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Q&A: Incoming Oregon Health Authority Director Sejal Hathi on Measure 110, delivery reforms

The former White House advisor supports the drug decriminalization law’s goals but says she’ll work with law enforcement and others on implementation
Dr. Sejal Hathi, 33, in January takes over as director of the Oregon Health Authority, an agency that oversees care to more than 1.3 million low-income people. | SCREENSHOT VIA THE LUND REPORT
November 7, 2023

Dr. Sejal Hathi, named the new director of the Oregon Health Authority on Monday by Gov. Tina Kotek, is the first physician to head the agency in nearly a decade. She brings to the job an Ivy League pedigree, White House experience and significant fluency in health policy issues and research. 

She also brings some questions. She spent just four months in her last job as deputy health commissioner for the state of New Jersey. She turned 33 last month and has scant experience in executive leadership of a large agency.

Now she’ll take over an agency of more than 5,000 employees, one whose performance Kotek blasted during her gubernatorial campaign. Since then, the agency has suffered a wave of high profile departures — including Kotek’s first pick for the job, James Schroeder. He left in March after only seven weeks, citing what he felt was a lack of support from the governor for his vision as well as resistance to his efforts internally. In texts obtained by The Lund Report he called the agency a “toxic place.”

Hathi will earn about $222,000 a year, a raise from the $165,000 salary she had in New Jersey. Her first day is Jan. 16.

On Monday, she said she is committed to moving to Oregon and staying indefinitely, saying she’s happy to return to her West Coast roots. She also addressed Measure 110, the state’s embattled drug decriminalization law, and Oregon’s history of health care reform.

This interview has been edited for clarity and brevity.

The Lund Report: You will soon take the reins of an agency that oversees care to more than 1.3 million Oregonians and influences the care of many others. What do you want Oregonians to know about you?

Sejal Hathi: I want them to know that I'm here for the long haul and I'm committed to seeing through the Governor's priorities to finish this term and hopefully another term that follows. I am thrilled to just soon make the move and to once again call the West Coast my home.I will be leaning on all of you to learn as much as I can and to ensure that I am living and breathing the values that I know we all share and and making sure that I'm centering those most impacted by poor health in the decisions and the policies that the Oregon Health Authority team, the governor's office and I choose to make. I'm committed to improving access to care for every Oregonian. 

TLR: Have you been able to get a handle on Oregon's drug decriminalization law and what's needed to best help people and communities struggling with addiction?

Hathi: I have been watching the implementation of Measure 110 closely, and I know that it has been an interesting rollout and it has been a topic of significant debate throughout the community. It's no question that implementation has had a rough start, if only because of the sheer scope and ambition of the changes that the measure unleashed and are still likely to unfurl. But because this measure is the current law of the land my job as OHA director will be to faithfully execute that law and to deliver ultimately on its promise by improving accountability and ensuring that appropriate services are accessible and affordable across the state. And I aim to do so by advancing a health and prevention-based approach to the ongoing crisis that we know in other settings across the country can and does work and that ultimately lies at the center of what Measure 110 aspires to accomplish. 

TLR: There are so many areas of health care in need of attention right now. What do you foresee making the top priorities of your administration? 

Hathi: My priorities will be the Governor's priorities of course, since this is Governor Kotek’s administration. But I do agree with you that there are a lot of urgent issues on the ground. Measure 110 and the behavioral health crisis obviously is one of them, but also we're looking at a nationwide workforce crisis. Our hospitals across the country are struggling under financial duress. Oregon is no exception. And in fact, hospitals on the West Coast can often be a canary in the coal mine, so I'll be looking to shore up our health system and also making sure that our frontline providers feel supported in the very hard work they're doing each and every day caring for our state's patients. I'm interested in making sure that we execute effectively our groundbreaking 1115 waiver. I'm interested in ensuring that we are addressing some of the structural impediments to health, from housing, and homelessness to food insecurity. But ultimately, I really see my responsibility as fulfilling the promises that the state has already made. Oregon consistently has been at the vanguard of really creative and bold policy and we have put a lot of ideas into the ether. We have initiated a lot of policies and programs that are setting the standard for how care should be defined and delivered in and outside of our hospitals. I want to make sure that we see that through those ideas and that we really set a standard not just for ideation and innovation but for impact, that the full potential of these reform are reached and that we are improving access to care for even, and including, our most vulnerable, There's a lot of work to be done. But I'm here to execute on the Governor's priorities. And that is what I will aim faithfully to do.

