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Kaiser Permanente is facing yet another allegation related to its behavioral health business.
The National Union of Healthcare Workers (NUHW), which represents more than 19,000 healthcare workers in California, filed a complaint on April 8 against the Oakland-based healthcare giant alleging it had illegally replaced licensed therapists with unlicensed clerks and a computer algorithm to direct mental health care.
Kaiser Permanente is currently in a state-mandated two-year corrective action plan following a 2023 investigation that found, among other violations, the system failed to provide timely access to mental health appointments, resulting in a $200 million settlement.
Plus, more than 2,000 of the system’s mental health workers have been on strike for six months over a range of reported issues, including claims about improper patient wait times and patients being directed to programs not equipped to handle their needs.
“This is yet another example of Kaiser Permanente putting patients at risk by refusing to provide the same level of care to those with mental health conditions as it does to those with medical conditions,” NUHW President Emeritus Sal Rosselli said in a statement.
What’s going on?
When a person with mental health concerns calls Kaiser Permanente seeking care, an unlicensed clerk asks a standardized list of questions and inputs answers into an algorithm from a company called Lucet, according to NUHW’s complaint. That algorithm then allegedly tells the clerk what kind of appointment the patient should be referred for and whether they need immediate care.
Lucet—which launched in early 2023 after a merger between health tech company Tridiuum and New Directions Behavioral Health—brands itself as a behavioral health solution for “connecting people to the care they deserve,” according to the company’s website.
When asked for comment, a Lucet spokesperson said the company “is not an in-network provider in the external Kaiser Permanente Network, nor does it serve as Kaiser’s external provider network.” The company did not clarify the nature of Lucet’s partnership with Kaiser. The spokesperson added that Lucet does not use generative artificial intelligence or large language models for clinical decision-making.
Fred Seavey, research director at NUHW, told us that when licensed therapists previously conducted the phone questionnaires, the conversations could last up to 30 minutes. (The Lucet algorithm has been rolled out across Kaiser facilities since 2019, but uptake varies depending on the location.) But, he said, Kaiser instructs the unlicensed clerks to complete the calls within 2.5 minutes.
Employing the unlicensed clerks to conduct the screenings instead of therapists is likely a money-saver for the health system since clerks are paid less, Seavey said.
Kaiser did not respond to a question about whether using the Lucet algorithm saves the health system money.
NUHW’s complaint argues using unlicensed clerks to conduct such questionnaires violates the California Health and Safety Code, which states that an unlicensed worker handling calls can ask questions to determine a patient’s condition but they cannot use the answers to “assess, evaluate, advise, or make a decision regarding the condition of an enrollee or determine when an enrollee needs to be seen by a licensed medical professional.”
The practice can lead to inadequate patient care, according to the union.
By filing the complaint, NUHW is asking the California Department of Managed Health Care to investigate the practice and ensure Kaiser follows the law, Seavey said.
Kaiser’s side
Kathleen Campini Chambers, a spokesperson for Kaiser Permanente, told Healthcare Brew the union’s allegations are “simply false.”
“Appointment clerks do not conduct any assessments, make any clinical determinations, nor conduct clinical triage,” Campini Chambers said in an emailed statement. “Their role is strictly administrative, involving scheduling appointments for members. Clinical assessments are exclusively conducted by qualified clinicians.”
Clinicians are the ones who decide the appropriate treatment course, she added, and appointment clerks use the screening questions to make sure patients “are directed to the most suitable and efficient type of appointment.” She also clarified that its screening tool does not use artificial intelligence or large language models.
The clerks are also trained to get clinical staff involved if the patient on the phone requires immediate care, Campini Chambers added.
Campini Chambers said call times vary depending on patient needs. “We do not have a requirement that these calls are completed in any time frame. We do track and monitor the average call time so that we can ensure we are staffing this team properly,” she said.
Clinicians also don’t make appointments across any of Kaiser’s health offerings, she added, and the allegation that it’s replacing experts with technology is “unfounded.”