Poor Kaiser!

Please forgive a brief interruption in my presentation of client and therapist stories…

As Kaiser Permanente and the National Union of Healthcare Workers square off for next week’s strike, I’ve been noticing subtle but significant shifts in Kaiser’s media strategy. For one thing, in articles from newspapers across California, one spokesperson seems to be doing all the talking: John Nelson, whose title is given as “Vice President of Government Relations.” This may have been his full title all along, but I don’t recall anything other than “a vice president” or “a senior vice president” attached to his press statements in the past. “Government Relations” suggests that he interfaces with the California Department of Managed Health Care (DMHC) and/or the federal Centers for Medicare and Medicaid. This further suggests that Kaiser is now defending its record of inadequate mental health services first and foremost to the government. The statements Mr. Nelson is making are actually a very poor defense of Kaiser’s track record. They can be challenged by the press with a minimal amount of research. Challenge they will. And apparently the government will be listening to how the Vice President of Government Relations rebuts.

This is significant because the DMHC has yet to release its follow-up report about Kaiser mental health services, the one in which they are expected to speak to the broader issue of continuity of care (treatment after the first visit). The report was originally promised in November 2014. When I wrote Rodger Butler, spokesperson for the DMHC, on December 2 he said he thought the target had always been November or December. When I wrote again on December 26 he replied “it will likely be in January, but things could change.” Perhaps they’re waiting to see how much impact the strike will have before enforcing a new set of conditions. The DMHC is, after all, under the leadershiip of the governor. And the governor must ration his policital clout.

In yesterday’s Santa Rosa Press Democrat, Mr. Nelson was quoted as saying Kaiser “’is not where we want to be’” in its provision of mental health services. According to an LA Daily report, he told reporters that they are “not where they want to be” because they are “’battling a nationwide shortage in behavioral health specialists.’” And in multiple papers he has been promoting the rest of Kaiser’s new story. Which is that Kaiser is already hiring way ahead of the growth of their membership, (for example, in 2014 “‘membership rose by 8%'” and Kaiser “‘hired 25% more staff than they had the year before'”). And that (and this is their old story) the strike is only about benefits.

I was particularly excited to hear a spokesperson acknowledge that services were “not where we want them to be.” This past September, when Kaiser pulled out of the court case challenging the DMHC’s $4 million fine, they posted on their new website (share.kaiserpermanente.org) that even though “we were not in violation with the timely access regulation” they were dropping the case to “forego the expense and distraction of litigation.” This was hardly an admission of guilt or even a taking of responsibility. And, yes, it would have been very expensive and distracting to develop a legal argument for the court along with a public relations campaign for future Kaiser members that could dispute the experience of hundreds of thousands of Kaiser customers and their therapists.

Instead, Kaiser continues to say that everyone in managed care is struggling the same way on the same boat, but that Kaiser is just the big fish being punished. This “poor Kaiser” part is not particularly new. But suggesting that there’s a national shortage of therapists, when there’s an excess of therapists in most major cities where Kaiser operates in California, is new, spurious, and a flat out bad career move. I’ll leave it to the union and the press to come up with the statistics to dispute Kaiser’s absurd claim of scarcity. It shouldn’t take long to Google the numbers of therapists in, e.g,, San Francisco, Oakland, Los Angeles, and San Diego, to name a few of the cities where clients wait at least four weeks between individual therapy appointments.

The applicant pool is shallow not because of a scarcity of therapists. I’ll remind my dear readers of the premise of this blog. I left Kaiser because I was unable to find a way to practice ethically within their system. I would have loved to stay and continue the good work I was doing, fairly compensated, with clients who needed my help. I left because Kaiser does not prioritize individual therapy, the heart of mental health treatment. And of the therapists I’ve met in the private practice world since I left, every last one has heard that Kaiser does not allow adequate individual time. Like me, they would love to work for an agency like Kaiser, one that provides excellent compensation, job security, and a steady flow of appropriate clients. But also like me, they will not trade quality client care for good money.

Lastly, I encourage the press to investigate the facts behind Nelson’s statistics about membership growth. Kaiser has increased the absolute number of therapists, true. Increased hiring started when they were fined by the DMHC and told to meet the letter of the law for initial access or get more fines. They’ve increased staff and are still unable to get clients to treatment in a timely fashion because they’re busy catching up with a decade of neglect. My conservative estimate is that they will have to double their staff to provide appropriate service. They need to restructure and reorganize, too. The Affordable Care Act changed Kaiser’s membership in ways that need more specialized staff, particularly case managers to work with the low income, severely mentally ill people now in the mix since MediCal expanded and since Kaiser took over their treatment from county care.

“Not where we want to be…” is a start. But where do you want to be, John Nelson? Of the deficits pointed out by therapists over the last four years, which are you planning to address? Timely access to a therapist for evaluation? Continuity of care with a primary therapist who can see clients as clinically appropriate?  Case management services for the seriously mentally ill clients who need them?  Crisis services and follow-up care?

You have over 2600 therapists willing to join you in the task of rehabilitating the system. If you want to get somewhere, you’re not alone. They do, too.