In her first two months leading the Oregon Health Authority, Sejal Hathi has focused on traveling the state and listening to local health leaders, providers, Medicaid specialists, insurers, advocates and tribal leaders.
Hathi had never worked or lived in Oregon before moving from New Jersey, where she worked for the health department for a short time. Her first day as Oregon Health Authority director was Jan 16, and a month later she started her “listening tour.”
She said she wants to get to know the state and hear people’s needs and concerns before making any major decisions.
“That’s the whole objective and principle and the spirit behind this listening tour,” she told the Capital Chronicle in a recent interview. “I will visit every major region of the state because I want to make sure that the strategies, the vision that I articulate, the specific strategies and actions that I name, the metrics that we use to hold myself and our agency accountable, are informed by and anchored in the real challenges, needs and priorities of the people who have been doing this work on the ground for years.”
The health authority is one of the biggest agencies in the state, with a yearly budget of nearly $18 billion and up to 5,600 employees who oversee crucial programs that touch most Oregonians’ lives. It sets state health and Medicaid policies and is charged with eliminating health care inequities that have hurt minority and rural communities.
Hathi has been meeting with providers who serve marginalized communities during her visits.
She hit Medford, Grants Pass and Klamath Falls in February and met with medical, oral and behavioral health providers at La Clinica, a nonprofit that serves about 30,000 people in Jackson County. At the end of February, she visited Astoria and toured a shelter that aims to shepherd people into permanent housing. In March, she visited Eugene, Salem and Lebanon, where she toured Colonia Paz, an affordable housing complex for farmworkers.
Hathi will visit Bend and the Portland area in April, and in May, she’s headed to Hood River and Pendleton.
Providers and officials have stressed the importance of community and their need for state policies to be adapted to local situations. They’ve also told her about the impact of the workforce shortage on services. And they’ve called for more affordable housing.
Some have even criticized the agency.
“I heard from local mental health providers that for every new requirement that we impose, to increase accountability for the grants that we’re providing, we’re layering yet another administrative burden,” Hathi said in a video statement after one visit, adding later, “We need to adopt, steward and support strategies that are tailored to the local context that they’re intended to serve.”
Biggest job of career
Hathi is also exploring the Portland area. That’s where she and her husband Sheel Tyle, founder and CEO of a global venture capital firm called Amplo, have settled.
”We’ve identified a favorite pizza spot, favorite neighborhood café, favorite workout place and a few gorgeous hiking trails, where we’ve also taken our families,” Hathi said in an email. “Both Sheel and I are looking forward to exploring more of the state and growing our family here in the years to come.”
She commutes to Salem a few days a week. At 32, running such a large agency is the biggest job of her career. Last year, she worked as the deputy health commissioner in New Jersey and oversaw public health services. She was the top manager for a number of areas, including the epidemiology, environmental and occupational health divisions and family health services. She also oversaw infectious diseases, laboratories, emergency preparedness and the offices of local public health.
Her budget was much less than the health authority’s – about $2 billion – and she led a much smaller staff, about 1,000 people. She only stayed five months, arriving in early July and leaving at the beginning of December.
Her background is varied. She grew up in the San Francisco Bay Area, the daughter of immigrants from Africa of Indian descent who came to America with little more than passports and a suitcase of dreams, she said.
As a youth, she struggled with a eating disorder and at 15, formed a nonprofit called Girls Helping Girls and co-founded another organization called girltank. They train young women to mobilize social change and together have gone global, with 30,000 women associated with the organizations in 100 countries.
Later, she earned a bachelor’s degree from Yale University in Connecticut and a medical degree and MBA from Stanford University in California. She completed her medical training at Harvard University in Massachusetts, held a faculty position at Johns Hopkins University in Maryland and treated patients at Massachusetts General Hospital during the pandemic.
She worked at the White House as a senior health care adviser for two years and then was hired by the New Jersey Department of Health.
I will visit every major region of the state because I want to make sure that the strategies, the vision that I articulate, the specific strategies and actions that I name, the metrics that we use to hold myself and our agency accountable, are informed by and anchored in the real challenges, needs and priorities of the people who have been doing this work on the ground for years.
– Dr. Sejal Hathi, director of the Oregon Health Authority
She told the Capital Chronicle in an email that these experiences taught her the importance of “fostering health systems that empower all people to reach their full potential – by building trust, ensuring accountability and espousing and embodying a more holistic definition of ‘health.’”
“It’s with this lens and perspective that I approach my work now in Oregon,” she said.
Some advocates and providers said they were surprised she won the job. They said she’s clearly intelligent and articulate but lacks the deep administrative experience they say is needed to run an agency with so many important programs and that has entrenched, siloed interests. Managing the politics of that will be challenging, they said.
The health authority oversees the Oregon State Hospital, which is headquartered in Salem and is the only state-run psychiatric facility in Oregon. It manages the Oregon Health Plan, the state’s version of Medicaid, which serves more than one in three Oregonians or nearly 1.5 million people. It oversees public health – which has taken more of a back seat now that the pandemic is over – and is in charge of behavioral health, an area of deep crisis in the state.
That crisis worsened during the pandemic, with Oregon losing professionals as they fled the largely low-paid, stressful field. The agency also lost staff and now is at a key juncture.
