From medical marijuana to the rise of for-profit hospitals, state health officials have had no shortage of hot-button issues to deal with in recent years.
But when Mary E. O’Dowd looks back on the past seven years with the state Department of Health – the last four years as health commissioner – she focuses on the details of policy implementation, including improving the state’s health-information technology and implementing a new federally funded program to improve healthcare delivery.
And it’s that same focus on the details that earned O’Dowd praise from observers who’ve given her high marks since she took over as commissioner at age 33 in 2011.
She’s leaving her position on July 31 and is joining the board of Horizon Blue Cross Blue Shield of New Jersey.
In a recent interview, the 37-year-old Princeton resident reflected on those initiatives that she’s most proud of, including an effort to increase statewide breastfeeding rates and initiating conversations about how patients want to be treated at the end of their lives.
She also highlighted healthcare issues that she thinks state health officials should continue to focus on.
Policy analysts say O’Dowd’s public health-focused approach served guided the department well as it transitioned away from overseeing senior services — a function that was shifted to the state Department of Human Services.
On the other hand, the state’s response to health-related issues – such as the handling of the Ebola scare – has sometimes come in for criticism, but O’Dowd maintains the state acted correctly.
Healthcare experts also said that, in other areas, her legacy remains to be resolved, including unresolved questions about the fate of Newark-area hospitals.
O’Dowd noted that her time as commissioner occurred amid broad shifts in healthcare delivery. She said a top priority for the department has been to support and protect the hospitals and federal qualified health centers that serve as a safety net for low-income residents.
Along with investing in a statewide “health information exchange,” which will allow hospitals to share patient information across geographic boundaries (not to be confused with the Affordable Care Act insurance marketplace exchange), she also pointed to the launch of the Delivery System Reform Incentive Program (DSRIP) as a significant achievement during her tenure.
The DSRIP program – funded with a mix of federal and state dollars — will pay hospitals based on how well they treat specific illnesses that they’ve identified.
“I see that as a new and innovative program that allowed us to align our (federal) subsidy dollars with” hospital performance and improving the health of entire populations of patients, O’Dowd said.
New Jersey Hospital Association CEO Betsy Ryan said she enjoyed working with O’Dowd on issues like baby and maternal health, as well as end-of-life care and healthcare quality improvement.
“She brought her own personal commitment and great energy to these efforts, and that work has made a real difference in people’s lives,” Ryan said. “That is one of the vital, lasting contributions of Commissioner O’Dowd.”
O’Dowd once worked for Ryan at the hospital association — Ryan described hiring O’Dowd as “one of the smartest professional moves I’ve ever made.”
As commissioner, O’Dowd also focused on improving birth outcomes, as well as maternal and infant health, which has contributed to higher breastfeeding rates, lower induced-labor delivery rates, and increased coordination with other state departments in delivering services to Medicaid recipients.
O’Dowd described the focus on improving babies’ health as “an opportunity to improve a generation’s health status, which is really exciting.”
Another area that O’Dowd points to with pride is the management of the department’s operations. Along with the successful transfer of senior services to DHS, O’Dowd also oversaw the department’s application to become nationally accredited. This has required showing the Public Health Accreditation Board that the department operates well and works efficiently. She expects the state public-health accreditation process to be completed in the next several months.
Joel Cantor said this bureaucratic management, which isn’t the most attention grabbing of government tasks, was a strong suit of O’Dowd’s.
“The operational side has run really well on her watch,” Cantor said, singling out O’Dowd’s handling of DSRIP for praise.
Heather Howard, a former commissioner who hired O’Dowd as her chief of staff in 2008, described O’Dowd as a “tremendous leader” who’s caring and effective.
“She led the health response to Sandy and had a very calm hand during very challenging times,” said Howard, who directs the State Health Reform Assistance Network at Princeton University’s Woodrow Wilson School of Public and International Affairs.
O’Dowd leaves with several efforts she initiated still underway, including the campaign to improve birth outcomes, of which she said: “There’s a lot of opportunity, and I’m hopeful that the momentum will continue.”
