Workers, which has been in a years-long, bitter contract fight with Kaiser, provided statistics to KQED that showed timely access rates at both the Oakland and Richmond medical centers suddenly dropped 28 percent and 32 percent, respectively, over the course of one month.\u003c/p>\n\u003cp>[contextly_sidebar id=\"DtHW2FaezVom7dvstOt3kRTcbQqNDv75\"]\u003c/p>\n\u003cp>\"While the report acknowledges that Kaiser Permanente ‘took significant steps’ to track and address timely access challenges,\" Kaiser said in its statement issued Tuesday, \"there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers and being more flexible and innovative in finding solutions.\"\u003c/p>\n\u003cp>The report did point to some success stories stemming from Kaiser's efforts at truncating wait times. In early 2013, for example, the psychiatry department at the Napa-Solano Medical Center was experiencing a months-long decline in on-time appointments.\u003c/p>\n\u003cp>\"The Plan began video and telephone appointments, utilized a psychiatrist from another medical center, increased clinic hours, recruited new staff, and utilized use of other staff temporarily to fulfill the duties,\" DMHC said. \"For the remainder of the year, the rate was above 90% with 100% compliance in December.\"\u003c/p>\n\u003cp>NUHW President Sal Roselli said, \"For four years-plus, our clinicians have been bringing these major issues to Kaiser and for four years-plus, Kaiser has dismissed their concerns, refused to talk about them.\" Roselli said Kaiser and the union returned to the bargaining table in Northern California last week, and that the DMHC report was \"certainly helping.\"\u003c/p>\n\u003cp>\u003cstrong>Delays and Misinformed Patients\u003c/strong>\u003c/p>\n\u003cp>The current report took into account delays in follow-up care in addition to initial appointments. Delays in follow-up appointments at Kaiser were the subject of an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">investigation by KQED's State of Health\u003c/a> last year, which found Kaiser patients and therapists complaining about delays similar to those found by the DMHC.\u003c/p>\n\u003cp>Department regulations state that non-urgent initial appointments with a therapist must be available within 10 business days of request; non-urgent appointments with a psychiatrist must be available within 15 business days, and urgent appointments that do not require prior authorization must be available within 48 hours.\u003c/p>\n\u003cp>The DMHC follow-up survey included a look at the medical records of 297 patients -- 149 in Kaiser's Southern Region and 148 in the Northern Region. It found that in the north, 33 out of 148 patients, or 22 percent, did not receive timely initial or follow-up appointments within those timeframes. Just 9 percent experienced the same delays in the south.\u003c/p>\n\u003cp>Regarding uncorrected deficiency No. 4, \"inaccurate and misleading information provided to enrollees about the limits of their coverage,\" the DMHC found that Kaiser mental health personnel did not inform patients they could be seen as often as medically necessary. From the report:\u003c/p>\n\u003cblockquote>\u003cp>\"To the contrary, messages conveyed to enrollees in certain cases indicated that access to behavioral health services is quite limited in scope. (Such) information ... can actively discourage patients from obtaining care. In addition, in situations where providers misunderstand the scope of benefits available to enrollees, they may fail to schedule patients for additional, medically necessary covered services.\"\u003c/p>\u003c/blockquote>\n\u003cp>The report pointed to examples of clinicians misinforming patients about their rights to coverage.\u003c/p>\n\u003cp>\"No one ever sees a therapist once a week in the Kaiser Health Plan,\" one psychiatrist wrote in an email to a patient. \"Not a covered benefit for the past 20 something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Andy Weisskoff, a former Kaiser therapist who published a scathing \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">series of blog posts\u003c/a> last year about his experiences with treatment delays at Kaiser Santa Rosa, thought the report was a step in the right direction but that it probably undercounted the number of delays. He pointed to a footnote in which the DMHC said it was \"difficult to differentiate between appointment availability and lack of clinical follow-up.\"\u003c/p>\n\u003cp>\"The reviewers were uncertain if the delays between initial appointment and follow-up were because a follow-up was unavailable or if the therapist didn't set one up properly,\" he said.\u003c/p>\n\u003cp>\"These reviewers were clearly uninformed about the great lengths therapists at Kaiser have gone to to try to make more appointments available.\"\u003c/p>\n\u003cp>Still, he was pleased.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I feel relieved that the facts are coming out, and they're coming out in such a dramatic and public way.\"\u003c/p>\n\n","blocks":[],"excerpt":"The report is a follow-up to a 2013 survey that found deficiencies and ended in Kaiser paying a $4 million fine.","status":"publish","parent":0,"modified":1429556382,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1656},"headData":{"title":"Calif. Calls Kaiser Mental Health Services 'Inadequate' as Treatment Delays Persist | KQED","description":"The report is a follow-up to a 2013 survey that found deficiencies and ended in Kaiser paying a $4 million fine.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"23993 http://blogs.kqed.org/stateofhealth/?p=23993","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/02/25/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist/","disqusTitle":"Calif. Calls Kaiser Mental Health Services 'Inadequate' as Treatment Delays Persist","path":"/stateofhealth/23993/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23433\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\">\u003cimg class=\"size-full wp-image-23433\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/01/Kaiser-jpg-640x480-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>A teenager with major depression and thoughts of suicide is forced to wait 24 days for an initial appointment.\u003c/p>\n\u003cp>A sexual assault victim, diagnosed with PTSD and major depression, sends numerous emails requesting individual psychotherapy, only to have her psychiatrist suggest she should get outside help at her own expense because no weekly appointments are available. Total time between appointments: Five months.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Following up on a survey that resulted in a $4 million fine against the HMO in 2013. \u003c/aside>\n\u003cp>A patient deemed high-risk for domestic abuse doesn't show up for appointments, but mental health staff do not attempt contact. The couples therapy called for in his treatment plan does not occur. Domestic violence resulting in severe injury ensues. The man then tries to make an appointment but can't get one.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>These are just a few of the cases documented in the California Department of Managed Health Care’s\u003ca title=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bhfu022415.pdf\" target=\"_blank\"> latest report of Kaiser’s mental health services,\u003c/a> released to the public Tuesday. The report, a follow-up to the survey that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">resulted in a $4 million fine against Kaiser in 2013,\u003c/a> says that while the health care giant has made progress in providing mental health services to its enrollees, it still has a long way to go in adequately serving patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Despite the very significant strides made by the Plan in monitoring and assessing corrective action related to timely access to behavioral health services,\" the report reads, \"the Plan’s monthly access reports suggest that the Plan’s current behavioral health provider network remains inadequate to serve the needs of its enrollee population.