This year, as the state wraps up weeding out ineligible Medicaid beneficiaries, the Oregon Health Authority is rolling out new benefits. That started this month with the Oregon Health Plan offering equipment to the most vulnerable to ensure they have heat, cooling and clean air. In November, the state will become the first nationwide to offer rental assistance through Medicaid. And at the beginning of 2025, it is due to offer food assistance.
Hathi has said that these innovations, which forge a new path for Medicaid in the country, were part of what attracted her to the state.
“I don’t think any state other than Oregon is doing more, leveraging Medicaid to expand coverage and address health related social needs,” she said.
Other transitions in the works
The agency also is readying a new health insurance plan to cover more low-income people, and it is amping up a focus on mental health.
The state has consistently ranked at or near the bottom of nationwide mental health surveys, and even the agency acknowledged the system is woefully underfunded. A recent report estimated that Oregon does not have enough providers to treat 3,000 people who need mental health and addiction treatment in a residential facility. It said Oregon needs nearly 8,000 beds in all, an increase of 70% from the 4,800 it has now.
At the same time, the agency lacks top level staff, giving Hathi key roles to fill. The agency is preparing to interview candidates for the agency’s Medicaid director. It is recruiting a health policy and analytics chief, state public health director, chief financial officer and a chief medical officer.
And the superintendent of the Oregon State Hospital, Dolly Matteucci, is retiring at the end of the month.
“We have a lot of individuals in their roles who are acting or who are interim,” Hathi said. “I think we need to hold space and grace for the tumult and transition that the agency has been in over the past 16 months and recognize that a lot of new blood will be coming in between now and June.”
The agency also is undergoing a reorganization. The Health Systems Division is being dissolved, with its behavioral health and Medicaid units becoming separate divisions.
The agency said the change will make them nimbler and more efficient. In the meantime, behavioral health director Ebony Clarke, who’s been on the job for about a year, has been staffing up.
“She has been rebuilding the division and has hired a number of folks to work under her,” Hathi said.
Addressing Oregon’s mental health crisis is one of Gov. Tina Kotek’s top priorities, and Hathi has made it a priority, too.
“Mental illness is a force multiplier, and that means it’s that much more critical that it’s central to any effort to make our state healthier,” Hathi said.
Critics worry about experience
Several providers and advocates told the Capital Chronicle they want to reserve judgment about Hathi to give her time to get used to the state and the agency. Chris Bouneff, executive director of National Alliance on Mental Illness Oregon, said the challenge of running the agency is enormous even for an old hand.
“This is a big job, and we’re in the midst of a huge crisis. We have just come out of a pandemic which compressed a whole chain of events that got us to where we are a lot faster than what would have happened had we not had a pandemic,” Bouneff said. “The challenges are immense. And you’re asking a person who is brand new to the role and brand new to the state and brand new to Medicaid and brand new to the politics of Oregon” to lead the agency.
“That’s a tough spot to be in,” he said, adding: “Could anybody do this job, let alone someone who comes to the job without much experience?”
Dr. Bruce Goldberg, who was in her shoes from 2010 to 2014, said her experience as a doctor in the role is a plus.
“A physician brings to the job an intimate and important understanding of the working of our health system and how it does and does not meet the needs of individuals, clinicians and communities,” Goldberg said.
He also said it’s important who she hires for leadership roles.
“One individual alone cannot do the job,” Goldberg said. “It takes a team with diverse skills and experience. Build a strong team.”
He also said she needs to listen, something she’s trying to do. Besides her statewide trips, she’s meeting with health authority staff. That’s a plus, Goldberg said.
“Being an active listener helps you to learn about the various needs, interests, values and challenges that exist across Oregon,” Goldberg said.
He’s optimistic Hathi will succeed and like others wants to give her time to get acquainted with Oregon and the job. Critics say the agency has lost its way over the years, becoming increasingly siloed with entrenched interests. She will have to learn how to break down barriers.
“You have to have hope that given the immensity of the challenges, that she will be up to the task,” Bouneff said. “But it’s too early to tell.”
Already, Hathi has been on the hot seat publicly. Last month, members of the state’s Task Force on Alcohol Pricing and Addiction Services asked her pointed questions about a report the agency withheld in 2021 while working on a proposal to raise beer and wine taxes. The report showed that increasing taxes did little to stem problem drinking. A lawmaker also asked her about misinformation she had given him, saying she had been lied to and needed to hold the agency accountable.
She answered the questions directly and has repeatedly said she aims to be transparent.
About a week ago, she made her first big hire, naming an insider, Ashley Thirstrup, as her new chief of staff. Thirstrup has been with the agency since 2017 and most recently was the agency’s director of government relations.
Hathi told the Capital Chronicle that it was too soon to name goals she has set but indicated she hopes to transform an agency known as a plodder and fan of red tape into a model of public service.
“My goal simply stated is that in three years, people across the agency and across the state of Oregon know that the Oregon Health Authority delivers on its commitments and every interaction they have with the agency is an excellent one,” she said. “I want this to be an agency that is trusted, that is commended and recognized for being one that practices and models transparency and accountability.”
