Kaiser Permanente may lose accreditation due to dangerously long wait times for patients seeking treatment at the HMO’s clinics in Hawai’i

Kaiser is the only health care provider in Hawai’i currently placed under corrective action by the accreditor for all U.S. health insurers. 

State regulators have so far failed to challenge Kaiser’s record of denying mental health service to Hawai’i residents. The HMO insures 266,000 people in the state.

News Release from National Union of Healthcare Workers, July 18, 2022 

HONOLULU – Citing “shortcomings in its behavioral health services,” the National Committee for Quality Assurance (NCQA), which accredits all health insurers in the United States, has called for “corrective action” at Kaiser Permanente’s mental health clinics in Hawai’i. The accreditation agency launched an investigation after a complaint from mental health therapists employed by the health provider revealed dangerously long wait times for therapy appointments. The NCQA investigation was first reported by the Honolulu Star-Advertiser.

“It appears that Kaiser is finally facing some consequences for years of denying Hawai’i residents adequate access to behavioral health care,” said Andrea Kumura, a licensed clinical social worker at Kaiser Permanente Waipio Medical Office. “But to really hold Kaiser accountable, we also need our state regulators to investigate Kaiser and demand that it end long waits for therapy appointments in the islands and provide parity with other health services.”

As part of its investigation the NCQA interviewed therapists employed by Kaiser in Hawai’i and reviewed internal records showing that Kaiser’s members across the state are forced to wait months between mental health therapy appointments in violation of national standards. 

As of June 15, every health plan Kaiser offers, including Medicaid, Medicare, Commercial and Exchange, are now under corrective action. No other health insurer in Hawai’i is listed as being under corrective action.

The National Union of Healthcare Workers, which represents Kaiser mental health clinicians in Hawai’i, filed the complaint with NCQA in January. The complaint, utilizing Kaiser’s own records, found that:

• Due to understaffed clinics, Kaiser members frequently wait months for their first therapy session to treat conditions such as depression, PTSD, anxiety, panic attacks and eating disorders — wait times that vastly exceed clinical practice guidelines.
• Only 28 percent of Kaiser’s out-of-network mental health therapists are accepting new Kaiser members for care. Kaiser contracts with these therapists to augment the care provided by its directly employed clinicians.
• Kaiser’s understaffed statewide mental health call center routinely forces patients to wait on hold for up to an hour before they can speak to a clinician and stunningly up to four weeks for a return call.
• Kaiser appears to be violating state laws requiring that it conduct performance reviews of its behavioral health services and that it provide members with out-of-network care when it doesn’t have a healthcare provider available.

The accreditation agency only puts insurers into corrective action if they fail to comply with a “must-pass” standard, which includes standards for mental health care.

However, the NCQA, which is funded by the health insurance industry, doesn’t disclose the findings of its investigations nor does it disclose the corrective action measures Kaiser must take to be in full compliance. 

Last November, before filing a complaint with the NCQA, NUHW filed a 57-page complaint with the Hawai’i Department of Commerce and Consumer Affairs detailing care denied to patients seeking mental health services at Kaiser’s clinics in Hawai’i. The state agency has so far declined to interview clinicians or take any transparent effort to investigate the complaint.

“It’s alarming that the accreditation agency, which is partially funded by Kaiser, wasted no time in interviewing therapists and taking action, but the taxpayer-funded state agency that has oversight over Kaiser has done nothing to protect Kaiser members in Hawai’i,” said NUHW President Sal Rosselli. “When NUHW raised similar concerns in California, the state’s Department of Managed Health Care, announced that it was launching a new investigation into Kaiser’s mental health services. In stark contrast, the Hawai’i Department of Commerce and Consumer Affairs won’t interview therapists about the challenges their patients are facing as they attempt to access care that they have paid for, included with their health insurance.”

Kaiser employs approximately 50 licensed clinical social workers, medical social workers, psychiatric nurses and chemical dependency counselors to care for 266,000 Kaiser members in Hawai’i. 

In May, Kaiser workers in Hawai’i, members of NUHW, held a three-day strike to demand a contract that would enable Kaiser to attract more mental health clinicians, but Kaiser is still proposing cuts to pension and healthcare benefits as well as offering smaller raises than it gave its other Hawai’i workers last year, raises that don’t keep pace with the growing rate of inflation.

###

The National Union of Healthcare Workers represents more than 16,000 healthcare workers in California and Hawaii, including 50 Kaiser mental health providers who provide treatment to 266,000 Kaiser enrollees at seven medical facilities and a call center on Oahu, Maui, and the Big Island.