\u003c/p>\n\u003cp>\"(T)he Plan’s own monthly access reports continue to show a lack of stability or a lack of available providers within the Plan’s behavioral health provider network,\" the DMHC writes in its conclusion to the 32-page report.\u003c/p>\n\u003cp>\"Even with all the changes Kaiser has made, there are still serious concerns about patients' ability to get timely access to mental health services,\" Shelley Rouillard, director of the Department of Managed Health Care, \u003ca title=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" href=\"http://www.latimes.com/business/la-fi-kaiser-mental-health-20150225-story.html\" target=\"_blank\">told the Los Angeles Times\u003c/a>. \"I want Kaiser to fix the problem and do what they need to do to make sure their members get the mental health services they need.\"\u003c/p>\n\u003cp>Kaiser, which serves nearly 7.7 million members statewide, agreed to pay the $4 million fine last September after an initial appeal. That penalty resulted from a routine DMHC \u003ca href=\"http://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055bh031813.pdf\" target=\"_blank\">survey\u003c/a> finding four basic deficiencies related to plan members experiencing excessive wait times for initial appointments.\u003c/p>\n\u003col>\n\u003cli>Kaiser measured wait times for initial appointments in ways that minimized their length. For instance, it used paper waiting lists, not counting the days patients languished there. Or it logged the interval between a canceled appointment and a new appointment instead of from the original appointment, thus decreasing its wait times statistically.\u003c/li>\n\u003cli>Kaiser's methodology for measuring timely access -- averaging all reported enrollee wait times for a given month -- obscured the lengthy wait times of some individuals. \"Such an approach could prevent effective treatment of an enrollee’s condition or fail to prevent further deterioration of an enrollee’s health,\" the DMHC said in its follow-up report.\u003c/li>\n\u003cli>Long wait times for an initial appointment and the failure of the plan's quality assurance program to address these delays violated department regulations.\u003c/li>\n\u003cli>By focusing on limitations and exclusions of mental health benefits, some Kaiser mental health personnel, as well as printed and online materials, disseminated \"inaccurate and misleading health education information to enrollees regarding the scope of their coverage for behavioral health services.\" Some materials, for instance, failed to inform enrollees that coverage for severe mental illness or serious emotional disturbances of a child is required.\u003c/li>\n\u003c/ol>\n\u003cp>The current report designates deficiencies 1 and 2 as \"corrected\" and numbers 3 and 4 as \"not corrected.\" The new report has been referred to the DMHC's Office of Enforcement \"for further investigation and possible disciplinary action, based on the Plan’s failure to correct Deficiencies #3 and #4.\"\u003c/p>\n\u003cp>\"Financial penalties are an option available to the DMHC,\" said DMHC information officer Rodger Butler, \"but it's too early to say if that will be the course of action.\"\u003c/p>\n\u003cp>\u003cstrong>Focusing on the Positive\u003c/strong>\u003c/p>\n\u003cp>In a lengthy \u003ca href=\"http://share.kaiserpermanente.org/article/kaiser-permanente-comments-on-the-department-of-managed-health-care-follow-up-mental-health-survey/\" target=\"_blank\">statement\u003c/a>, Kaiser focused on the progress the DMHC said Kaiser had made in correcting problems:\u003c/p>\n\u003cblockquote>\u003cp>\"We are proud of the progress we have made to improve access to mental health care. The DMHC’s initial survey was conducted in 2012. This follow-up survey was conducted in 2013-14, including the case review portion. Since the follow-up review was conducted, we have made even more progress. We have hired new mental health therapists in Northern and Southern California, and we currently are recruiting to hire more. We have engaged with high quality community-based mental health care providers, including ValueOptions, a network of community providers with which we began successfully partnering in 2014, to ensure our patients receive timely access to mental health care, especially in locations where there are increases in appointment requests.\"\u003c/p>\u003c/blockquote>\n\u003cp>In its statement, Kaiser acknowledged that DMHC had found some Kaiser health centers experienced significant fluctuations in providing timely access. The report cited four unnamed medical centers in Northern California at which access rates plummeted over several months or more.\u003c/p>\n\u003cp>Last year, the National Union of Healthcare Workers, which has been in a years-long, bitter contract fight with Kaiser, provided statistics to KQED that showed timely access rates at both the Oakland and Richmond medical centers suddenly dropped 28 percent and 32 percent, respectively, over the course of one month.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"While the report acknowledges that Kaiser Permanente ‘took significant steps’ to track and address timely access challenges,\" Kaiser said in its statement issued Tuesday, \"there remain locations where access to appointments is not consistently where it should be. We are continuing to address these challenges, through making caregivers available where they are needed, continuing to recruit more staff, partnering more with community providers and being more flexible and innovative in finding solutions.\"\u003c/p>\n\u003cp>The report did point to some success stories stemming from Kaiser's efforts at truncating wait times. In early 2013, for example, the psychiatry department at the Napa-Solano Medical Center was experiencing a months-long decline in on-time appointments.\u003c/p>\n\u003cp>\"The Plan began video and telephone appointments, utilized a psychiatrist from another medical center, increased clinic hours, recruited new staff, and utilized use of other staff temporarily to fulfill the duties,\" DMHC said. \"For the remainder of the year, the rate was above 90% with 100% compliance in December.\"\u003c/p>\n\u003cp>NUHW President Sal Roselli said, \"For four years-plus, our clinicians have been bringing these major issues to Kaiser and for four years-plus, Kaiser has dismissed their concerns, refused to talk about them.\" Roselli said Kaiser and the union returned to the bargaining table in Northern California last week, and that the DMHC report was \"certainly helping.\"\u003c/p>\n\u003cp>\u003cstrong>Delays and Misinformed Patients\u003c/strong>\u003c/p>\n\u003cp>The current report took into account delays in follow-up care in addition to initial appointments. Delays in follow-up appointments at Kaiser were the subject of an \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">investigation by KQED's State of Health\u003c/a> last year, which found Kaiser patients and therapists complaining about delays similar to those found by the DMHC.\u003c/p>\n\u003cp>Department regulations state that non-urgent initial appointments with a therapist must be available within 10 business days of request; non-urgent appointments with a psychiatrist must be available within 15 business days, and urgent appointments that do not require prior authorization must be available within 48 hours.