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Last month, Oregon Health Authority director Sejal Hathi penned an essay in the nation’s leading newspaper, arguing the health care system abandoned her after she gave birth to a child. A few days later, Oregon’s largest primary care group sent Hathi a letter outlining ways she might use her official position to help primary care providers treat families in a more holistic and coordinated way.
“Thank you for your timely and thought-provoking New York Times op-ed on the challenges new mothers face in our fragmented health care system,” said the letter from leaders with the Oregon Academy of Family Physicians. “We agree that too often the system offers inadequate support to new families. Thankfully, Oregon has the infrastructure to address many aspects of the excellent model you propose.”
The letter, reviewed by WW, recommended several courses of action (for example, defining primary care more precisely, making it easier for providers to get into primary care). But it began with the starkest fact: Oregon has for years allocated money to incentivize primary care providers to offer quality, wraparound care. But recently, as it diverted funds to manage out-of-control costs, OHA, which Hathi runs, has “drastically” reduced this portion of its budget.
“The care you describe in your op-ed is possible,” the letter said, “if Oregon builds on its achievements with a sustainable funding model that enhances team-based care instead of tying reimbursement to a one-on-one visit between a patient and a clinician. Too many Oregonians do not experience the coordinated, comprehensive care available in this model, and that number will grow without intervention.”
Hathi’s May 25 op-ed detailed her experience of receiving close health care during her pregnancy, but then feeling abandoned by the health care system after giving birth to her child, even as she experienced serious, lingering postpartum health problems. Hathi argued the the dominant obstetric care model treats postpartum recovery as a brief coda to pregnancy, leaving new moms to fend for themselves, often while dealing with ongoing physical and mental health issues.
“My obstetric specialist discharged me at six weeks after delivery, and the general OB clinic was stretched so thin it had stopped scheduling new postpartum patients,” Hathi wrote. “My primary care physician said postpartum recovery was outside her scope. So I assembled my own care: researching my symptoms, calling pelvic floor therapists, coordinating referrals.”
Hathi noted that her struggles to find health care were particularly striking given that she is a leading health official with good insurance and paid leave. “What I did not have,” she wrote, “was a single provider who could serve as a quarterback for my care.”
She proposed an alternative integrated model in which maternal and pediatric services were in the same location, and mothers and babies screened for common conditions during the same visit. She wrote that such models would require not just a change in how the health system pays and delivers care, but a broader conceptual shift too: an acknowledgement that a “mother’s recovery matters as much as her newborn’s growth.” She cited Finland’s strides in this direction.
In its response letter, the Oregon Academy of Family Physicians said models resembling this vision also exist in Oregon, and described the state as a national leader in primary care delivery. Clinics tied to Oregon’s “Patient-Centered Primary Care Home” program generally provide maternal and pediatric services in one location, the letter said, “often along with mental and behavioral health specialists and access to traditional health workers who connect families with resources to address social drivers of health.” But these institutions, the letter suggested, could use additional support.
In any event, the primary care leaders said the issues Hathi discussed were “closely aligned with the primary care-centered system evidence tells us would best benefit all Oregonians,” and that they would like to meet with her to discuss these issues in greater depth.
Asked, among other things, if Hathi had responded to the letter, an OHA spokesperson said the New York Times essay was a personal submission Hathi made independently of the agency, and that OHA would thus decline to comment.
