What I’ve witnessed inside our clinics doesn’t always match that founding purpose. Money meant to support patients doesn’t always make it to the front lines, and the people who pay the price are the patients themselves.

I see it constantly. Families wait months just to get an appointment. Others can’t keep up with the cost of their prescriptions, or they abandon treatment altogether after an insurance change pushes the price out of reach.

That’s why, as someone who works in this system every day, I’m supporting Proposition 44 this fall — the Clinic Funding Accountability and Transparency Act. The measure would require community clinics to direct at least 90% of their revenue toward patient care and the services that support it, while publicly disclosing how the rest of their money is spent. Under the proposal, no more than 10% of clinic revenue could go toward executive salaries, administrative costs and overhead.

This isn’t about restricting care. It’s about accountability — making sure clinics that receive public healthcare dollars are transparent about where that money actually goes, and ensuring patients and taxpayers can see it for themselves.

Prop. 44 doesn’t cut what clinics can spend on care. It does the opposite: it protects that spending. Patients walk through our doors because they trust that we’ll have what we need to treat them properly. We owe them the staffing, equipment and resources to make that trust worth something.

That obligation becomes especially critical in emergencies. I’ve stood in a room where a patient’s heart had stopped and staff scrambled to locate a working defibrillator. In situations like that, seconds decide outcomes. No patient’s life should hinge on whether working equipment can be found fast enough.

Community clinics statewide receive billions of dollars annually to serve some of the most vulnerable Californians. Yet some spend as little as half of that funding on direct patient care, while a significant share goes toward high executive salaries and expenses unrelated to the person sitting in the exam room.

When I think about moments like the one with that defibrillator, that’s exactly the kind of funding gap that comes to mind.

The stakes are only growing. California could lose as much as $30 billion annually in healthcare funding because of federal cuts moving through Congress. Clinics are already shutting their doors across the state, and more than a million Californians are at risk of losing coverage. In this climate, every dollar clinics receive needs to reach the patients who depend on them.

This issue is personal for me. My sister has cerebral palsy, and because my mother didn’t speak English, I was interpreting for my family by the time I was six years old, just so my sister could get proper medical care. For families like mine, interpretation and language access aren’t optional extras — they’re essential to getting treated at all. Prop. 44 would help safeguard funding for those exact kinds of services.

This measure wouldn’t take a single dollar away from community clinics. It would simply ensure the money already flowing into these clinics ends up where it’s supposed to: with patients. At a time when California’s healthcare system is under so much strain, that kind of accountability matters more than ever.

I hope the people leading our clinics remember why they got into this work to begin with. Healthcare was never supposed to be about inflated executive pay or shiny new facilities. It’s about the person sitting across from us, trusting that we’ll show up for them when it counts.

That’s the standard our community clinics should be held to — and it’s the standard every patient in California deserves.

Original source: CalMatters

The post Proposition 44 Aims to Keep Patient Care Ahead of Executive Pay at California Community Clinics appeared first on The Hemet & San Jacinto Chronicle.

The complaint, filed with state regulators by the National Union of Healthcare Workers, targets Kaiser’s online e-visit screening tool, which patients use when they believe they’re dealing with anxiety or depression. Patients answer a series of multiple-choice questions, and the system then generates care recommendations and referral pathways “automatically and instantly” based on those answers, according to the filing.

Those recommendations don’t necessarily lead to a session with an in-person therapist. The complaint states that patients may instead be directed toward virtual therapy, health education classes or self-guided wellness apps.

The union represents therapists, social workers and other clinicians employed at Kaiser facilities. The state’s Department of Managed Health Care says this marks the first time a union has filed a grievance against a health plan specifically over the alleged use of algorithms and artificial intelligence in mental health treatment decisions.

Union members say they have seen no proof that licensed mental health professionals review patients’ e-visit answers in real time — or at all — before the tool spits out follow-up care recommendations. At a hearing held last week by the San Francisco Board of Supervisors examining the issue, therapists and social workers testified that automated digital screenings cannot substitute for a trained clinician’s judgment.