In addition, O’Dowd said that it’s important for the state to push the healthcare system “in the right direction from a public-health perspective and a population-health perspective,” using programs like DSRIP. But these changes in how healthcare providers are paid must not “pull the rug out from under” these providers, she added.
O’Dowd praised Gov. Chris Christie’s management of health issues.
“I’ve really enjoyed” working for Christie, she said. “He is very smart. He considers a lot of different aspects of an issue. When I have an opportunity to brief him on challenging or complex issues, I feel that he always adds valuable insight.”
She also credits Christie for appointing her as commissioner when she was far along in a pregnancy.
“You don’t see that in society. It’s not very often that you see someone choose an individual for such a important office” who’s about to have a baby, she said. “It speaks to Gov. Christie’s character and interest in women’s leadership.”
Her son is now 4, and she’s expecting her second child in late August.
Not all of O’Dowd’s projects have been met with praise.
O’Dowd defended the state’s handling of one area where it has come in for severe criticism – the response to the Ebola outbreak last fall. Dr. Fred Jacobs, one of O’Dowd’s predecessors, has said that state health officials should have been “out in front” on Ebola.
“This was kind of preempted by the political people, mainly the governor, so that the credibility of the message was tainted by seeing it through a political prism — that shouldn’t happen,” Jacobs said last December.
O’Dowd described Jacobs’ critique as a “reflection of the media coverage” rather than being based on the state government response. O’Dowd noted she was at Christie’s side when he announced that those who had direct contact with Ebola patients would be quarantined, and that he was appointing her to lead the state’s response.
“I think that we worked to try to bring a very comprehensive plan to our response, but also worked with local health officials,” to respond to each person investigated for Ebola contact, O’Dowd said.
She also said public health officials had to balance the desire of the public and media for more information about new cases with the privacy of those under investigation, including those that she described as “the heroes of the response to Ebola” – the providers who went overseas to fight the spread of the disease.
“I think that we tried to do a good job in preparing in advance and in our response but, you know, it’s not always covered in exactly the way that I would write it,” she said.
[related]O’Dowd said that the state learned from the Ebola experience and has used federal funding to better prepare it for future incidents of travel-based illnesses, such as Lassa fever and measles.
Supporters of medical marijuana say that the state’s implementation of the program has been heavy-handed and slow. State health officials have responded that progress has been steady.
O’Dowd unsuccessfully proposed raising taxes on electronic cigarettes – a rare occasion in which the Christie administration proposed a tax hike only to see it shot down by the Legislature.
And advocates for Saint Michael’s Medical Center in Newark have criticized the state for its lengthy review of California-based for-profit hospital chain Prime Healthcare’s proposal to buy the hospital.
Saint Michael’s is anxious for the acquisition to move forward, but that transaction may have been complicated by a report by a state consultant that recommended ending Saint Michael’s and two other hospitals’ role as full-service, acute-care hospitals and transitioning them to become outpatient centers.
O’Dowd has said she hopes the department will use the consultant’s report in its review of the sale.
The past few months have presented a new challenge for O’Dowd, as she had to negotiate an ethical minefield since last fall, when her husband Kevin O’Dowd, Christie’s former chief of staff, became an executive at Camden-based Cooper University Health Care. O’Dowd said she would recuse herself from any decisions involving Cooper. She hasn’t said whether that situation was a factor in her resignation.
Looking toward the future, O’Dowd said she’s excited about the opportunity to bring a public-health perspective to Horizon.
David Knowlton, CEO of the New Jersey Health Care Quality Institute, said Horizon “can use somebody with her policy savvy” during a time of significant changes for the insurer. Knowlton said O’Dowd “really turned the Department of Health back to what it should be – a public health agency.”
Cathleen Bennett, the Department of Health’s policy and planning chief, will become the acting health commissioner. O’Dowd said the department is in good hands.
“I’m really excited to see what she brings to the department’s top job,” O’Dowd said.