\u003c/p>\n\u003cp>The DMHC follow-up survey included a look at the medical records of 297 patients -- 149 in Kaiser's Southern Region and 148 in the Northern Region. It found that in the north, 33 out of 148 patients, or 22 percent, did not receive timely initial or follow-up appointments within those timeframes. Just 9 percent experienced the same delays in the south.\u003c/p>\n\u003cp>Regarding uncorrected deficiency No. 4, \"inaccurate and misleading information provided to enrollees about the limits of their coverage,\" the DMHC found that Kaiser mental health personnel did not inform patients they could be seen as often as medically necessary. From the report:\u003c/p>\n\u003cblockquote>\u003cp>\"To the contrary, messages conveyed to enrollees in certain cases indicated that access to behavioral health services is quite limited in scope. (Such) information ... can actively discourage patients from obtaining care. In addition, in situations where providers misunderstand the scope of benefits available to enrollees, they may fail to schedule patients for additional, medically necessary covered services.\"\u003c/p>\u003c/blockquote>\n\u003cp>The report pointed to examples of clinicians misinforming patients about their rights to coverage.\u003c/p>\n\u003cp>\"No one ever sees a therapist once a week in the Kaiser Health Plan,\" one psychiatrist wrote in an email to a patient. \"Not a covered benefit for the past 20 something years and will not be a benefit in the future.”\u003c/p>\n\u003cp>Andy Weisskoff, a former Kaiser therapist who published a scathing \u003ca href=\"http://90daystochange.com/\" target=\"_blank\">series of blog posts\u003c/a> last year about his experiences with treatment delays at Kaiser Santa Rosa, thought the report was a step in the right direction but that it probably undercounted the number of delays. He pointed to a footnote in which the DMHC said it was \"difficult to differentiate between appointment availability and lack of clinical follow-up.\"\u003c/p>\n\u003cp>\"The reviewers were uncertain if the delays between initial appointment and follow-up were because a follow-up was unavailable or if the therapist didn't set one up properly,\" he said.\u003c/p>\n\u003cp>\"These reviewers were clearly uninformed about the great lengths therapists at Kaiser have gone to to try to make more appointments available.\"\u003c/p>\n\u003cp>Still, he was pleased.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I feel relieved that the facts are coming out, and they're coming out in such a dramatic and public way.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23993/calif-calls-kaiser-mental-health-services-inadequate-as-treatment-delays-persist","authors":["80"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_803","stateofhealth_68"],"featImg":"stateofhealth_23433","label":"stateofhealth"},"stateofhealth_23522":{"type":"posts","id":"stateofhealth_23522","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23522","score":null,"sort":[1421522963000]},"guestAuthors":[],"slug":"nurses-strike-called-off","title":"Kaiser Nurses Reach Agreement, Call Off Strike","publishDate":1421522963,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_22548\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/458806130-e1416265695728.jpg\">\u003cimg class=\"size-large wp-image-22548\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/458806130-640x432.jpg\" alt=\"Nurses carry signs as they strike outside of Kaiser Permanente hospital in San Francisco last week. (Justin Sullivan/Getty Images)\" width=\"640\" height=\"432\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser nurses staged a two-day strike in November, citing concerns about Ebola preparedness. (Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The California Nurses' Association has called off a two-day strike scheduled to begin Wednesday after reaching a tentative agreement with Kaiser Permanente on a new three-year contract.\u003c/p>\n\u003cp>The nurses' bargaining team is recommending ratification of the proposed contract that would affect 18,000 registered nurses and nurse practitioners at 86 Kaiser sites throughout Northern and Central California.\u003c/p>\n\u003cp>\"It's really, really a good deal,\" said Diane McClure, a nurse at Kaiser's South Sacramento facility and a member of the bargaining team, adding that the strike threat strengthened the nurses' position with Kaiser. \"They saw the momentum the nurses had. They didn’t want us out in the public, because they knew the public was behind us.\"\u003c/p>\n\u003cp>Kaiser issued a statement saying it was pleased with the economic priorities accomplished by the agreement, including \"slowing the growth of our long-term liabilities,\" and offering benefits to nurses that are \"consistent with our commitment to affordability.\"\u003c!--more-->\u003c/p>\n\u003cp>The agreement comes after months of contentious negotiations. The first bargaining meetings, originally scheduled for August, were delayed by several weeks when both sides disagreed over where to meet.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nurses conducted a two-day strike in November, citing a lack of adequate Ebola protections as a top complaint - a concern that was later resolved after the union convinced Gov. Jerry Brown to pass new regulations that required hospitals to provide the kind of training and protective gear the union demanded. The nurses had a list of more than 30 other demands that focused on workload and patient safety.\u003c/p>\n\u003cp>On the economic front, nurses made no additional requests beyond their last contract, which included annual raises for nurses, full health care coverage, and 100 percent employer-paid pensions and retiree health benefits.\u003c/p>\n\u003cp>It wasn't until after the November strike that Kaiser put any proposals on the table. As of earlier this week, the hospital system was requesting various new cost-sharing measures, according to nurses involved in the negotiations.\u003c/p>\n\u003cp>One would require nurses to pay higher co-pays when they sought medical services for themselves and their families at a Kaiser facility, a measure pursued by many employers nationwide as a way to reduce unnecessary use of the health care system. McClure says nurses agreed to a version of this request.\u003c/p>\n\u003cp>“But it’s extremely minimal cost sharing,” she said. “It’s extremely reasonable.”\u003c/p>\n\u003cp>Another proposal would have required retired nurses to contribute toward the costs of their health care, starting in ten years. And another would have tied future negotiations over pensions to agreements reached by other unions. McClure says the nurses rejected both of these proposals, and that nurses’ retirement benefits remained in tact, “for the most part.”\u003c/p>\n\u003cp>Kaiser awarded nurses several of their requests on working conditions.\u003c/p>\n\u003cp>The most important, McClure says, is that Kaiser will now advertise job listings for vacant nursing positions, a move she says is critical for easing the work load of current nurses.\u003c/p>\n\u003cp>Kaiser also agreed to provide supplemental insurance to nurses who are hurt on the job, or become ill at work.\u003c/p>\n\u003cp>And Kaiser will provide a 14 percent salary increase to all nurses.\u003c/p>\n\u003cp>“This agreement is a timely and clear reminder that differences are best resolved at the bargaining table, and not on the picket line,” said John Nelson, Kaiser’s vice president of government relations.\u003c/p>\n\u003cp>In addition to averting a second nurses’ strike, Kaiser is currently facing an ongoing strike by 2,500 of its psychologists and therapists. That week-long strike is scheduled to end Monday morning. The union for mental health professionals, the National Union of Healthcare Workers, has been bargaining with Kaiser for four years.