“AI and algorithms don’t capture what trained humans can,” said Ilana Marcucci-Morris, a therapist and member of the union’s bargaining committee. She noted that people experiencing depression often downplay their symptoms, meaning a tool relying solely on self-reported answers could miss warning signs of a more serious condition.

Kaiser did not send a representative to last week’s hearing. But in a written statement emailed to CalMatters, the company pushed back on the union’s characterization of its mental health processes.

The e-visit tool “does not use artificial intelligence to diagnose patients, make clinical decisions, or determine medical necessity. Clinical decisions remain the responsibility of licensed health care professionals,” said Kaiser spokesperson Lena Howland. She did not provide additional details about the technology powering the tool.

Howland added that patients can still reach a live person by calling a phone number provided during the e-visit process. “The online assessment tool is an additional pathway to care, not the only one,” she said.

In a blog post published last year, Kaiser described the e-visit tool as increasingly popular, particularly among younger members, and said it’s available for roughly 30 different health concerns. The post stated that patient responses “are reviewed by a health care professional” and that members “receive a response by secure message within 4 hours, and often sooner.”

Union leaders counter that care recommendations often arrive almost instantly after a patient completes the questionnaire — far too quickly, they argue, for any clinician to have actually reviewed the responses.

The union contends Kaiser’s screening practice violates state law, which requires that medical decisions be made by a licensed health care professional and bars “artificial intelligence, algorithms or other software tools” from replacing that judgment.

The Department of Managed Health Care confirmed it received the union’s complaint and is looking into the matter. “Details of ongoing investigations are confidential, pursuant to law and to protect the integrity of the investigation,” the department said in a statement.

A Shift in Mental Health Triage

The complaint arrives amid stalled contract negotiations between the union and Kaiser Northern California, which have dragged on for more than a year without resolution.

Therapists and health workers who spoke at last week’s hearing said a new triage system, which includes the e-visit tool, was rolled out in 2023. Before that, Kaiser relied on specialized triage teams made up of licensed clinicians — professionals trained to pick up on cues like tone of voice — who gathered patient history over the phone, screened for self-harm risk, and offered preliminary diagnoses along with next steps for care.

Now, the union says, much of that case evaluation work has shifted to administrative staff or the digital tool itself. The union filed a separate complaint last year alleging that Kaiser was using call-center representatives, rather than clinicians, to field mental health-related calls.

Marcucci-Morris said she often doesn’t see patients until roughly two weeks after they’ve gone through Kaiser’s new screening system. “The severity and critical nature of the symptoms I’m seeing have increased significantly because the app, the AI, an algorithm or an unlicensed phone operator wrongly determined they could wait 10 days to see me,” she said.

San Francisco Supervisor Chyanne Chen said she called last week’s hearing after hearing concerns from constituents — both Kaiser employees and patients — about the health system’s mental health services. Kaiser provides coverage to roughly a third of San Francisco’s population.

Chen called Kaiser’s absence from the hearing “unacceptable,” saying it left many of her questions unanswered.

“As a San Francisco resident, I’m not against technology,” Chen said. “For me, this is about making sure we’re not compromising the quality of our care and safety.”

Kaiser’s Troubled Mental Health Record

This isn’t the first time Kaiser has skipped a hearing focused on its mental health services. Last year, state lawmakers criticized the health plan after it declined to participate in an informational hearing on its behavioral health programs.

Kaiser’s mental health struggles are well documented. In 2023, the company agreed to pay a $50 million fine and invest $150 million to improve its programs, settling state findings that mental health patients faced serious delays in care. In 2021, California regulators noted a rise in mental health-related complaints, prompting a survey that ultimately led to that settlement. Kaiser currently operates under a corrective action plan and must submit quarterly progress reports to the state.

Back in 2014, state regulators fined Kaiser $4 million over lengthy waits between therapy appointments. Kaiser has largely attributed its past troubles to a shortage of mental health professionals statewide.

