Kaiser Permanente Comments on the Department of Managed Health Care

Follow-Up Mental Health Survey

OAKLAND, Calif. (Feb. 24, 2015) Kaiser Permanente issued the following statement today,
in response to the follow-up survey on mental health care released by the Department of
Managed Health Care (DMHC):
We are proud of the progress we have made to improve access to mental health care. The
DMHCs 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.
We are pleased the DMHC has deemed two of its prior findings corrected. Our very concrete
efforts to improve monitoring of access, and improve access itself through traditional and
innovative means, are recognized by the DMHC throughout its findings. Examples include:

The survey highlights our extensive measures to track, report, and monitor appointment
wait times, and then take prompt action when needed. The department found that our
teams are carefully and closely monitoring access issues, and reacting quickly in
situations where issues arise within a medical clinic or department.
The report confirms that we have created and put in place a robust reporting measure
that appropriately measures compliance with wait time standards. No other health plan
in California has anything like this in place.
The department also calls out the steps we have taken to increase access to individual
therapy appointments, including hiring hundreds of additional providers, increasing clinic
hours, beginning video and telephone appointments, and being flexible in moving
physicians from one medical center to another when needed, among other steps.

We are pleased that the department acknowledges the significant improvements that Kaiser
Permanente has made in providing and monitoring access to mental health care.

The statistics on initial appointment access show very strong performance in

appointments booked within the regulatory time frames. Northern Californias
performance was at 91% and Southern Californias performance was at 96%.
The department reviewed follow-up appointments as well. While there are no identical
time frames in the law for follow-up appointments (they are based on the individual
needs of each patient, using the clinical judgment of the treating provider working in
concert with the patient), the DMHC elected to apply the regulatory standard for initial
appointment timeframes to follow-up visits. Even under this different application of the
regulatory standard, the overall statistics for follow-up visit access show performance of
82% timely access in Northern California and performance of 93% timely access in
Southern California.

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We are committed to continuing to improve. We acknowledge there are still some areas where
we need to continue making progress, and do better for our patients. Those include:

While the report acknowledges that Kaiser Permanente took significant steps to track
and address timely access challenges, 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. We are committed to making sure our patients have
access to the mental health care they need, when and where they need it.
We agree that we need to do more to improve the clarity and accuracy of the information
in our files. While a deeper review of some of the cases in the report reveals greater
context and better outcomes than indicated, that is not always easy to determine, and
would be improved with better information included in patient records.
We also agree that it is unacceptable for anyone at Kaiser Permanente to provide
erroneous information to our members and patients about access to mental health care.
We have already addressed the specific cases included in this report. We determined
that these cases were isolated examples and not representative of the information we
regularly give our members and patients. We are nonetheless engaging in broad
additional training and education for our physicians and staff.

We need the union representing mental health care providers to work with us. The report
acknowledges that we have openly discussed the significant challenges we have encountered
with the National Union of Healthcare Workers, the union which represents our therapists. The
department acknowledged that at times we have faced significant delays in taking action,
because of the need to engage in bargaining with the union over improvements, like engaging
high quality community providers to help meet our patients mental health care needs. We need
union leadership to work constructively together with us to remove obstacles and solve
problems more quickly, including making the best use of our partnership with high-quality
community providers when we need those providers to help us meet our patients immediate
needs. We are committed to continue working to resolve our labor issues. While we have made
significant progress in mental health access despite the unions disagreements, we need to
work together to continue making improvements. Together, we can solve these problems on
behalf of our patients, and the broader mental health community.
We are working to advance mental health care for all. We are on a continuing path of
improvement, and we will not stop at good enough. Kaiser Permanente is building a 21st
century model of care for mental health care that will be based on evidence of what works,
measurable outcomes and integration of emerging technologies all necessary parts of an
improved way of treating mental health needs. We remain dedicated to continuing to deliver the
highest quality mental health care, and are always striving to improve.
The challenges we face are not unique to Kaiser Permanente. We are the largest mental health
provider in California. We acutely feel the challenges that all of us face in the mental health
treatment community. That also means we are in a position to lead, and that is what we are
undertaking now. With our commitment to continuously improve, we will share what we learn to
benefit the entire community.
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