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KPGA Complaints and Grievances Updates

Member services desk

                 August 2025

                     

YOY Volume

1,103
Members
1248
Cases
1501
Issues
3.84
Cases/1k member

4.04 Threshold

4.00 Target

3.87 Stretch

from 2024 PTD

Top Issues

Shared Service

Percent
Volume

Billing

20%
165

Benefits

18%
154

KP.org

6%
52

Total

41%
371

Service Area

Percent
Volume

Diag/Treatment/Care

20%
135

Appointments

18%
122

Behavior

8%
51

Total

48%
308

Spotlight

Most Improved

Town Park Comprehensive Medical Center 

Volumes -32% YTD
(69 to 47)

Actions: Clinic team proactively utilizing ambulatory real-time feedback to identify and address member concerns early and conducting timely service recovery to enhance member experience.

Service Area

Access, Appointments, Service Area

Volumes -5% YoY
(206 to 195)

Drivers: Complaints show moderate fluctuation month to month rather than a steady trend .  From Oct-Dec 24 there was a decline then in Dec 24 to Jan 25 a jump, likely a seasonal factor.  No consistent month-to-month decrease, but overall the number of comlaints decreased slightly.

Actions: The data is cyclical, suggeting recurring operational challenges.  Continue to look for opportunities that provide sustained improvement.

Shared Services

Billing

Volumes 40% YoY
(118 to 165)

Drivers: Charged for No-Cost Service, driving 39% of billing issues.

Key efforts to improve the Patient Financial Experience in Q4 include: enhancing the Cost Estimator process and improving communication.

Actions: The Cost Estimator tool was updated, and support from the Cost Estimator team when issues and concerns arise.

*The consolidation of service billing subcategories has led to a significant YOY increase in the “billing” subcategory and a decrease in other subcategories. A consolidation of existing categories took place.  Stability will happen over time, providing a clearer analysis of genuine trends
Happy couple outside a Kaiser Permanente Facility

Voice of the Member

"I Love how the facility (Panola) is staffed with the necessary medical people to make things run smoothly."

" The medical personnel was friendly and attentive. The doctor took his time with explaining things and answering questions. His focus was not to diagnose but to gain an understanding of my concerns and properly assess me."

A message from:

Leslie M. Blair, Vice President, Marketing, Communications, Community Relations, Community Health and Care Experience
Christina Martin MBA, MHA, CPXP Director, Care Experience Strategy
Christopher Jones, M.D., AMD, Access, Care Transformation, and Outside Medical, The Southeast Permanente Medical Group
Alan F. Johnson, MHA, LSSBB, Director, Access, Strategy, and Care Experience, The Southeast Permanente Medical Group
Chaundrissa M.O. Smith PhD, ABPP, Clinician Program Director, Care Experience Enculturation, Licensed Clinical Psychologist, Kaiser Permanente, Department of Behavioral Health