Concerns About Kaiser Call Centers Prompt California Investigation
The California Department of Managed Health Care is investigating Kaiser Permanente's three call centers because of allegations that the HMO might be letting nonmedical workers make decisions that could affect members' access to care, the Sacramento Bee reports.
The investigation centers on Kaiser's use of scripts that call center personnel follow when taking calls from members, according to the Bee.Â Call centers are staffed with non-medical professionals as well as nurses and doctors.
A 2003 law that Kaiser had opposed aimed to bar health plans from using semi-automated systems that let non-medical personnel make decisions that could affect members' access to care.Â
DMHC's investigation was sparked by a nurse voicing concerns that call center staff were not handling calls appropriately, increasing the possibility of members receiving inaccurate information and having their care delayed.
Evan Goldberg, who was chief of staff for then-Sen. Debra Bowen (D) when she authored the 2003 law, said, "No script can be written for every individual caller and every cause."
Kaiser contends that call center staff do not make medical decisions and follow scripts written by physicians.
Lesley Levine, a physician who serves as regional director for Kaiser's three call centers said, "The script is what I would say if I were standing next to them as a physician."
Levine said that patients who specifically ask for a nurse are transferred to one.Â Levine added that DMHC's investigation has not uncovered any "substantiated" complaints about patient safety and that Kaiser's call centers have not prompted any fines from DMHC.
State investigators plan to visit the Sacramento call center soon and will demand the scripts as part of their probe into the call centers.The HMO has denied requests that it provide copies of the scripts to DMHC, arguing that the scripts are proprietary (Peyton Dahlberg, Sacramento Bee, 1/11). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.