Model of Care committees further NorCal contract wins

NewsMarch 14, 2024

The five Model of Care Committees in Northern California completed their work recently with strong gains for clinicians and overall patient care.

Among the biggest victories are more Indirect Patient Care Time/Patient Management Time for intake clinicians, more time to conduct child intakes, more treatment tracks to ease the burden of generalists and crisis care availability at every clinic.

As part of the contract therapists won following their 10-week strike in Northern California, Kaiser Permanente agreed not only to form the committees but to fund their recommendations. That was a sharp departure from previous Model of Care Committee experiences, in which Kaiser would either not collaborate in good faith or not agree to pay for the reforms suggested by workers and managers.

Although Kaiser is required to implement and fund the recommendations, NUHW stewards are already organizing to make sure management honors both the letter and the spirit of the agreements.

Earlier this month, NUHW leaders requested a meeting to address concerns that management has made it more difficult for intake clinicians to get the full benefit of their increased Indirect Patient Care/Patient Management Time and that Kaiser isn’t recognizing portions of the agreement that was made to ease the burden on generalists.

“We forced Kaiser to agree to major model-of-care improvements through our strike and our work documenting Kaiser’s violations of state law,” said Ilana Marcucci-Morris, a licensed clinical social worker who serves NUHW’s Model of Care Committee Co-Chairperson. “These recommendations represent major victories that we had fought to achieve in prior contract campaigns. However, we still have to stay active and involved to make sure Kaiser follows through on implementation.”

Under the $200 million settlement agreement that Kaiser entered into last year with state authorities, the HMO must develop a Corrective Action Plan to address major shortcomings in its mental health services and face increasing fines if the approved plan isn’t fully implemented.

Here are key improvements agreed to by the Model of Care Committees in Northern California:

Kaiser’s Centralized Call Center (C2C)

  • Reduced the number of appointments per full-time clinician from 33 to 30 per week.
  • Increased Indirect Patient Care/Patient Management Time from 3.5 hours to 6 hours per week.

Crisis Management

  • Every clinic will soon offer crisis services and must have:
    • A plan to assess risk and safety concerns at the initial point of contact for patients who either self-report being in crisis or are referred by another department.
    • A dedicated licensed provider, scheduled to be available for crisis services.
  • All clinicians will receive disposition and crisis training within 90 days of hire.
  • Clinicians who provide crisis services will start crisis-specific training before they are asked to manage crisis patients. This will include shadowing a crisis provider, being observed by a crisis provider and receiving feedback from a crisis provider after the observation.

Child Intake Process

  • Clinicians will be able to have one-to-two 90-minute child secondary intake appointments per week.
  • Kaiser had previously reduced all child intakes to 60 minutes prior to the 2022 strike.

Case Management Recommendations

  • Case management services will be expanded to include programs for children with severe and persistent mental illness, people with autism spectrum disorder and patients not currently receiving care from a therapist.

Treatment Track Recommendations

  • Treatment tracks, such as those focused on depression and anxiety, will be expanded throughout the Northern California region and new treatment tracks focusing on personality disorders and trauma will be added.
  • Generalists will be provided time to review caseload lists and determine which patients would qualify and benefit from being moved into treatment tracks.
  • A system will be established to make sure patients can navigate care pathways and get care that meets timely access standards without relying on generalists.
  • Consultation groups will be established so that genrelists can review cases with their colleagues.