
New NC health secretary reveals priorities: improving healthcare access and child welfare
(News & Observer, Luciana Perez Uribe Guinassi) — Dr. Devdutta Sangvai* was sworn in last month as the 19th secretary of North Carolina’s Department of Health and Human Services, becoming the first Indian American cabinet member under a North Carolina governor.
Gov. Josh Stein appointed Sangvai, a family medicine physician and Duke University professor, to lead one of the state’s largest agencies.
Having previously served as president of Duke Regional Hospital and the North Carolina Medical Society, Sangvai also brings private sector experience to DHHS — experience he told The News & Observer he hopes to leverage.
“I’m really excited to partner with the General Assembly to continue moving forward on some of these things we’ve already outlined for the future of North Carolina,” he told The N&O. “When I think about the 11 million citizens — and the 11 million people — we serve day in and day out, it’s that perspective that really excites me to be in this role.”
The leadership transition comes as the state faces shifts at both state and federal levels: North Carolina’s new governor and a new slate of Council of State members were elected in November. Nationally, President Donald Trump, in his first weeks in office, has signaled major shifts in policy, including in health care, that are expected to affect states.
Sangvai succeeds Kody Kinsley, who took over the agency in early 2022. Kinsley, the first openly gay cabinet secretary in North Carolina history, oversaw aspects of the state’s COVID-19 pandemic response, the historic expansion of Medicaid, behavioral health investments and more.
However, he also faced challenges, including lawsuits over inadequate services for underserved populations. In an interview, Sangvai outlined his vision for addressing challenges, improving service delivery and expanding access to care for all North Carolinians.
This interview has been edited for clarity and length.
DHHS priorities
Q: What are some of your priorities?
A: Part of my excitement in this role was the incredible foundation that we’ve laid in North Carolina. As you think across health and human services, we probably have the best-in-class Medicaid program and really foundational human services programs.
So when you think about the work we’ve done around everything from behavioral health to medical debt, I was excited to come into the agency at a time when that foundation has been laid.
Note: To encourage states that had not expanded Medicaid to get on board, the federal government allotted a $1.6 billion or so “signing bonus” to new states. After North Carolina passed Medicaid expansion with bi-partisan support, the General Assembly used part of that signing bonus to fund about $835 million for behavioral health. DHHS used some of those funds to increase the rates paid to Medicaid providers for behavioral health services, among other things.
The state also got approval by the federal government last year for a plan that leverages Medicaid funds to relieve existing hospital medical debt for people in the state.
Among my priorities is to continue that work. We’ve got work to continue to do with Medicaid. We have a pretty significant behavioral health investment, and so I’m excited to see how we roll that out.
We are also strengthening our relationship with our stakeholders and county partners, and to that end, there are a few areas that I’m particularly interested in.
One is to really strengthen access in North Carolina and make sure communities have access to the type of services they need. I also want to work to ensure that our programs and services are working for all North Carolinians.
The third piece I’m really focused on is building a sustainable workforce in North Carolina. We have a shortage across almost every healthcare job type and even in the human services job types. So, what can we do to really retain people in North Carolina, and what can we do to recruit individuals into those crucial roles?
Possible Medicaid changes
Q: In terms of Medicaid and continuing to bolster it, as well as behavioral health services, can you share more on how you plan to do that? Especially considering the possibility that Medicaid could face cuts under the Trump administration?
Note: Congressional Republicans are reportedly considering changes to Medicaid to fund immigration initiatives and tax cuts desired by President Donald Trump. But on Friday, Trump said he would not institute cuts to Medicaid, save for fraud and abuse, as reported by various outlets.
A: On the behavioral health front, we have been fortunate to have $835 million appropriated through the General Assembly for the work that we are going to do to improve behavioral health. Part of that has already been allocated to increase rates, so we can really create a cadre of providers in the community.
Our position is that these types of services are best served and meet the needs of people when they are offered in the communities in which individuals live and work. There’s also additional work (needed) to create more community-based services around behavioral health, particularly with the justice-involved population.
One of the things I’m interested in is creating sustainable programs as we spend that money. So, not only how do we meet the immediate need, but how do we lay a further foundation to ensure that those dollars are going to build sustainable programs?
On the Medicaid front, I think we have one of the best Medicaid programs in the country. If you look back at the last six to eight years, a number of very deliberate, thoughtful steps were taken to figure out how to ensure that we have a program that is best in class and meets the needs of as many people as possible. That was achieved through bipartisan support.
I think that’s a really important element of what we have in North Carolina, and nearly every stakeholder —providers, beneficiaries, elected officials, even local law enforcement — were really important in helping us understand how to put together a Medicaid program, and in particular, Medicaid expansion.
I think what you have there is a spirit of collaboration and consensus building, and I’m hopeful that as we start to see changes from the federal government, we can rely on that to really think about what our impact might be.
Until then, our goal is to continue to put people first and serve those who really depend on us.
Access to care
Q: What are some of the ways you’re thinking about improving access to care?
A: When I think about access to care, it’s really across the continuum. It’s not just the services that we provide here that are directly related to the work that the department does, but it’s also the broader health care landscape.
What can we do to ensure that providers, for example, are able to see as many people as possible? So are there technology tools that we can use to give providers more face-to-face time with their patients or their clients? Are there technology tools to reduce administrative burden on that front?
Similarly, on our side, on the agency side, are there things we can do to really get that value, so that the time that individuals are spending is really in direct service to beneficiaries, and not, if you will, spent doing things that don’t provide direct value.