\u003c/p>\n\u003cp>Nelson said the agreement with the nurses was the result of intensive, productive negotiations that became very serious in early December.\u003c/p>\n\u003cp>The hospital system is trying to control future costs and liabilities associated with its pension obligations and retiree health benefits, challenges that are shared by many other health care organizations and employers across the country, Nelson said.\u003c/p>\n\u003cp>“We try to work together with labor organizations that represent our employees to find solutions to those challenges,” Nelson said, though he declined to discuss details of the agreement that might address those challenges, because the union had not had a chance to ratify it yet.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If you look at the comprehensive nature of all the pieces of the agreement, we are pleased that it helps us meet our objectives,” he said. “We wanted to offer benefits to our nurses that are consistent with making this a great place to work, while meeting affordability for our patients.”\u003c/p>\n\n","blocks":[],"excerpt":"The proposed contract would cover 18,000 nurses at Kaiser sites across Northern California.","status":"publish","parent":0,"modified":1421536139,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":808},"headData":{"title":"Kaiser Nurses Reach Agreement, Call Off Strike | KQED","description":"The proposed contract would cover 18,000 nurses at Kaiser sites across Northern California.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"23522 http://blogs.kqed.org/stateofhealth/?p=23522","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/01/17/nurses-strike-called-off/","disqusTitle":"Kaiser Nurses Reach Agreement, Call Off Strike","path":"/stateofhealth/23522/nurses-strike-called-off","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22548\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/458806130-e1416265695728.jpg\">\u003cimg class=\"size-large wp-image-22548\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/458806130-640x432.jpg\" alt=\"Nurses carry signs as they strike outside of Kaiser Permanente hospital in San Francisco last week. (Justin Sullivan/Getty Images)\" width=\"640\" height=\"432\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser nurses staged a two-day strike in November, citing concerns about Ebola preparedness. (Justin Sullivan/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The California Nurses' Association has called off a two-day strike scheduled to begin Wednesday after reaching a tentative agreement with Kaiser Permanente on a new three-year contract.\u003c/p>\n\u003cp>The nurses' bargaining team is recommending ratification of the proposed contract that would affect 18,000 registered nurses and nurse practitioners at 86 Kaiser sites throughout Northern and Central California.\u003c/p>\n\u003cp>\"It's really, really a good deal,\" said Diane McClure, a nurse at Kaiser's South Sacramento facility and a member of the bargaining team, adding that the strike threat strengthened the nurses' position with Kaiser. \"They saw the momentum the nurses had. They didn’t want us out in the public, because they knew the public was behind us.\"\u003c/p>\n\u003cp>Kaiser issued a statement saying it was pleased with the economic priorities accomplished by the agreement, including \"slowing the growth of our long-term liabilities,\" and offering benefits to nurses that are \"consistent with our commitment to affordability.\"\u003c!--more-->\u003c/p>\n\u003cp>The agreement comes after months of contentious negotiations. The first bargaining meetings, originally scheduled for August, were delayed by several weeks when both sides disagreed over where to meet.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nurses conducted a two-day strike in November, citing a lack of adequate Ebola protections as a top complaint - a concern that was later resolved after the union convinced Gov. Jerry Brown to pass new regulations that required hospitals to provide the kind of training and protective gear the union demanded. The nurses had a list of more than 30 other demands that focused on workload and patient safety.\u003c/p>\n\u003cp>On the economic front, nurses made no additional requests beyond their last contract, which included annual raises for nurses, full health care coverage, and 100 percent employer-paid pensions and retiree health benefits.\u003c/p>\n\u003cp>It wasn't until after the November strike that Kaiser put any proposals on the table. As of earlier this week, the hospital system was requesting various new cost-sharing measures, according to nurses involved in the negotiations.\u003c/p>\n\u003cp>One would require nurses to pay higher co-pays when they sought medical services for themselves and their families at a Kaiser facility, a measure pursued by many employers nationwide as a way to reduce unnecessary use of the health care system. McClure says nurses agreed to a version of this request.\u003c/p>\n\u003cp>“But it’s extremely minimal cost sharing,” she said. “It’s extremely reasonable.”\u003c/p>\n\u003cp>Another proposal would have required retired nurses to contribute toward the costs of their health care, starting in ten years. And another would have tied future negotiations over pensions to agreements reached by other unions. McClure says the nurses rejected both of these proposals, and that nurses’ retirement benefits remained in tact, “for the most part.”\u003c/p>\n\u003cp>Kaiser awarded nurses several of their requests on working conditions.\u003c/p>\n\u003cp>The most important, McClure says, is that Kaiser will now advertise job listings for vacant nursing positions, a move she says is critical for easing the work load of current nurses.\u003c/p>\n\u003cp>Kaiser also agreed to provide supplemental insurance to nurses who are hurt on the job, or become ill at work.\u003c/p>\n\u003cp>And Kaiser will provide a 14 percent salary increase to all nurses.\u003c/p>\n\u003cp>“This agreement is a timely and clear reminder that differences are best resolved at the bargaining table, and not on the picket line,” said John Nelson, Kaiser’s vice president of government relations.\u003c/p>\n\u003cp>In addition to averting a second nurses’ strike, Kaiser is currently facing an ongoing strike by 2,500 of its psychologists and therapists. That week-long strike is scheduled to end Monday morning. The union for mental health professionals, the National Union of Healthcare Workers, has been bargaining with Kaiser for four years.\u003c/p>\n\u003cp>Nelson said the agreement with the nurses was the result of intensive, productive negotiations that became very serious in early December.\u003c/p>\n\u003cp>The hospital system is trying to control future costs and liabilities associated with its pension obligations and retiree health benefits, challenges that are shared by many other health care organizations and employers across the country, Nelson said.\u003c/p>\n\u003cp>“We try to work together with labor organizations that represent our employees to find solutions to those challenges,” Nelson said, though he declined to discuss details of the agreement that might address those challenges, because the union had not had a chance to ratify it yet.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If you look at the comprehensive nature of all the pieces of the agreement, we are pleased that it helps us meet our objectives,” he said. “We wanted to offer benefits to our nurses that are consistent with making this a great place to work, while meeting affordability for our patients.