The health plan is also facing growing scrutiny over its expanding use of artificial intelligence and digital tools across its broader operations.

Kaiser’s own mental health clinicians have pushed back against transcription tools used to record patient appointments, arguing the company hasn’t disclosed how that data is used or shared. Separately, call-center nurses have raised concerns about Kaiser’s use of AI and software to monitor their calls.

This coverage is supported by the California Health Care Foundation, which works to ensure people have access to the health care they need, when they need it, at a price they can afford.

Original source: CalMatters

The post Union Alleges Kaiser Used Algorithm, Not Doctors, to Evaluate Mental Health Patients appeared first on The Hemet & San Jacinto Chronicle.

The National Union of Healthcare Workers filed the complaint with the state Department of Managed Health Care, taking aim at Kaiser’s e-visit screening system used for patients who suspect they may be dealing with anxiety or depression. Under the process, patients fill out a multiple-choice questionnaire, and the system immediately spits out care recommendations, according to the complaint. Those recommendations don’t necessarily mean a session with an in-person therapist — patients may instead be pointed toward virtual therapy, educational classes or self-help apps.

The Department of Managed Health Care, which regulates health plans statewide, said this marks the first time it has received a complaint from a union alleging misuse of algorithms or artificial intelligence in behavioral health services.

Union members say they’ve seen no proof that a licensed clinician reviews patients’ responses before the system generates its recommendations. At a San Francisco Board of Supervisors hearing last week, therapists and social workers testified that automated screenings simply can’t substitute for a trained professional’s judgment.

“Artificial intelligence and algorithms don’t capture what trained humans can,” said Ilana Marcucci-Morris, a therapist who sits on the union’s bargaining committee. She noted that people struggling with depression often downplay their symptoms, meaning a tool that relies purely on self-reported answers could easily overlook a more serious condition.

Kaiser did not send a representative to last week’s hearing. In a written statement to CalMatters, spokesperson Lena Howland disputed the union’s account of how the health system handles behavioral health screening.

The e-visit tool “does not use AI to diagnose patients, make clinical decisions, or determine medical necessity,” Howland said. “Clinical decisions remain with licensed healthcare professionals.” She declined to elaborate on the technology powering the tool.

Howland added that patients can still speak with a live person by calling a phone number provided during the e-visit process, describing the online tool as “an additional path to getting care — not the only path.”

A blog post Kaiser published last year touts the e-visit tool’s growing popularity, particularly among younger patients, noting it covers roughly 30 health concerns. The post states that patient responses “are reviewed by a health care professional” and that members typically get a reply within four hours.

Union representatives dispute that timeline, saying care recommendations often arrive almost instantly after a patient submits the questionnaire — too quickly, they argue, for any clinician to have reviewed the answers.

The union maintains Kaiser’s approach violates a state law requiring that medical decisions be made by licensed healthcare professionals and explicitly prohibiting “artificial intelligence, algorithms, or other software tools” from taking over that role.

The Department of Managed Health Care confirmed it received the complaint and is looking into it, though officials said details of the investigation remain confidential while it’s underway.

A change in how patients are triaged

The complaint arrives amid contract negotiations between the union and Kaiser Northern California that have stretched on for more than a year without resolution.

Workers who testified at last week’s hearing said the current system, including the e-visit tool, was rolled out in 2023. Previously, they said, dedicated triage teams of licensed clinicians took brief patient histories by phone, screened for signs of self-harm, and offered an initial diagnosis along with next steps — all while picking up on cues like tone of voice that a written questionnaire can’t capture.

Now, the union alleges, much of that triage work falls to clerical staff or the automated tool itself. The union filed a separate complaint last year claiming Kaiser was using telephone service representatives, rather than clinicians, to field mental health calls.

Marcucci-Morris said she often doesn’t see patients until roughly two weeks after they’ve been triaged under the new system. “The acuity and critical nature of symptoms I am seeing has increased significantly because the app, AI, an algorithm, or an unlicensed telephone operator incorrectly determined that they could wait 10 days to see me,” she said.

