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Incoming DHSS secretary: We have the tools to avoid another shutdown

Molly Margarik will take over the Delaware's largest state department in August.

It’s THE question on everybody’s mind:

Would Delaware dare to close businesses and initiate another lockdown if the number of COVID-19 cases and hospitalizations begin to rise again?

Molly Magarik, who takes over Aug. 1 as secretary of the Delaware Health and Social Services Department, won’t say yes or no.

But she did say, “I think we have more confidence in having the necessary tools to avoid a shutdown.”

Margarik, who will become secretary when Dr. Kara Odom Walker leaves the job on July 31, talked about a variety of topics Thursday: the impact of the coronavirus pandemic, tracking state health costs, attempts to reorganize and maybe split the department, the certificate of need process and complaints that she’s not a medical doctor, among others.

Walker is leaving to become Nemours’ National Office of Policy and Prevention in Washington, D.C. Nemours, which owns A.I. du Pont Children’s Hospital in Wilmington, also has facilities in New Jersey, Pennsylvania and Florida.

Margarik, who is a Delaware native, has served as deputy secretary since February 2017. She directed and managed key priorities for the department, including health care financing, payment and delivery system reform; budget administration and management; and early childhood education. 

Before that, she was state director for Carney when he was a U.S. congressman, and political director for Beau Biden’s campaign for attorney general.

DHSS is the state largest department, with a 2021 budget of $1.3 billion, which is 27.9 percent of the state budget. Those figures don’t include federal Medicaid money. It has 11 divisions and in 2021 is budgeted for 3,925 full-time employees who handle a large variety of social services, including public health, public assistance programs and more.

Margarik and her husband have twin 5-year-old daughters and live in Middletown.

One of the best things about the new job, Margarik said, is the intrinsic certainty of the work:

“We never have to question when we get up and go to work whether we have the opportunity to make a difference for the people of Delaware.”

Here’s what she had to say about taking the leadership of DHSS:

Contact tracers are one means to help Delaware avoid another shudown, incoming DHSS secretary Molly Magarik  said.
Contact tracers are one means to help Delaware avoid another shudown, incoming DHSS secretary Molly Magarik said. Photo courtesy of Capt. Brendan Mackie.

Covid-19

The department has become accustomed to people asking whether the state might face another shutdown, she said.

“We’re in a very different place than we were when this pandemic really started to take hold in the spring,” she said.

Then, she said, as the global pandemic unfolded, there was concern about supplies, include ventilators and personal protective equipment, as well as whether the state had enough beds for the severely ill. Testing was an issue on many levels.

Now, she says, supply chains have leveled out and warehouses are stocked. Reliable testing is readily available through public and private means.

The state will turn to contact tracing, with first workers starting that job Monday, to try to slow the spread, she said. Those workers will contact people who test positive for the novel coronavirus, and try to find out where they were and have been.

Then the tracers will try to contact people who may have been exposed to the virus and ask them to stay home for two weeks and break the chain of the infection. Both the original case and the contacts will be tracked to be sure they are getting care and they stay home.

“I don’t think anybody wants to go backward,” Margarik said. 

But that also means the state needs the public to take seriously wearing face coverings, washing their hands and observing social distancing. 

“Those things are really cornerstones of how we prevent the spread of infection,” she said on the same day that Carney announced he was delaying Phase 3 of the reopening. 

The reorganization committee

Margarik said a task force created last year by State Sen. Nicole Poore (D-Wrangle Hill) to look at reorganizing DHSS had been beneficial for the department. Many thought at the time that Poore intended to try to split the massive department. 

It’s turned out to be a great place to dive into the details about what the department does and why it does it, Margarik said.

She said there have been great series of conversations about why things happen and a shared vision about how to improve. That includes things like communicating better with stakeholders, embracing social media, being responsive to the people they serve, empowering those people and helping them more seamlessly navigate those services.

Margarik felt like the department and task force made great strides. Like much other government work, the task force is paused until 2021. 

“I think, again, our understanding is that it really wasn’t about the size of the department per se,” Margarik said. “It was about how does the department serve the people of Delaware.”

Benchmarking

Two years ago, the state announced it would start a process to measure the cost of health care in Delaware.

The goal was to slow the rise in costs by keeping them at less than 3.8 percent a year, considered sustainable when compared to economic growth. The state planned to look at health care expenditures — by state, employees and patients — and see where and why costs rose as a first step of addressing it.

The state collected the 2018 expenditures and is still collecting the 2019. It will collect 2020 data, Margarik said

“I think it’s important to collect it whether there is a pandemic or not,” she said. But if 2020 expenditures are out of whack, she said, “We have a clear reason why.”

Asked if the program will continue, she said, “I think that remains to be seen.”

“Being able to have Delaware data, including the year-over-year trend, helps us tackle the big problem of health care costs and start looking at a little bit more of a gradually leveling.”

Eventually, DHSS officials said when they began the program, they would like make data collected available to the public.

That will not be coming any time soon, Margarik said.

The Certificate of Need Board, which oversees hospital beds and other health business issues, will face the state's Sunset Committee next year.
The Certificate of Need Board, which oversees hospital beds and other health business issues, will face the state’s Sunset Committee next year.

The Certificate of Need board

The state’s Certificate of Need board, which is supposed to help reduce state spending on health care, expand access to service and improve the quality of health care, is before the Sunset Committee. Most government boards routinely face review by that committee.

The CON board is charged with regulating the number of hospital and nursing home beds and tries to prevent duplication in medical service, among other things.

While some hospitals and the Delaware Healthcare Association say the board is needed government oversight, opponents say it squashes free market competition, has outlived its usefulness and should be disbanded.

DHSS staffs the board, but it does not control it, Margarik said. She said that in the sunset process, the department provides information requested by the committee. 

“If something is going to drive up health care costs or something is going to be a redundant service, that needs to be a consideration,” she said. “And we think the language is consistent with other conversations we’ve had about thinking about the number of services vs. the value of services in keeping people healthy.”

On not being an M.D.

When Carney nominated Margarik, some people pointed out she isn’t a medical doctor. 

The secretary is not required to be an M.D., but the state health officer is, she said. And the department has clinicians in every department to advise the leadership, she said.

She is about to earn master’s degree in health care delivery science from Dartmouth College. That program is a merger of a master of business administration and a master’s in public health.

Trends she expects to face

Among that things Margarik said she expects to face is the continuing opioid epidemic. The pandemic has stressed people out and cut them off from programs that helped because access was closed or because people lost their jobs, she said.

“People are scared,” she said. “People are scared to go to a doctor’s appointment or scared to go to an emergency department or seek out services … There’s so much fear and uncertainty.”

There’s been an increase in domestic and child abuse, she said. 

The state is going to have to deal with the lack of primary care in many areas, especially downstate, she said. She pointed to the state’s Primary Care Reform Collaborative under the Delaware Health Care Commission as one way to tackle that.

And, she said, “I hope through the pandemic we’ve realized the importance of public health.” 

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