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23522/nurses-strike-called-off","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_814","stateofhealth_803"],"featImg":"stateofhealth_22548","label":"stateofhealth"},"stateofhealth_23418":{"type":"posts","id":"stateofhealth_23418","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23418","score":null,"sort":[1421050296000]},"guestAuthors":[],"slug":"kaiser-mental-health-workers-launch-7-day-strike","title":"Kaiser Mental Health Workers Launch 7-Day Strike","publishDate":1421050296,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_20284\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/jpg-e1420908404158.jpg\">\u003cimg class=\"size-large wp-image-20284\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Dembosky\u003c/strong>\u003c/p>\n\u003cp>Mental health clinicians at Kaiser are walking off the job Monday, commencing a week-long, statewide strike. Their main complaint: Kaiser isn't hiring enough therapists and psychologists to see patients in a timely manner.\u003c/p>\n\u003cp>But the strike also comes after four years of contract negotiations between Kaiser and the National Union of Healthcare Workers have yielded few agreements.\u003c/p>\n\u003cp>\"We’ve tried one and two day actions in the past. Kaiser is not paying attention to that,\" says Clement Papazian, a social worker at Kaiser and a local union representative. \"We feel like it’s the appropriate time to escalate these actions.\"\u003c/p>\n\u003cp>Kaiser called the strike \"unnecessary and counterproductive.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>John Nelson, Kaiser's vice president of government relations, says the the hospital system is meeting its patients' mental health needs, even after Kaiser has taken on thousands of new patients under the Affordable Care Act.\u003c/p>\n\u003cp>\"Since 2011, we’ve grown membership by eight percent in California. We’ve increased the number of therapists in California who work at Kaiser Permanente by 25 percent,\" Nelson said. \"That's quite an accomplishment.\"\u003c!--more-->\u003c/p>\n\u003cp>Nelson said that health care systems across the country have been having difficulty hiring enough therapists and psychologists, because of a shortage of professionals. He said there isn't enough incentive to get people to enter the field.\u003c/p>\n\u003cp>\"There are challenges in encouraging folks to pursue that training and to go to school and complete the long licensing process,\" he said.\u003c/p>\n\u003cp>Kaiser has faced the ire of state regulators \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">over wait times \u003c/a>for mental health care. In 2013, the Department of Managed Health Care fined Kaiser $4 million over long wait times for mental health care. Kaiser initially contested the fine, but agreed to pay it last September -- while still \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">insisting it had not violated regulations\u003c/a>.\u003c/p>\n\u003cp>Nelson insisted the strike was really a bargaining strategy by the union. The latest issue to be debated in contract negotiations is retiree health benefits.\u003c/p>\n\u003cp>\"They want to carve out retiree health care,\" said Clement Papazian. He says Kaiser's latest proposal is to put current employees, once they retire, on a \"substandard\" Medicare plan. \"It’s a much less desirable health care benefit, and it's a bitter pill for those of us who work in health care and expend a career providing these services.\"\u003c/p>\n\u003cp>The union plans to hold rallies outside Kaiser facilities in Northern and Southern California throughout the week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Nelson says Kaiser has enough non-union staff to handle any urgent psychiatric needs during the strike, but some routine therapy appointments will be canceled.\u003c/p>\n\n","blocks":[],"excerpt":"Contract negotiations between Kaiser and the union have dragged on more than four years.","status":"publish","parent":0,"modified":1421087441,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":458},"headData":{"title":"Kaiser Mental Health Workers Launch 7-Day Strike | KQED","description":"Contract negotiations between Kaiser and the union have dragged on more than four years.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"23418 http://blogs.kqed.org/stateofhealth/?p=23418","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/01/12/kaiser-mental-health-workers-launch-7-day-strike/","disqusTitle":"Kaiser Mental Health Workers Launch 7-Day Strike","path":"/stateofhealth/23418/kaiser-mental-health-workers-launch-7-day-strike","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20284\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/jpg-e1420908404158.jpg\">\u003cimg class=\"size-large wp-image-20284\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/01/Kaiser-jpg-640x480.jpg\" alt=\"Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente’s medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Dembosky\u003c/strong>\u003c/p>\n\u003cp>Mental health clinicians at Kaiser are walking off the job Monday, commencing a week-long, statewide strike. Their main complaint: Kaiser isn't hiring enough therapists and psychologists to see patients in a timely manner.\u003c/p>\n\u003cp>But the strike also comes after four years of contract negotiations between Kaiser and the National Union of Healthcare Workers have yielded few agreements.\u003c/p>\n\u003cp>\"We’ve tried one and two day actions in the past. Kaiser is not paying attention to that,\" says Clement Papazian, a social worker at Kaiser and a local union representative. \"We feel like it’s the appropriate time to escalate these actions.\"\u003c/p>\n\u003cp>Kaiser called the strike \"unnecessary and counterproductive.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>John Nelson, Kaiser's vice president of government relations, says the the hospital system is meeting its patients' mental health needs, even after Kaiser has taken on thousands of new patients under the Affordable Care Act.\u003c/p>\n\u003cp>\"Since 2011, we’ve grown membership by eight percent in California. We’ve increased the number of therapists in California who work at Kaiser Permanente by 25 percent,\" Nelson said. \"That's quite an accomplishment.\"\u003c!--more-->\u003c/p>\n\u003cp>Nelson said that health care systems across the country have been having difficulty hiring enough therapists and psychologists, because of a shortage of professionals. He said there isn't enough incentive to get people to enter the field.\u003c/p>\n\u003cp>\"There are challenges in encouraging folks to pursue that training and to go to school and complete the long licensing process,\" he said.\u003c/p>\n\u003cp>Kaiser has faced the ire of state regulators \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">over wait times \u003c/a>for mental health care. In 2013, the Department of Managed Health Care fined Kaiser $4 million over long wait times for mental health care. Kaiser initially contested the fine, but agreed to pay it last September -- while still \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">insisting it had not violated regulations\u003c/a>.\u003c/p>\n\u003cp>Nelson insisted the strike was really a bargaining strategy by the union. The latest issue to be debated in contract negotiations is retiree health benefits.\u003c/p>\n\u003cp>\"They want to carve out retiree health care,\" said Clement Papazian. He says Kaiser's latest proposal is to put current employees, once they retire, on a \"substandard\" Medicare plan. \"It’s a much less desirable health care benefit, and it's a bitter pill for those of us who work in health care and expend a career providing these services.\"\u003c/p>\n\u003cp>The union plans to hold rallies outside Kaiser facilities in Northern and Southern California throughout the week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Nelson says Kaiser has enough non-union staff to handle any urgent psychiatric needs during the strike, but some routine therapy appointments will be canceled.