UNION RESCHEDULES KAISER PERMANENTE STRIKE POSTPONED AFTER CEO’S DEATH

https://www.healthleadersmedia.com/strategy/union-reschedules-kaiser-permanente-strike-postponed-after-ceos-death?spMailingID=16676008&spUserID=MTg2ODM1MDE3NTU1S0&spJobID=1780330838&spReportId=MTc4MDMzMDgzOAS2

The health system’s senior vice president of national labor relations said the conflict is resolvable, ‘and there is no reason to strike.’

A five-day strike that was postponed last month after the sudden death of Kaiser Permanente Chairman and CEO Bernard J. Tyson is back on the calendar.

Thousands of psychologists, therapists, psychiatric nurses, and other healthcare professionals plan to strike December 16–20 at more than 100 Kaiser Permanente facilities across California, the National Union of Healthcare Workers (NUHW) said Wednesday.

“Mental health has been underserved and overlooked by the Kaiser system for too long,” said Ken Rogers, PsyD, MEd, a Kaiser Permanente clinical psychologist who serves as a vice president on the NUHW executive board, in a statement released by the union.

“We’re ready to work with Kaiser to create a new model for mental health care that doesn’t force patients to wait two months for appointments and leave clinicians with unsustainable caseloads,” Rogers said. “But Kaiser needs to show that it’s committed to fixing its system and treating patients and caregivers fairly.”

The union accuses Kaiser Permanente of refusing to negotiate unless mental health clinicians agree to “significantly poorer retirement and health benefits” than those received by its more than 120,000 other California employees.

Dennis Dabney, senior vice president of national labor relations and the Office of Labor Management Partnership at the Kaiser Foundation Health Plan and Hospitals, said the parties have been working together with an external mediator in pursuit of a collective bargaining agreement. The union rejected a compromise solution proposed last week by the mediator, Dabney said.

“The only issues actively in negotiation in Northern California are related to wage increases and the amount of administrative time that therapists have beyond patient time,” Dabney said. “We believe these issues are resolvable and there is no reason to strike.”

The mediator’s recommendation includes about 3% in annual wage increases for therapists in Northern California for four years, plus a $2,600 retroactive bonus, Dabney said

“In Southern California, the primary contract concern relates to wage increases and retirement benefits,” Dabney said.

The mediator’s recommendation includes about 3% in annual wage increases for therapists in Southern California for four years, plus a $2,600 retroactive bonus, even though the organization’s therapists in Southern California “are paid nearly 35% above market,” Dabney said.

“Rather than calling for a strike, NUHW’s leadership should continue to engage with the mediator and Kaiser Permanente to resolve these issues,” Dabney said.

 

 

 

5 Things Consumers Want From Healthcare

https://www.managedhealthcareexecutive.com/news/5-things-consumers-want-healthcare?rememberme=1&elq_mid=9853&elq_cid=876742&GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F

Demanding

The healthcare system is not meeting the needs of the people who need it most, according to a new focus group study.

Based on nine focus groups of low-income consumers with complex health and social needs, “In Their Words: Consumers’ Vision for a Person-Centered Primary Care System, from the Center for Consumer Engagement In Health Innovation (the Center) at Community Catalyst, also reported:

Poll participants reported:

• The primary care system is not meeting the needs of the people who need it most because they do not have the ability to form meaningful primary care relationships and the system does not address the impact that problems like transportation, housing insecurity, mental health issues, and more have on their overall health. “Consumers expressed the desire for a primary care relationship that is not necessarily tied to a credential [e.g., an MD], but rather one that is rooted in empathy for the significant challenges and barriers this population faces in their day to day life,” says Ann Hwang, MD, director of the Center for Consumer Engagement in Health Innovation, a national, non-profit consumer health advocacy organization based in Boston. “These consumers don’t feel that doctors have the time to listen to them, that their stuck on a profit-driven treadmill, regardless of if the institution is for- or not-for-profit.”

• Unhappiness at a system they see as profit-driven.

• Strong desire for supportive services they do not get now, such as:

  • An ongoing relationship with a trusted provider;
  • Help navigating the complex health and social services system;
  • Providers with greater cultural sensitivity and empathy; and
  • A centralized place which would include mental healthcare and supportive services in addition to primary care (a “one-stop shop”).

