How a large health organization addresses high demand

In California, the National Union of Healthcare Workers has outspokenly complained about the largest integrated health system in the state, Kaiser Permanente (KP), saying it fails to adequately staff mental-health departments, which forces patients to wait weeks or months for appointments. The union also says in written materials that too many patients are driven to group therapy rather than individual treatment.

Union officials have been voicing concerns for years, and members threatened to go on strike in December. The demand for behavioral health services nationwide is only increasing, and the delivery system must find solutions to meet the needs of patients. One of the biggest hurdles can be the work force shortage.

According to John Nelson, spokesperson for Kaiser Foundation Health Plan, there are 2,000 psychologists on staff in California. He tells Behavioral Healthcare that the health workers in Southern California have agreed to a process that allows patients in the KP system to access out-of-network community providers when demand is high. However, he says, Northern California workers have not agreed to a similar arrangement.

“The bottom line is that there is shortage of skilled, qualified therapists and psychologists and other clinical practitioners in the mental health field,” he says.  “I don’t know that it’s more acute in California, but it’s certainly an issue here.”

Nelson says, being both a health plan with 9.5 million members and a provider of physical and behavioral care, KP must hire enough providers to care for its own covered members in the health plan. When there’s a shortage of qualified candidates, the process can be a challenge from the start. It can take six months from the time a position is open to the time a new KP clinician is onboard.

Even so, Nelson says, from 2011 to early 2014, KP has increased the number of therapists by 273 in California, from 1,105 in 2011 to 1,378 in early 2014, for a 25 percent increase. Comparatively, California health-plan membership grew by 8 percent. 

“We think we’ve actually made good progress, and we are hopeful that the professionals would join us in trying to make more progress,” he says. “Unfortunately the union’s position is around try to put pressure on us by criticizing and not being instructive and helpful.”

Appointment window
California is known for its high penetration of managed care, and the state governing body monitors consumer protections such as network adequacy and timeliness of appointments. The state also enacted the nation’s first set of regulations in 2011 to reduce waiting times for patient access to treatment, which includes behavioral healthcare.

“For initial non-urgent mental health appointments, a patient must be scheduled within 10 working days or 15 calendar days from the official day that the patient seeks a medical appointment,” Nelson says.

He also says that the union’s claim that people are forced into group treatment isn’t true because data shows that 70 percent of KP’s mental-health appointments are individual, one-on-one therapy services—not group. What’s more, he says, group therapy is effective for certain patients and shouldn’t be discounted as inferior.

The bottom line, according to Nelson, is that the union is not trying to work cooperatively on solutions. The onus is on providers to go to their managers to discuss options for scheduling appointments when they’re getting booked up and patients might not receive care within the 15-day standard. Bargaining tactics aren’t the answer, he says.

California regulations state the following time limits for access to care:

• Urgent care appointments—within 48 hours if the service does not need to be pre-authorized or within 96 hours if the service requires preauthorization by the plan.

• Appointments with psychiatrists—within 15 business days of patient request.

• Appointments with other licensed mental health professionals—within 10 business days of patient’s request for an appointment.

• Speaking to a health plan representative to get an appointment—no more than 10 minutes, during normal business hours.

• Receiving a call back from a mental health professional—If patients are unable to directly reach their mental health professional, the law requires a live operator or recorded message to communicate how long it will take to get back to the patient.

• Triage and screening—Health plans are required to provide 24/7 triage or screening services to patients by phone. Waiting times for triage or screening services may not exceed 30 minutes. However, the waiting time must be appropriate for the problem and if that problem is urgent, a plan’s screening and triage must respond more quickly.