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23418/kaiser-mental-health-workers-launch-7-day-strike","authors":["8344"],"categories":["stateofhealth_11"],"tags":["stateofhealth_803","stateofhealth_68"],"featImg":"stateofhealth_23433","label":"stateofhealth"},"stateofhealth_23009":{"type":"posts","id":"stateofhealth_23009","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"23009","score":null,"sort":[1418800984000]},"guestAuthors":[],"slug":"study-west-eliminates-race-gap-on-key-health-measures-disparities","title":"Study: Western States Eliminate Race Gap on Key Health Measures","publishDate":1418800984,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_23040\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-e1418800457273.jpg\">\u003cimg class=\"size-large wp-image-23040\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-640x425.jpg\" alt=\"Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A major new study looking at health disparities across the U.S. finds that significant gaps in managing heart disease and diabetes persist -- except in Western states, where the gap has been eliminated.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'It's possible to eliminate deeply ingrained racial disparities.' \u003c/aside>\n\u003cp>Researchers at the University of Michigan and Harvard University \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">looked at 100,000 Medicare patients\u003c/a> who were enrolled in HMOs, called \"Medicare Advantage\" plans, from 2006 to 2011. While management of blood pressure, cholesterol and blood sugar improved overall, blacks \"substantially\" trailed whites everywhere except\u003ca title=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" href=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" target=\"_blank\"> the Western U.S\u003c/a>., an area from the Rocky Mountains to the Pacific, as well as Alaska and Hawaii.\u003c/p>\n\u003cp>\"We were certainly hoping we would see indications of progress in eliminating disparities in the country as a whole,\" said lead author Dr. John Ayanian, who heads the Institute for Healthcare Policy and Innovation at the University of Michigan. He said that while it was \"disappointing\" that disparities persisted, \"it's also heartening to see that ... in the West, the disparities had been eliminated, and that was both surprising and encouraging.\"\u003c!--more-->\u003c/p>\n\u003cp>The \u003ca title=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">study was published\u003c/a> in the New England Journal of Medicine and was funded by a grant from the National Institute on Aging.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/182310570&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Disparities in health care have long been noted in the American system. The researchers wrote that, in 2008, \"life expectancy was 5.4 years shorter for black men and 3.7 years shorter for black women than for white men and white women.\" Heart disease and diabetes -- diseases that can be better managed by controlling blood pressure, cholesterol and blood sugar, the risk factors measured in the study -- accounted for 38 percent of the gap in mortality between black and white men, and 54 percent of the gap among women, the researchers said. That's why closing the racial gap on these measures is so critical.\u003c/p>\n\u003cp>\"It's one of the first large studies to show that it's possible to eliminate deeply ingrained racial disparities in important risk factors,\" Ayanian said. He said that outcomes for Hispanics, Asians and Pacific Islanders were \"also encouraging.\" Hispanics were 1 to 3 percent less likely than whites to have blood pressure, cholesterol or blood sugar under control. Asians and Pacific Islanders were more likely than whites to have good control of blood pressure and cholesterol. Blood sugar control was about the same.\u003c/p>\n\u003cp>\u003cstrong>Kaiser Health Plans Noted\u003c/strong>\u003c/p>\n\u003cp>Specifically, the researchers pointed to Kaiser health plans as being successful in eliminating disparities.\u003c/p>\n\u003cp>\"Our findings in the West of nearly identical control of three major risk factors among black Medicare enrollees and white Medicare enrollees in Kaiser health plans and control of [blood sugar] in other health plans show the potential to achieve equity in these key health outcomes,\" the researchers wrote. Kaiser includes \"nearly half\" of Medicare HMO enrollees in the western region of the U.S., Ayanian said.\u003c/p>\n\u003cp>Kaiser representatives said they did not have any advance knowledge of the publication of the study. Dr. Joseph Young who leads Northern California Kaiser's clinical hypertension program said that Kaiser adopted a \"population management approach to managing chronic conditions\" in 2006. He said that Kaiser has created registries for people with various kinds of conditions, so that patients who might be missing preventive care or better management of disease can be easily identified.\u003c/p>\n\u003cp>In the area of blood pressure control specifically, Kaiser changed its drug formulary to allow a \"combined pill\" -- a single pill that includes two drugs, to make medication adherence easier for patients.\u003c/p>\n\u003cp>These population-based strategies across the board resulted in big improvements in overall outcome for Kaiser patients. Young said that during the 2000s, \"very serious heart attacks ... fell by 62 percent, and our stroke mortality fell by 42 percent.\" Kaiser does have some remaining racial disparities in its non-Medicare population, and Young said they are \"actively focusing\" on closing those remaining gaps.\u003c/p>\n\u003cp>Dr. Anthony Iton leads the Healthy Communities initiative at the California Endowment. He's also past director of the Alameda County Public Health Department. In both roles, he has championed fighting disparities in health care. He called the study \"very hopeful\" and believes that Kaiser's approaches are replicable elsewhere. \"We want clinicians to do what Kaiser is doing and take seriously to provide high quality race-blind clinical care. Kaiser is showing it can be done.\"\u003c/p>\n\u003cp>\"Any other system that says it's not doable has to explain how they can justify not providing the same high-quality care to everyone that comes in the door,\" Iton said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Iton observed that California probably has \"less of a socioeconomic spread between whites and blacks than you do in the Southeastern United States. Those are quite disparate populations. ... It's a heavier lift in the Southeast than in the West, but despite that it's clearly doable.\"\u003c/p>\n\n","blocks":[],"excerpt":"National study points to the success of Kaiser health plans in ending disparities among older members.","status":"publish","parent":0,"modified":1419028594,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://w.soundcloud.com/player/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":820},"headData":{"title":"Study: Western States Eliminate Race Gap on Key Health Measures | KQED","description":"National study points to the success of Kaiser health plans in ending disparities among older members.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"23009 http://blogs.kqed.org/stateofhealth/?p=23009","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/","disqusTitle":"Study: Western States Eliminate Race Gap on Key Health Measures","path":"/stateofhealth/23009/study-west-eliminates-race-gap-on-key-health-measures-disparities","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_23040\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-e1418800457273.jpg\">\u003cimg class=\"size-large wp-image-23040\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000001039817_Large-640x425.jpg\" alt=\"Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Researchers looked at how effectively patients had their blood pressure, blood sugar and cholesterol controlled. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A major new study looking at health disparities across the U.S. finds that significant gaps in managing heart disease and diabetes persist -- except in Western states, where the gap has been eliminated.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'It's possible to eliminate deeply ingrained racial disparities.' \u003c/aside>\n\u003cp>Researchers at the University of Michigan and Harvard University \u003ca title=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">looked at 100,000 Medicare patients\u003c/a> who were enrolled in HMOs, called \"Medicare Advantage\" plans, from 2006 to 2011. While management of blood pressure, cholesterol and blood sugar improved overall, blacks \"substantially\" trailed whites everywhere except\u003ca title=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" href=\"https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf\" target=\"_blank\"> the Western U.S\u003c/a>., an area from the Rocky Mountains to the Pacific, as well as Alaska and Hawaii.\u003c/p>\n\u003cp>\"We were certainly hoping we would see indications of progress in eliminating disparities in the country as a whole,\" said lead author Dr. John Ayanian, who heads the Institute for Healthcare Policy and Innovation at the University of Michigan. He said that while it was \"disappointing\" that disparities persisted, \"it's also heartening to see that ... in the West, the disparities had been eliminated, and that was both surprising and encouraging.\"\u003c!--more-->\u003c/p>\n\u003cp>The \u003ca title=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" href=\"/www.nejm.org/doi/full/10.1056/NEJMsa1407273\" target=\"_blank\">study was published\u003c/a> in the New England Journal of Medicine and was funded by a grant from the National Institute on Aging.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/182310570&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Disparities in health care have long been noted in the American system. The researchers wrote that, in 2008, \"life expectancy was 5.4 years shorter for black men and 3.7 years shorter for black women than for white men and white women.\" Heart disease and diabetes -- diseases that can be better managed by controlling blood pressure, cholesterol and blood sugar, the risk factors measured in the study -- accounted for 38 percent of the gap in mortality between black and white men, and 54 percent of the gap among women, the researchers said. That's why closing the racial gap on these measures is so critical.\u003c/p>\n\u003cp>\"It's one of the first large studies to show that it's possible to eliminate deeply ingrained racial disparities in important risk factors,\" Ayanian said. He said that outcomes for Hispanics, Asians and Pacific Islanders were \"also encouraging.\" Hispanics were 1 to 3 percent less likely than whites to have blood pressure, cholesterol or blood sugar under control. Asians and Pacific Islanders were more likely than whites to have good control of blood pressure and cholesterol. Blood sugar control was about the same.\u003c/p>\n\u003cp>\u003cstrong>Kaiser Health Plans Noted\u003c/strong>\u003c/p>\n\u003cp>Specifically, the researchers pointed to Kaiser health plans as being successful in eliminating disparities.\u003c/p>\n\u003cp>\"Our findings in the West of nearly identical control of three major risk factors among black Medicare enrollees and white Medicare enrollees in Kaiser health plans and control of [blood sugar] in other health plans show the potential to achieve equity in these key health outcomes,\" the researchers wrote. Kaiser includes \"nearly half\" of Medicare HMO enrollees in the western region of the U.S., Ayanian said.\u003c/p>\n\u003cp>Kaiser representatives said they did not have any advance knowledge of the publication of the study. Dr. Joseph Young who leads Northern California Kaiser's clinical hypertension program said that Kaiser adopted a \"population management approach to managing chronic conditions\" in 2006. He said that Kaiser has created registries for people with various kinds of conditions, so that patients who might be missing preventive care or better management of disease can be easily identified.\u003c/p>\n\u003cp>In the area of blood pressure control specifically, Kaiser changed its drug formulary to allow a \"combined pill\" -- a single pill that includes two drugs, to make medication adherence easier for patients.\u003c/p>\n\u003cp>These population-based strategies across the board resulted in big improvements in overall outcome for Kaiser patients. Young said that during the 2000s, \"very serious heart attacks ... fell by 62 percent, and our stroke mortality fell by 42 percent.\" Kaiser does have some remaining racial disparities in its non-Medicare population, and Young said they are \"actively focusing\" on closing those remaining gaps.\u003c/p>\n\u003cp>Dr. Anthony Iton leads the Healthy Communities initiative at the California Endowment. He's also past director of the Alameda County Public Health Department. In both roles, he has championed fighting disparities in health care. He called the study \"very hopeful\" and believes that Kaiser's approaches are replicable elsewhere. \"We want clinicians to do what Kaiser is doing and take seriously to provide high quality race-blind clinical care. Kaiser is showing it can be done.\"\u003c/p>\n\u003cp>\"Any other system that says it's not doable has to explain how they can justify not providing the same high-quality care to everyone that comes in the door,\" Iton said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Still, Iton observed that California probably has \"less of a socioeconomic spread between whites and blacks than you do in the Southeastern United States. Those are quite disparate populations. ... It's a heavier lift in the Southeast than in the West, but despite that it's clearly doable.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/23009/study-west-eliminates-race-gap-on-key-health-measures-disparities","authors":["240"],"categories":["stateofhealth_11","stateofhealth_13"],"tags":["stateofhealth_249","stateofhealth_803"],"featImg":"stateofhealth_23040","label":"stateofhealth"},"stateofhealth_22634":{"type":"posts","id":"stateofhealth_22634","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22634","score":null,"sort":[1416497450000]},"guestAuthors":[],"slug":"kaiser-mental-health-clinicians-considering-strike","title":"Kaiser Mental Health Clinicians Authorize Strike","publishDate":1416497450,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_20235\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-e1414092083605.jpg\">\u003cimg class=\"size-large wp-image-20235\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-640x480.jpg\" alt=\"Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A union of 2,500 mental health clinicians at Kaiser have voted to authorize a strike, just one week after Kaiser's nurses\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/11/17/nurses-to-resume-negotiations-with-kaiser-after-strike/\" href=\"http://ww2.kqed.org/stateofhealth/2014/11/17/nurses-to-resume-negotiations-with-kaiser-after-strike/\" target=\"_blank\"> went on strike for two days\u003c/a>.