“The healthcare system has been going through major changes that are too often designed without meaningful input from the very people it exists to serve,” Hwang says. “Because primary care is often the first point of entry for a consumer into the larger healthcare system, these focus groups were conducted to capture the perspective of consumers with complex health and social needs about what they need and want from their primary care relationship.”

This reflects the mission of the Center for Consumer Engagement in Health Innovation which is to bring the consumer experience to the forefront of health system transformation to deliver better care, better value, and better health for every community, particularly vulnerable and historically underserved populations, according to Hwang.

“The voices in this report belong to people with complex health and social needs—a group that tends to include some of the highest-need and highest-cost patients.,” she says. “As systems shift toward value-based payment and try to understand and address non-medical drivers of good health (i.e., social determinants of health), this kind of insight is critical to designing and delivering care that actually meets the needs of the people it serves.”

Based on the poll, there are five takeaways for healthcare executives, according to Hwang:

  1. Consumers want a long-term, trusting relationship with their primary care provider.
  2. Consumers value a coordinator or navigator who can help them manage their care, connect them to social services and advocate for them when needed.
  3. Consumers welcome a broader conversation with their primary care provider, not just focused on their medical treatment, but exploring the needs of the whole person.
  4. Consumers want a “one-stop shop” where they could receive a wide variety of services under one roof, including medical services, mental health treatment and counseling, and social services.
  5. Consumers hope for a provider who is culturally sensitive, able to relate to their life experience and struggle, and who uses language they can understand.

 

 

 

Bruising labor battles put Kaiser Permanente’s reputation on the line

Bruising labor battles put Kaiser Permanente’s reputation on the line

Image result for Bruising labor battles put Kaiser Permanente’s reputation on the line

The ongoing labor battles have undermined the health giant’s once-golden reputation as a model of cost-effective care that caters to satisfied patients — which it calls “members” — and is exposing it to new scrutiny from politicians and health policy analysts.

Kaiser Permanente, which just narrowly averted one massive strike, is facing another one Monday.

The ongoing labor battles have undermined the health giant’s once-golden reputation as a model of cost-effective care that caters to satisfied patients — which it calls “members” — and is exposing it to new scrutiny from politicians and health policy analysts.

As the labor disputes have played out loudly, ricocheting off the bargaining table and into the public realm, some critics believe that the nonprofit health system is becoming more like its for-profit counterparts and is no longer living up to its foundational ideals.

Compensation for CEO Bernard Tyson topped $16 million in 2017, making him the highest-paid nonprofit health system executive in the nation. The organization also is building a $900 million flagship headquarters in Oakland. And it bid up to $295 million to become the Golden State Warriors’ official health care provider, the San Francisco Chronicle reported. The deal gave the health system naming rights for the shopping and restaurant complex surrounding the team’s new arena in San Francisco, which it has dubbed “Thrive City.”

The organization reported $2.5 billion in net income in 2018 and its health plan sits on about $37.6 billion in reserves.

Against that backdrop of wealth, more than 80,000 employees were poised to strike last month over salaries, retirement benefits and concerns over outsourcing and subcontracting. Nearly 4,000 members of its mental health staff in California are threatening to walk out Monday over the long wait times their patients face for appointments.

“Kaiser’s primary mission, based on their nonprofit status, is to serve a charitable mission,” said Ge Bai, associate professor of accounting and health policy at Johns Hopkins University. “The question is, do they need such an excessive, fancy flagship space? Or should they save money to help the poor and increase employee salaries?”

Lawmakers in California, Kaiser Permanente’s home state, recently targeted it with a new financial transparency law aimed at determining why its premiums continue to increase.

There’s a growing suspicion “that these nonprofit hospitals are not here purely for charitable missions, but instead are working to expand market share,” Bai said.

The scrutiny marks a disorienting role-reversal for Kaiser, an integrated system that acts as both health insurer and medical provider, serving 12.3 million patients and operating 39 hospitals across eight states and the District of Columbia. The bulk of its presence is in California. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Many health systems have tried to imitate its model for delivering affordable health care, which features teams of salaried doctors and health professionals who work together closely, and charges few if any extraneous patient fees. It emphasizes caring and community with slogans like “Health isn’t an industry. It’s a cause,” and “We’re all in this together. And together, we thrive.”

