By Jaymie Baxley
The walls of Devdutta Sangvai’s office were mostly bare on his third day as North Carolina’s top health official.
A physician, professor and former president of Duke Regional Hospital, Sangvai had been far too busy settling into his new role as secretary of the state Department of Health and Human Services to decorate.
“It feels like Month Three based on how busy it’s been, but it’s been remarkable,” he said in an exclusive interview with NC Health News. “I entered into this space because I had such a strong affinity for what the department does […]. And then when you’re actually here and you get to see the people doing the work — it really is a special place.”
Sangvai was tapped in December by newly elected Gov. Josh Stein to lead the department. Once he’s confirmed, he will be the first Indian-American cabinet secretary in North Carolina history. He will oversee a complex, multi-faceted agency with more than 18,000 employees and an annual budget of about $1.6 billion.
His appointment follows the departure of Kody Kinsley, whose three-year run as secretary coincided with the state’s expansion of Medicaid in 2023. That decade-in-the-making measure has allowed more than 600,000 low-income adults to join the government-funded health insurance program, swelling the state’s total enrollment to more than 3 million.
Kinsley succeeded Mandy Cohen, who was secretary from 2017 to 2021. She spearheaded North Carolina’s Medicaid transition from a traditional fee-for-service system to one run by large managed care insurance companies. Cohen also led the state’s response to the COVID-19 pandemic before being chosen by President Joe Biden to serve as director of the federal Centers for Disease Control and Prevention.
“My two predecessors in this role did such a fantastic job — not just in actually doing the work, but being able to communicate the vision of the department,” said Sangvai, adding that he has been repeatedly reminded he has “big shoes to fill.”
Sangvai believes he’s up to the task. He hopes to build on his forerunners’ successes by improving access to services for Medicaid beneficiaries and increasing “efficiency around the work we do.”
“First and foremost, we’re going to continue the work that’s already been laid forward but ask ourselves along the way: ‘Are there things we can do differently? Are there things we might be able to do more creatively?’” he said. “This idea around ‘how do we get more efficient’ may require us to think about creativity. Are there any technology tools that we might be able to use to help us achieve these outcomes?”
Another priority, he said, is addressing the ongoing shortage of health care professionals across the state. Demand for registered nurses, in particular, is expected to exceed North Carolina’s supply by nearly 12,500 positions by 2033, according to projections from UNC Chapel Hill’s Cecil G. Sheps Center for Health Services Research.
“We know that we have an opportunity to really train up a workforce that North Carolina needs in the future,” Sangvai said. “Not only in the department, but really throughout health care.”
‘Good guy’
A graduate of what was then the Medical College of Ohio, Sangvai has been licensed to practice medicine in North Carolina since 2001 — the same year he joined the Duke University Health System as a family physician.
He led several divisions and departments during his two-decade rise through the Duke system’s ranks, and in 2023 he became president of Duke Regional Hospital in Durham.
His career at Duke, which also included stints at the helm of a hospice program, a nursing school and an office that seeks to improve patient outcomes through population-focused health initiatives, gave him a “sense of the enormity of a complex organization,” he said.
“I felt that so much of that translated to the type of complexity that we see here at HHS,” Sangvai said. “But more importantly, every one of those [positions] had a touchpoint with the kind of work we do here.”
Mary Martin, chief operating officer for Duke University Hospital, worked closely with Sangvai when he was in charge of Duke Regional. She described him as a collaborative, inclusive leader who “understands the challenges facing the citizens of North Carolina from a health care perspective in a way that most people do not.”
“Selfishly, I’m excited that he understands the hospital side of the business, because the requirements to continue to make sure that we keep our folks well, which is the right thing to do, often come with an unfunded mandate,” Martin said. “Him understanding the balance of making sure we need to keep our patients well while also being able to provide the staff to make sure that happens, I think, is going to be so invaluable.”
She added that Sangvai is a “very personable” collaborator who believes in positive reinforcement.
“He was always a colleague that when I did something well, he’d be the first one to reach out and say, ‘Great job. Congrats,’” she said. “I would just classify him in the ‘Good Guy’ category. He’s one of the good people, and I think that the state of North Carolina and Governor Stein are very lucky to have him on board.”
His appointment was also praised by Chip Baggett, CEO of the North Carolina Medical Society. Sangvai was president of the organization in 2013 and has served on its board of directors.
“Having worked with Dr. Sangvai for many years, I am thrilled at his selection to lead the Department of Health and Human Services,” Baggett said in a statement on the society’s website. “He brings a wealth of knowledge and leadership experience to this role. I am confident he will uphold North Carolina’s strong tradition of providing excellent health services to residents, with a focus on vulnerable populations such as children, the elderly, individuals with disabilities, and low-income families.”
Bracing for change
Sangvai is taking the reins at a time of uncertainty for DHHS’ largest program: Medicaid.
The incoming Republican majorities in Washington, D.C., have signaled interest in cutting Medicaid funding during President Donald Trump’s second term. The program facilitates care for low-income children and many of their parents, low-income seniors and people with disabilities.
There have also been calls to implement stricter eligibility requirements to qualify for care. Project 2025, the controversial policy blueprint whose Heritage Foundation think tank authors have been elevated to key roles in Trump’s administration, includes a proposal that would force unemployed Medicaid participants to find work in order to keep their benefits.
The department, Sangvai said, is bracing itself for potential changes.
“I think our responsibility now will be just to focus on what the federal government may or may not propose, and then try to understand what the impact would be here,” he said. “But clearly it’s something that we may need to even focus on as early as [Trump’s first day in office].”
Additional uncertainty surrounds North Carolina’s first-in-the-nation Healthy Opportunities Pilots, which use Medicaid dollars to address nonmedical health needs like food, transportation and housing in three rural regions of the state.
The federal Centers for Medicare and Medicaid Services recently approved a request that gives DHHS the option to take HOP statewide, but its expansion must first be approved — and supported financially — by lawmakers in the General Assembly.
“We have to think about how we exercise the options that CMS has given us, so it’ll definitely require partnership with the General Assembly to understand where those priorities are,” Sangvai said. “We’re not going to be able to do everything all at once, and we’re not going to be able to do it at 100 percent all at once.”
Learning the ropes
Sangvai, who is serving as interim secretary until his appointment is confirmed by the state Senate, said his predecessors have given him a few pointers for navigating North Carolina’s political landscape.
“Dr. Cohen shared with me some things to do and some things to be cautious about,” he said. “And similarly, with Secretary Kinsley, I actually had an opportunity to hang around here a little bit [with him] before I actually took office.”
He said the former secretaries told him to do “a lot of listening” and “be prepared for long hours,” among other advice.
Still, Sangvai acknowledged one of the biggest challenges he’ll face in the months ahead is taking his “experience at the individual level and communicating it up at the policy level.”
“I think I have a really good experience as it relates to many of the things the department does and how it impacts individuals,” he said. “But then taking that and being able to communicate it at a policy level or communicate that at a department initiative level — that’s one of the things that I’m going to focus on.”
At the same time, Sangvai said he feels well positioned to succeed thanks to the administrative groundwork laid by Cohen and Kinsley.
“I think that I’m probably one of the luckiest secretaries to be in this role because so much of that foundation has already been built,” he said. “That vision that’s already there is so much of what resonates with me.”
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