\u003c/p>\n\u003cp>In September, Kaiser agreed to pay a \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">$4-million fine levied by state regulators\u003c/a>. The Department of Managed Health Care found patients were subject to \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">excessively long wait times \u003c/a>to get a therapy appointment, or were shuttled into groups when they wanted individual therapy.\u003c/p>\n\u003cp>Psychiatric social worker Clement Papazian says various fixes, like after-hours appointments, still aren't meeting demand.\u003c!--more-->\u003c/p>\n\u003cp>\"Kaiser has attempted to make some changes, but they're woefully inadequate in really addressing the full nature of the problem,\" he says. \"Our mental health workers are really fed up.\"\u003c/p>\n\u003cp>These complaints are part of a long, drawn-out contract negotiation between Kaiser and its psychologists and therapists. Bargaining has been dragging on for four years with no settlement. And the small, scrappy National Union of Healthcare Workers is eager to make a name for itself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Union president Sal Rosselli says the threat of a statewide strike will strengthen the union's position when they return to the table next month.\u003c/p>\n\u003cp>\"We've had it,\" Rosselli said. \"We're drawing a line in the sand. And we'll be presenting Kaiser with a final offer to resolve this crisis.\"\u003c/p>\n\u003cp>In a statement, Kaiser was critical of the union's strike vote:\u003c/p>\n\u003cblockquote>\u003cp>“After a long hiatus, NUHW has now approached Kaiser Permanente to resume bargaining in Northern California. But for the union to threaten a strike before we even meet, and to resort to clichéd bargaining tactics, makes us concerned about the union’s intentions. We hope the union will join us in seeking solutions to the challenges we face. But whichever way the union chooses to go, we are going to continue to work hard on our own to make progress.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Kaiser says the union has resisted several of its proposals, like sending some patients to non-Kaiser therapists for treatment. It says increasing access to mental health care is a challenge faced by the entire health care industry, and Kaiser is working hard to make improvements.\u003c/p>\n\n","blocks":[],"excerpt":"The union will release results of a strike authorization vote later on Thursday.","status":"publish","parent":0,"modified":1416592685,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":380},"headData":{"title":"Kaiser Mental Health Clinicians Authorize Strike | KQED","description":"The union will release results of a strike authorization vote later on Thursday.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"22634 http://blogs.kqed.org/stateofhealth/?p=22634","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/11/20/kaiser-mental-health-clinicians-considering-strike/","disqusTitle":"Kaiser Mental Health Clinicians Authorize Strike","path":"/stateofhealth/22634/kaiser-mental-health-clinicians-considering-strike","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20235\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-e1414092083605.jpg\">\u003cimg class=\"size-large wp-image-20235\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/photo-3-640x480.jpg\" alt=\"Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED) \u003ccite>(Lisa Aliferis/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A union of 2,500 mental health clinicians at Kaiser have voted to authorize a strike, just one week after Kaiser's nurses\u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/11/17/nurses-to-resume-negotiations-with-kaiser-after-strike/\" href=\"http://ww2.kqed.org/stateofhealth/2014/11/17/nurses-to-resume-negotiations-with-kaiser-after-strike/\" target=\"_blank\"> went on strike for two days\u003c/a>.\u003c/p>\n\u003cp>In September, Kaiser agreed to pay a \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" href=\"http://ww2.kqed.org/stateofhealth/2014/09/09/kaiser-agrees-to-pay-4-million-fine-over-mental-health-care-drops-lawsuit/\" target=\"_blank\">$4-million fine levied by state regulators\u003c/a>. The Department of Managed Health Care found patients were subject to \u003ca title=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" href=\"http://ww2.kqed.org/stateofhealth/2014/07/17/therapists-patients-criticize-kaiser-over-long-delays-for-therapy/\" target=\"_blank\">excessively long wait times \u003c/a>to get a therapy appointment, or were shuttled into groups when they wanted individual therapy.\u003c/p>\n\u003cp>Psychiatric social worker Clement Papazian says various fixes, like after-hours appointments, still aren't meeting demand.\u003c!--more-->\u003c/p>\n\u003cp>\"Kaiser has attempted to make some changes, but they're woefully inadequate in really addressing the full nature of the problem,\" he says. \"Our mental health workers are really fed up.\"\u003c/p>\n\u003cp>These complaints are part of a long, drawn-out contract negotiation between Kaiser and its psychologists and therapists. Bargaining has been dragging on for four years with no settlement. And the small, scrappy National Union of Healthcare Workers is eager to make a name for itself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Union president Sal Rosselli says the threat of a statewide strike will strengthen the union's position when they return to the table next month.\u003c/p>\n\u003cp>\"We've had it,\" Rosselli said. \"We're drawing a line in the sand. And we'll be presenting Kaiser with a final offer to resolve this crisis.\"\u003c/p>\n\u003cp>In a statement, Kaiser was critical of the union's strike vote:\u003c/p>\n\u003cblockquote>\u003cp>“After a long hiatus, NUHW has now approached Kaiser Permanente to resume bargaining in Northern California. But for the union to threaten a strike before we even meet, and to resort to clichéd bargaining tactics, makes us concerned about the union’s intentions. We hope the union will join us in seeking solutions to the challenges we face. But whichever way the union chooses to go, we are going to continue to work hard on our own to make progress.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Kaiser says the union has resisted several of its proposals, like sending some patients to non-Kaiser therapists for treatment. It says increasing access to mental health care is a challenge faced by the entire health care industry, and Kaiser is working hard to make improvements.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22634/kaiser-mental-health-clinicians-considering-strike","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_803"],"featImg":"stateofhealth_20235","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2023/08/possible-5gxfizEbKOJ-pbF5ASgxrs_.1400x1400.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/10/ATC_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/powerpress/1440_0018_AmericanSuburb_iTunesTile_01.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/powerpress/1440_0017_BayCurious_iTunesTile_01.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/BBC_1400.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2021/12/CodeSwitchLifeKit_StationGraphics_300x300EmailGraphic.png","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.","airtime":"SAT 4pm-5pm","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png","officialWebsiteLink":"https://www.revealnews.org/episodes/","meta":{"site":"news","source":"npr"},"link":"/radio/program/reveal","subscribe":{"apple":"https://itunes.apple.com/us/podcast/reveal/id886009669","tuneIn":"https://tunein.com/radio/Reveal-p679597/","rss":"http://feeds.revealradio.org/revealpodcast"}},"says-you":{"id":"says-you","title":"Says You!","info":"Public radio's game show of bluff and bluster, words and whimsy. 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