Praised by President Barack Obama for its efficiency and high-quality care, the health maintenance organization has tried to set itself apart from its profit-hungry, fee-for-service counterparts.

Now, its current practices — financial and medical — are getting a more critical look.

As a nonprofit, Kaiser doesn’t have to pay local property and sales taxes, state income taxes and federal corporate taxes, in exchange for providing “charity care and community benefits” — although the federal government doesn’t specify how much.

As a percentage of its total spending, Kaiser Permanente’s charity care spending has decreased from 1.29% in 2012 to 0.8% in 2017. Other hospitals in California have exhibited a similar decrease, saying there are fewer uninsured patients who need help since the Affordable Care Act expanded insurance coverage.

CEO Tyson told California Healthline that he limits operating income to about 2% of revenue, which pays for things like capital improvements, community benefit programs and “the running of the company.”

“The idea we’re trying to maximize profit is a false premise,” he said.

The organization is different from many other health systems because of its integrated model, so comparisons are not perfect, but its operating margins were smaller and more stable than other large nonprofit hospital groups in California. AdventHealth’s operating margin was 7.15% in 2018, while Dignity Health had losses in 2016 and 2017.

Tyson said that executive compensation is a “hotspot” for any company in a labor dispute. “In no way would I try to justify it or argue against it,” he said of his salary. In addition to his generous compensation, the health plan paid 35 other executives more than $1 million each in 2017, according to its tax filings.

Even its board members are well-compensated. In 2017, 13 directors each received between $129,000 and $273,000 for what its tax filings say is five to 10 hours of work a week.

And that $37.6 billion in reserves? It’s about 17 times more than the health plan is required by the state to maintain, according to the California Department of Managed Health Care.

Kaiser Permanente said it doesn’t consider its reserves excessive because state regulations don’t account for its integrated model. These reserves represent the value of its hospitals and hundreds of medical offices in California, plus the information technology they rely on, it said.

Kaiser Permanente said its new headquarters will save at least $60 million a year in operating costs because it will bring all of its Oakland staffers under one roof. It justified the partnership with the Warriors by noting it spans 20 years and includes a community gathering space that will provide health services for both members and the public.

Kaiser has a right to defend its spending, but “it’s hard to imagine a nearly $300 million sponsorship being justifiable,” said Michael Rozier, an assistant professor at St. Louis University who studies nonprofit hospitals.

The Service Employees International Union-United Healthcare Workers West was about to strike in October before reaching an agreement with Kaiser Permanente.

Democratic presidential candidates Kamala HarrisBernie SandersElizabeth Warren and Pete Buttigieg, as well as 132 elected California officials, supported the cause.

California legislators this year adopted a bill sponsored by SEIU California that will require the health system to report its financial data to the state by facility, as opposed to reporting aggregated data from its Northern and Southern California regions, as it currently does. This data must include expenses, revenues by payer and the reasons for premium increases.

Other hospitals already report financial data this way, but the California legislature granted Kaiser Permanente an exemption when reporting began in the 1970s because it is an integrated system. This created a financial “black hole” said state Sen. Richard Pan (D-Sacramento), the bill’s author.

“They’re the biggest game in town,” said Anthony Wright, executive director of the consumer group Health Access California. “With great power comes great responsibility and a need for transparency.”

Patient care, too, is under scrutiny.

California’s Department of Managed Health Care fined the organization $4 million over mental health wait times in 2013, and in 2017 hammered out an agreement with it to hire an outside consultant to help improve access to care. The department said Kaiser Permanente has so far met all the requirements of the settlement.

But according to the National Union of Healthcare Workers, which is planning Monday’s walkout, wait times have just gotten worse.

Tyson said mental health care delivery is a national issue — “not unique to Kaiser Permanente.” He said the system is actively hiring more staff, contracting with outside providers and looking into using technology to broaden access to treatment.

At a mid-October union rally in Oakland, therapists said the health system’s billions in profits should allow it to hire more than one mental health clinician for every 3,000 members, which the union says is the current ratio.

Ann Rivello, 50, who has worked periodically at Kaiser Permanente Redwood City Medical Center since 2000, said therapists are so busy they struggle to take bathroom breaks and patients wait about two months between appointments for individual therapy.

“Just take $100 million that they’re putting into the new ‘Thrive City’ over there with the Warriors,” she said. “Why can’t they just give it to mental health?”