Q: Are there any particular technologies that you’re thinking of, or any particular administrative task or red tape that you see impacting providers being able to give the best care they can give?
A: Well, I think everyone is going to look to figure out the role AI will play across various industries, including health and human services. I’d like to explore where we might have AI tools that can help us better identify individuals at risk or tools that allow those providing direct services to do so more efficiently. Also, some of this doesn’t need to be as fancy as AI. We will be implementing a new software platform that will allow county DSS offices to work more collaboratively with one another, streamline documentation on the case management platform, and help individuals understand what’s happening in adjacent and surrounding counties.
Note: The official name of the new Child Welfare Information System is “PATH NC,” which stands for “Partnership and Technology Hub.”
Child Welfare Services
Q: DHHS is facing lawsuits regarding failures with child welfare services provision in the state. Can you share more details about that tool and any other ideas for how to improve child welfare services in the state?
Note: One lawsuit alleges DHHS unnecessarily warehouses foster children in locked psychiatric facilities and another accuses DHHS of endangering thousands of children by failing to fix the state’s child welfare system. This second lawsuit also accuses DHHS of failing to develop and implement a comprehensive electronic record and case management system.
North Carolina has a county-administered social service system, meaning that counties largely control child welfare services, while the state provides guidance and some oversight.
A: As you know, we have a decentralized model where the department works in close collaboration with the county agencies to help meet those goals together. So what can we do to help support those county agencies, either through processes or procedures? I think the software tool is going to help because, as you may know, part of the work that’s been previously done has been done on paper, and a modern workforce is more accustomed to doing things on an electronic platform.
(PATH NC) is going to allow us to do data and analytics a little more effectively, so we can really understand who the children in the system are, where they are, and what types of services they’ve received. The plan is to start implementation and roll out this year. The other challenge, of course, is staffing at these agencies. These agencies face the same staffing challenges that we have at the central office. As we think about the type of efficiency that a software tool can provide, we might energize individuals into thinking this is a place where they want to start a career or build a career, because it’s modern, effective, and provides data and feedback. I feel like there are multiple things that will move in a forward direction as we start rolling out the software and working more closely with our county partners.
Staffing shortages
Q: So on the challenge of staffing shortages across DHHS, beyond the technological improvements, what steps will you take to recruit more people?
A: My experience in the private sector has informed me well in this space. We faced the same staffing challenges at private hospitals. One of the things I learned is that there is clearly a role for salary and benefits in that conversation. I think the state has done a good job, and this agency has done a good job prior to my arrival, in understanding what we can do to make salaries more competitive. What can we offer in the form of retention bonuses? What can we do in the context of sign-on bonuses? And, of course, we’re working with the Office of State Human Resources to understand what we can and cannot do in that space.
I think we need to take it a step further, based on my further experience, and start asking the question: What does it take to make you feel like you belong, and what does it take for you to find joy in your work? In my previous experience, what I learned is that it’s not always salary and benefits. It’s about, “How do you make me feel like a member of the team? How do I know that the work I’m doing is contributing to the broader mission? What are you providing for me to build a career? Help me understand what other career options I may have.”
So, the career trajectory piece is another part of it. How do we recruit them, and then, importantly, how do we retain them?
Behavioral Health Services
Q: There’s been lots of reports about how behavioral health services are lacking in the state and DHHS is facing a lawsuit on this as well. So what do you think can be done to further improve?
Note: DHHS and plaintiffs in the Samantha R. case reached an agreement that, among other things, gives DHHS two years to transition more people with disabilities into community-based services. That includes those on the heavily backlogged waitlist for Innovation Waivers, North Carolina’s primary program for individuals with intellectual and developmental disabilities.
North Carolina also faces a shortage of resources for people who need urgent mental health treatment, including in the three state-run facilities that specialize in treating individuals with complex developmental disabilities, as previously reported by The News &. Observer.
A: We know the system isn’t perfect, and we know it’s not functioning the way it should. But what I’m committed to is truly understanding the scope of the issues and then thinking about how we can propose solutions.
Many of these issues overlap, and so, as we think about the work we want to do to support those vital team members in the county agencies, some of the issues they’ll raise regarding services for their beneficiaries and clients will be related to behavioral health. So, part of what I want to understand is where those points of connectivity are, so we don’t need to silo the work as much.
Even if I go back to my three priorities, strengthening access will come from having a more stable workforce. A more stable workforce will come from having individuals experience the benefits that their clients and beneficiaries are getting through our programs and services. So, part of it is an intentional model to figure out how efficient we can be as an organization.
Working with legislators
Q: In terms of working with the General Assembly, how has that been going in terms of getting feedback on funding for your priorities, such as for salary raises?
A: When it comes to the agency’s priorities, it’s still very early. I’m still very much in the process of introducing myself to key legislators. My approach is to first understand what their priorities are as I share ours. Again, I think most health and human services are really understood at the local level, so understanding the specific priorities of legislators, both at the local level and how they roll up in North Carolina, will be part of that initial dialogue.
*Dr. Devdutta Sangvai is a former president of the North Carolina Medical Society
Dev, the denizens of our great State can breathe easy with you captaining this ship. A champion of our communities, but also a respected friend of so many of your physician peers.
Your long track record of serving, teaching and leading is an inspiration to many, including me.
Godspeed to you, Amy and all in your inner circle.