TLR: The governor’s previous pick for this job resigned after seven weeks, citing resistance to making change at the agency. How do you plan to succeed where he did not?

Hathi: I can't comment on the prior director. I have read about the duration of his tenure. And I do know the impact that it's had on people of Oregon as well as the Oregon Health Authority. But I have had the privilege now of meeting a broad swath of people at the agency and the Governor's team, and each and every one of my interactions has reinforced my conviction that this is a team and this is an administration that espouses my values. And moreover, let's just recognize that James Schroeder is one person. The work that he did didn't occur in a vacuum, it occurred and the work Dave Baden is doing now is occurring in the context of a community of 5,700 employees who have been rolling up their sleeves and doing the hard work day in and day out for months and years on end. I have full faith in the capacity of that team to do hard things and to accelerate progress on the Governor's priorities.

TLR: One perception that's been raised is that in the absence of a permanent director, that high-level managers at the health authority have been operating in silos. How would your leadership style bring people in the agency behind a unified vision to move forward on behalf of Oregonians.

Hathi: Silos are what we've seen emerge all over the country at the federal level as well as in New Jersey and across states. In each of my roles I have learned how to navigate bureaucracy and to work nimbly with people of different politics, skill sets, objectives to achieve tangible deliverables, under high pressure and tight deadlines. And so I know that I'm going to have a lot to learn, I know that I'm going to need to earn the trust not only of OHA, but of the broader people of Oregon. But I have full confidence that, over time, our values are aligned enough and in the right place that I will be able to build that trust and mobilize the broader community to strengthen health and well-being for all Oregonians.

TLR: More than a decade ago, then—Oregon Health Authority director Dr. Bruce Goldberg and Dr. John Kitzhaber, as governor, shaped reforms to the state’s version of Medicaid, The Oregon health Plan, through which they hoped to leverage system-wide improvements across health care in access, quality, cost and equity. Do you hope to revive those efforts to leverage reforms or do you think they were just unrealistic given all the challenges that were inherent to that goal?

Hathi: I think Oregon stands as a beacon of hope  and a model among states in the reforms that it advanced in 2012 with establishing coordinated care organizations and being the first and only state to have an enforcement mechanism for its cost growth target. One of the areas that I want to focus on is delivery system reform and improving access to care and lowering the costs of care, and doing so in partnership with our hospitals and in particular with our CCOs. So I don't view the movement that launched over a decade ago now as fantastical or unachievable. I think that that is the work that we will continue to do, and that is even more urgent now in the wake of this past pandemic.

TLR: Harm reduction has become politically fraught in Oregon, with some providers in rural areas facing challenges and the state’s most populous county facing blowback when it became public that it planned to distribute straws and foil for fentanyl consumption. It actually rescinded that plan. Harm reduction is also a focus of Measure 110 funding. How are you going to approach this issue?

Hathi: I'm a champion of harm reduction and I am inspired by Oregon’s commitment to centering harm reduction services and its fight against the opioid epidemic, from decriminalizing possession of syringes and fentanyl test strips to issuing two standing orders to deploy Naloxone statewide. I have been an advocate for harm reduction as a doctor because I've seen that it works and it helps people get on track. It connects them to services, it is more likely to keep them in care. I know that implementation of Measure 110 is fraught. I know that this is a complicated issue around which many people have many very reasonable, valid concerns. Even while I'm a vocal champion for a harm reduction—centered or rather a public health centered approach to addiction, I fully understand that public safety plays a critical role and one of my responsibilities and areas of focus will be (bridging) our public health system with our law enforcement and public safety system and fostering that partnership to because at the end of the day, I know that we all have to be rowing in the same direction for Measure 110 and our broader behavioral health system goals to be a success.

TLR: You were a deputy health commissioner in New Jersey, you were an advisor in the White House. Now you're actually going to take the reins of this massive agency that has such incredible life and death consequences for real people. Is this daunting at all to you? 

Hathi: It's certainly exciting. I have the fortune of coming into an agency that has an incredible leadership team already at the top that I know that I will be able to trust and lean on. And so the work of a leader can be lonely, but I know that in this case, I have the utmost support of the OHA staff and the Governor's team to be as successful as possible.