 

 

 

Northwell CEO Urging Healthcare Providers to Mobilize for Gun Control

https://www.healthleadersmedia.com/strategy/northwell-ceo-urging-healthcare-providers-mobilize-gun-control

Image result for Gun Control

The prominent executive is pushing beyond a letter he released last week and is now seeking to rally his peers around solving what he sees as a public health crisis.


KEY TAKEAWAYS

‘All of us have allowed this crisis to grow,’ he wrote in a letter published Thursday in The New York Times.

Healthcare CEOs should put pressure on politicians without resorting to ‘blatant partisanship,’ he said.

Northwell Health President and CEO Michael J. Dowling isn’t done pushing fellow leaders of healthcare provider organizations to take political action in the aftermath of deadly mass shootings.

Dowling addressed healthcare CEOs in a call to action published online last week by the Great Neck, New York–based nonprofit health system. Now he’s published a full-page print version of that letter in Thursday’s national edition of The New York Times, while reaching out directly to peers who could join him in a to-be-determined collective action plan to curb gun violence.

“To me, it’s an obligation of people who are in leadership positions to take some action, speak out, and prepare their organizations to address this as a public health issue,” Dowling tells HealthLeaders.

Wading into such a politically charged topic is sure to give some healthcare CEOs pause. Even if they keep their advocacy within all legal and ethical bounds, they could face rising distrust from community members who oppose further restrictions on firearms. But leaders have a responsibility to thread that needle for the sake of community health, Dowling says.

“I do anticipate that there’ll be criticism about this, but then again, if you’re in a leadership role, criticism is what you’ve got to deal with,” he says.

Dowling argues that healthcare leaders have successfully spoken out about other public health crises, such as smoking and drug use. But they have largely failed to respond adequately as gun violence inflicts considerable harm—both physical and emotional—on the communities they serve, he says.

“It is easy to point fingers at members of Congress for their inaction, the vile rhetoric of some politicians who stoke the flames of hatred, the lax laws that provide far-too-easy access to firearms, or the NRA’s intractable opposition to common sense legislation,” Dowling wrote in the print version of his letter. “It is far more difficult to look in the mirror and see what we have or haven’t done. All of us have allowed this crisis to grow. Sadly, as a nation, we have become numb to the bloodshed.”

His letter proposes a four-part agenda for healthcare leaders to tackle together:

  1. Put pressure on elected officials who “fail to support sensible gun legislation.” He urged healthcare CEOs to increase their political activity but avoid “blatant partisanship.” The online version of his letter links to OpenSecrets.org‘s repository of information on campaign contributions from gun rights interest groups to politicians.
  2. Invest in mental health without stigmatizing. Most mass murderers aren’t “psychotic or delusional,” Dowling wrote. Rather, they’re usually just disgruntled people who let their anger erupt into violence, which is why firearms sales to people at risk of harming themselves or others should be prohibited, he wrote.
  3. Increase awareness and training. Individuals shouldn’t be allowed to buy or access certain types of firearms “that serve no other purpose than to inflict mass casualties,” he wrote. Healthcare leaders should support efforts to spot risk factors and better understand so-called “red flag” laws that empower officials to take guns away from people deemed to be a potential threat to themselves or others, he wrote.
  4. Support universal background checks. In the same way that doctors shouldn’t write prescriptions without knowing a patient’s medical history to ensure the drug will do no harm, gun sellers shouldn’t be allowed to complete a transaction without having a background check conducted on the buyer, Dowling wrote, adding that a majority of Americans support this idea.

The letter notes that the U.S. has nearly 40,000 firearms-related deaths each year and that several dozen people have died in mass shootings thus far in 2019, including 31 earlier this month in separate shootings in El Paso, Texas, and Dayton, Ohio.

Corporate Responsibility

The way for-profit companies think about their relationship with the communities in which they operate has been shifting for some time. The most recent evidence of that shift came earlier this week, when the influential Business Roundtable released a revised statement on the principles of corporate governance, responding to criticism over the so-called “primacy of shareholders.”

The 181 CEOs who signed onto the new statement said they would run their business not just for the good of their shareholders but also for the good of customers, employees, suppliers, and communities. There’s some similarity between that updated notion of corporate responsibility and the sort of advocacy work Dowling wants to see from his for-profit and nonprofit peers alike.