San Francisco Supervisor Chyanne Chen said she called last week’s hearing after hearing concerns from both Kaiser patients and employees in her district. Kaiser serves roughly a third of San Francisco’s population.

Chen called the company’s absence from the hearing “unacceptable,” saying it left many of her questions unanswered. “As a San Franciscan, I’m not against technology,” she said. “For me it’s making sure we’re not shortcutting our quality of care and safety.”

A pattern of scrutiny

This isn’t the first time Kaiser has declined to appear before lawmakers examining its mental health services. Last year, state legislators criticized the company after it skipped an informational hearing on the same topic.

Kaiser’s behavioral health track record has drawn scrutiny before. In 2023, the company agreed to pay a $50 million fine and invest $150 million toward improving its programs, settling state findings that behavioral health patients were facing serious delays in care. That settlement followed a 2021 spike in behavioral health complaints that prompted a state survey. Kaiser now operates under a corrective action plan and must submit quarterly progress updates to regulators.

Further back, in 2014, state regulators fined Kaiser $4 million over lengthy gaps between therapy appointments. Kaiser has largely blamed its past struggles on a broader shortage of mental health providers.

The company is also facing growing criticism over its use of artificial intelligence and digital tools more broadly. Kaiser’s own mental health staff have objected to transcription software that records patient sessions, arguing the company hasn’t been transparent about how that data is used or shared. Separately, call center nurses have raised alarms about Kaiser using AI-driven software to monitor their phone calls.

Original source: CalMatters

The post Union Alleges Kaiser Relied on Algorithm, Not Clinicians, to Screen Mental Health Patients appeared first on The Hemet & San Jacinto Chronicle.

Mental health workers represented by the National Union of Healthcare Workers prepared for the strike over the weekend after declining Kaiser’s terms on Friday.

Kaiser in a written statement said it is notifying patients whose appointments could be affected by the strike. “Patients will have the opportunity to be seen by another professional in our extensive network of highly qualified, licensed therapists, if their regular provider is engaged in a strike,” the statement read.

The previous strike in 2022 among mental health clinicians in Northern California lasted 10 weeks and led to a commitment from Kaiser to hire more therapists and to give employees specific work hours away from face-to-face patient care.

Southern California Kaiser workers now are asking for more time in between appointments to prepare for patients. They also want wage increase and a pension benefit that the company provides to its Northern California clinicians. 

“It’s pretty simple,” said psychological social worker William Johnson, a union steward who serves on the bargaining committee. “We’re looking for the same three top priorities that Kaiser already said ‘Yes’ to for our Northern California mental healthcare workers.”

Johnson said his current workload includes seeing 32 to 35 patients a week in one-hour sessions.

Kaiser released a statement in response to the union’s plans to strike, saying, “unfortunately this comes as no surprise, as this seems to have been their intention all along.”

The company has offered wage increases amounting to 18% over four years and a number of other perks, according to the statement. Kaiser representatives said they have invested more than a billion dollars expanding mental health capabilities in California and increased the number of  licensed mental health clinicians in Southern California by 30% over the past four years.

But union members say turnover has been a problem, with a quarter of therapists hired between January 2021 and August 2024 leaving their jobs. 

“Kaiser leadership has consistently been dismissive whenever we voice our concerns or experiences,” said Johnson. “They like to tell us things like, ‘We get that it’s not ideal,’ and they also add, ‘But it works for us.’”

Jared Garcia, another union steward on the bargaining committee, said he’s hoping the strike lasts less than a month, but he’s prepared to see it go on as long as it takes.

“Scabs aren’t going to work,” said Garcia. “Kaiser knows the limitations of finding mental health professionals – let alone to replace 2,400 of our union members at this time.”

A year ago, Kaiser entered into a $200 million settlement agreement with the state of California, agreeing to pay a $50 million fine and invest another $150 million over five years to address delays in behavioral health appointments.

The post Kaiser Permanente mental health workers begin open-ended strike in Southern California appeared first on The Hemet & San Jacinto Chronicle.