Health

California joins a state trying to reduce mental health care wait times

When Greta Christina fell into deep depression five years ago, she called a therapist in San Francisco. She had a great connection with her provider when she needed treatment in the past. She was pleased to know that he is currently in the “network” with insurance companies. This means you don’t have to pay yourself to meet him anymore.

But her excitement was short-lived. Over time, the appointments with Christina’s therapist became every two weeks, every four weeks, every five or six.

“Telling a person with depression with a serious and chronic disability that the therapist can only see every 5-6 weeks sees a physiotherapist only every 5-6 weeks for a person with a broken leg. It’s like telling you that you can’t do it, “she said. “Not enough. Not close enough.”

And this summer, Christina was diagnosed with breast cancer. While her depression treatment stumbled, everything related to her cancer treatment (mammograms, biopsies, surgery appointments) happened immediately (like a “well-oiled machine”).

“It’s a hot mess,” she said. “I need to be treated — I have cancer! Still nothing has changed.”

A new law, signed by Governor Gavin Newsom in October, aims to resolve this issue for Californians. Senate Bill 221, which passed the state legislature with a nearly unanimous vote, requires state-wide health insurance companies to reduce mental health care wait times within 10 business days. Six other states, including Colorado, Maryland, and Texas, have similar legislation that limits waiting times.

Long waits for mental health treatment are a national problem, with patients waiting an average of 5-6 weeks of care at local clinics, Department of Veterans Affairs facilities, and private offices from Maryland to Los Angeles County. There is a report that. Across California, half of the residents surveyed by the California Health Care Foundation in late 2019 said it would take too long to meet a mental health care provider when needed.

According to a 2020 survey by the National Federation of Healthcare Professionals representing KP therapists, 87% of therapists say weekly appointments are not available to patients who need a weekly appointment, according to Kaiser Permanente, the state’s largest insurance company. increase. California Waiting Law.

Triage therapist Brandy Plumley says he “feels very unethical” about the typical two-month wait time seen at Kaiser Permanente’s Mental Health Clinic in Vallejo, eastern San Francisco. ..

She said she received multiple critical calls each day from patients who were assigned therapists but couldn’t meet them, and explained that the provider’s case load was “huge.”

“It’s a pain, and it eats me every day,” Plumley said. “All Kaiser simply needs to do is hire more clinicians.”

Kaiser Permanente says there aren’t enough therapists out there to hire. According to a statement by Yener Balan, vice president of behavioral health at insurance company North California, KP is an integrated system, a healthcare provider and insurance company under one umbrella, filling 300 jobs in clinical behavioral health. I’m having a hard time.

Hiring more clinicians wouldn’t solve the problem, Balan said. He suggested that maintaining one-on-one treatment for everyone who wants it in the future is not possible with the current system. Existing national care model. “

Kaiser Permanente has expressed concern about the waiting time bill when it is introduced. The California Health Insurance Association, an industry group representing insurance companies in the state, also opposed, saying that a shortage of therapists would make it extremely difficult to meet two-week obligations.

“The COVID-19 pandemic only exacerbated this labor shortage, and the demand for these services increased significantly,” California Health Planning Association lobbyist Jed Hampton testified at a spring state legislature hearing. Did.

Hampton referred to a study at the University of California, San Francisco, and predicted that by 2028 there would be nearly 30% fewer therapists than needed to meet demand.

“Simply put, mandating more frequent bookings without addressing the underlying labor shortage does not improve the quality of care,” said Hampton.

The lawmakers pushed back. Senator Scott Wiener (D-San Francisco), who drafted the bill, accused the insurance company of exaggerating the shortage. Senator Connie Leiva (D-Chino) said the care providers are there, but insurers are responsible for hiring them into the network by paying higher fees and reducing administrative burden.

If insurance companies want more young people to take up the mental health profession, they must improve their salaries and working conditions right now, state senator Richard Pan (D-Sacramento) said. Stated. (The 2016 KQED survey revealed multiple ways insurers can save money by artificially keeping their provider networks small.)

As bipartisan support for the bill grew in Sacramento, insurers withdrew formal opposition.

However, it is unclear whether other states have the political will or resources to legislate similar solutions, said Hemi Tewerson, managing director of the Independent National Health Policy Academy in Washington, DC, California. She said there weren’t enough therapists at any price in places like New Mexico, Montana, Wyoming, and parts of the South, where the company could be forced into employment.

“They don’t have a provider, so you can fine the insurance company as much as you like. In the short term, if they already exist, you can’t make up for those waits,” she said. rice field.

Ronnie Snowden, a professor of health policy and management at the University of California, Berkeley, said the new California law is a solid step towards improving access to mental health care and that the color community will benefit most. .. African-Americans, Asian-Americans, and Latino-Americans face the greatest barriers to caring, according to Snowden, and may drop out when people of color come in for treatment. Will be higher.

Keith Humphreys, a professor of psychiatry at Stanford University, said the new rules need to be monitored and enforced for them to work. Kaiser Permanente has a data system that can track the time between bookings, but other insurers have contracts with privately-owned therapists to manage their own caseloads and schedules.

“Who will track if people once seen are seen again after 10 days, when it’s hard enough to keep track of the number of providers we have and who they are looking at? He asked.

Such questions apply to state regulators, primarily the California Department of Health Care. The agency has fined insurance companies $ 6.9 million for violating state standards since 2013. This includes a $ 4 million fine for Kaiser Permanente for excessive mental health care waiting time. Previous state law stipulates that insurers must provide their first mental health care appointment within 10 days, and new law clarifies that the same should be done for follow-up appointments. ..

Greta Christina, who takes care of Kaiser Permanente’s facility, said she was anxious for the new law to begin working. It will come into effect on July 1, 2022. Christina considered paying at her own expense in the meantime to find a therapist that she could see more often. But in a cancer crisis, she said it would be difficult to start over with a new person. So she is waiting.

“Knowing that this bill is imminent has helped me cling,” she said.

This story is part of a partnership that includes: KQED, NPR and KHN.

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California joins a state trying to reduce mental health care wait times

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