Every single organization has a social mission, and large organizations that have sway in a local community have a responsibility to the community’s health, Dowling says.

“A healthy community helps and creates a healthy organization,” he says.

One major factor that may be pushing more CEOs to take a public stance on politically sensitive issues—or at least giving them the cover to do so confidently—is the generational shift in the U.S. workforce. Although most Americans overall say CEOs shouldn’t speak out, younger workers overwhelmingly support such action, as Fortune‘s Alan Murray reported, citing the magazine’s own polling.

Dowling says he has received hundreds of letters, emails, and phone calls from members of Northwell Health’s 70,000-person workforce expressing support in light of his original letter published online last week.

“The feedback has been absolutely universal in support,” he says.

But Which Policies?

Even among healthcare professionals who agree it’s appropriate to speak out on politically charged topics, there’s sharp disagreement over which policies lawmakers should enact and whether those policies would infringe on the public’s Second Amendment rights.

The group Doctors for Responsible Gun Ownership (DRGO) rejects the premise of Dowling’s argument: “Firearms are not a public health issue,” the DRGO website states, arguing that responsible gun ownership has been shown to benefit the public health by preventing violent crime.

Dennis Petrocelli, MD, a psychiatrist in Virginia, wrote a DRGO article that called Virginia’s proposed red flag law “misguided” and perhaps “the single greatest threat to our constitutional freedoms ever introduced in the Commonwealth of Virginia.” His concern is that the government might be able to take guns away without any real evidence of a threat.

While gun rights advocates may see Dowling as merely their latest political foe, Dowling contends that he’s pushing for a cause that can peaceably coexist with the constitutional right to bear arms.

“You can have effective, reasonable legislative action around guns that still protects the essence of what many people believe to be the core of the Second Amendment,” Dowling says. “It’s not an either/or situation.”

Others Speaking Out

Dowling isn’t, of course, the only healthcare leader speaking out about gun violence.

On the same day last week that Northwell Health published Dowling’s online call to action, Ascension published a similar letter from President and CEO Joseph R. Impicciche, JD, MHA, who referred to gun violence in American society as a “burgeoning public health crisis.”

“Silence in the face of such tragedy and wrongdoing falls short of our mission to advocate for a compassionate and just society,” Impicciche wrote, citing the health system’s Catholic commitment to defend human dignity.

The American Medical Association (AMA) and American College of Emergency Physicians (ACEP) each issued statements this month calling for public policy changes in response to these recent shootings, continuing their long-running advocacy work on the topic.

American Hospital Association 2019 Chairman Brian Gragnolati, who is president and CEO of Atlantic Health System in Morristown, New Jersey, said in a statement this month that hospitals and health systems “play a role in the larger conversation and are determined to use our collective voice to prevent more senseless tragedies.”

 

 

 

America’s mental health problem isn’t mass shootings

https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2013.0085

illustration of guns

The U.S. has a gun violence problem and a mental health problem. But conflating the two won’t solve either.

The big picture: The average person suffering from a mental illness is no more prone to violence than anyone without a mental illness, and mental-health advocates say exaggerating a link between mass shootings and mental illness can be stigmatizing and harmful.

Between the lines: “A very small proportion of people with a mental illness are at increased risk of violent behavior if they are not treated,” 2 former CEOs of Mental Health America wrote in Health Affairs in 2013.

  • These are the people with the most severe mental illnesses — often those characterized by paranoia and delusions, the authors added. These people also may have a substance abuse problem or a “history of victimization.”

Yes, but: Nearly two-thirds of gun deaths are suicides, and “mental illness is a very strong causal factor in suicide,” Duke University’s Jeffrey Swanson said.

Even if Congress did decide to further limit people with mental illness’ access to guns, they’ll quickly run up against the mental health system’s broader shortcomings.

  • A patient must interact with the system to receive a mental health diagnosis. And one of the system’s biggest problems is that many people with mental illness can’t get the treatment they need.
  • Only 25% of active shooters included in an analysis released by the FBI last year had ever been diagnosed with a mental illness, even though 62% had appeared to be struggling with some kind of mental health issue in the year before the attack.
  • “The act of somebody who goes out and massacres a bunch of strangers, that’s not the act of a healthy mind,” Swanson said. “But that doesn’t mean that person has a mental illness.”