Meet the CEO who'll run Cook County Health

This year was among the most challenging of Israel Rocha Jr.’s career. And the months to come likely won’t be a cakewalk, either.

After running two of New York City’s busiest hospitals during the first U.S. wave of COVID-19, Rocha is set to take the helm at Cook County’s public health system, just as hospitals here brace for another virus surge.

Like many hospital and clinic leaders, 42-year-old Rocha will face pressure to manage tectonic shifts in health care, driven partly by new payment models, and rein in mounting operating costs. But unlike many of those leaders, Rocha also will be responsible for an insurance company, medical services for detainees at the Cook County Department of Corrections and the county's Department of Public Health. He’ll do it all while navigating a public health crisis that has resulted in 76,000 COVID cases and more than 2,300 deaths in suburban Cook County alone.

“The legacy and reputation of this organization is not lost on me,” Rocha said in an interview this week, as the Cook County Legislation & Intergovernmental Relations Committee voted to approve his appointment. The move is expected to be confirmed by the Cook County Board today. His start date is still being worked out.

“My first priority is to listen . . . and to understand what the needs are," Rocha said. “And then I want to do an evaluation of our operations and see what we’re doing well, what we can do better and how we can make that happen as a team.”

That approach has served Rocha well as a vice president at NYC Health & Hospitals, the largest public health system in the country, where he’s been CEO of 545-bed Elmhurst Hospital since 2016 and CEO of 253-bed Queens Hospital since earlier this year. NYC Health has a total annual budget of $8 billion. Cook County Health's budget this year is $3.4 billion.

Elmhurst Hospital “is in the most ethnically diverse part of our entire country, with immigrants from a wide variety of countries, and he’s universally loved,” NYC Health & Hospitals CEO Dr. Mitchell Katz said. “He does these street tours where he walks with the doctors and meets various storekeepers. He works closely with community groups.”

Rocha demonstrated his commitment to serving the community by expanding hospital capacity, among other initiatives, during the pandemic, Katz said, noting that the two hospitals Rocha ran were hit hardest out of all 11 in the network. 

“In many ways, the fact that people kept coming to Elmhurst, and felt safe to go to Elmhurst, was a testimony to the work he and his colleagues did at the hospital,” Katz said.

But the influx of COVID cases at Elmhurst and Queens led Rocha to suspend his candidacy for the top spot at Cook County Health, which was battling the pandemic without a permanent leader. As time went by and social distancing caught on, the number of cases and hospitalizations fell in New York City—as well as in the Chicago area—and Rocha was able to pick up where he left off in the county's CEO hiring process.

In addition to his experience serving a diverse community, Rocha will be the first permanent Latino CEO of Cook County Health, which treats large numbers of poor and uninsured patients, many of whom are Black and Brown.

With African American and Latino communities disproportionately impacted by the pandemic, “it’s a particularly appropriate time for a person of color to be leading this system,” said Cook County Board President Toni Preckwinkle.

The significance is not lost on Rocha, who grew up in a small South Texas community at least 300 miles away from specialized medical care. While Rocha said the distance wasn’t a barrier for his parents, an educator and a factory worker, he saw the toll it took on family and friends.

“Growing up in that way, when you don’t have those services readily available, it leaves you with an impression that we have to fight to increase access,” Rocha said. “It made a meaningful change in my life to see what can happen when you don’t have health care.”

A focus on increasing access to care has been a mainstay throughout Rocha’s career, from working on health policy on Capitol Hill to leading safety-net hospitals that treat patients regardless of their ability to pay.

When he takes the helm at Cook County Health, commissioners will look to Rocha to leverage the work he did at Elmhurst Hospital—including increasing patient revenue and securing additional funds for infrastructure improvements—to build financial strength while reducing gaps in care here.

And with a new CEO on board, Preckwinkle said Cook County Health can resume plans to build a $240 million facility to replace Provident Hospital in Bronzeville. The new facility, which was approved by the state late last year, will focus on outpatient services to prevent patients on the South Side from having to travel to Stroger Hospital, about 8 miles away.

Among challenges Rocha will face leading the health system, Preckwinkle said the rising burden of uncompensated care is toward the top of the list. The system's two hospitals provided more than half of all free care for low-income patients—about $348 million worth—in the county in 2018, according to the most recent state data available.

“Clearly, the other providers in the Cook County ecosystem are not carrying their weight, and how to get them to do that has eluded me so far,” said Preckwinkle, adding that she met with a number of local health system CEOs before the pandemic to discuss Cook County Health’s disproportionate share of charity care. 

In addition, the health care system is bracing for a potential repeal of the Affordable Care Act, which could result in more than 300,000 Cook County residents losing coverage. Oral arguments are scheduled to begin Nov. 10 in the U.S. Supreme Court to determine the fate of the landmark health care law, which expanded the state’s Medicaid program and established a health insurance marketplace for uninsured individuals, among other protections.

Cook County Health estimates the impact on the health system of an ACA rollback would be roughly $1.4 billion annually, including increased uncompensated care costs and lost revenue from CountyCare and other Medicaid managed care plans.

“When it comes to federal reimbursement and policy, there’s a set amount of funds, and we use those to fund our hospitals in different ways through different programs,” Rocha said. “Any time that’s changed, you need to see what’s coming forward. I would always advocate to make sure safety-net systems are covered and that they’re empowered to render care.”

As CEO, Rocha will get a base salary of $650,000 with a 10 percent annual bonus opportunity. He’ll move to Chicago soon after his appointment is confirmed. He said his wife, a prosecutor for the U.S. Department of Justice, will to join him here eventually.

While Rocha said he plans to lean on clinicians, community members and other stakeholders to quickly get up to speed, he does have some insight from two former Cook County Health leaders.

Dr. Ram Raju, who led the system until 2014, when he took over at NYC Health & Hospitals, hired Rocha in New York. There, Rocha also worked alongside William Foley, Raju’s predecessor at Cook County Health.

Asked what advice the former system CEOs gave him about running Cook County’s public health network, Rocha said they told him, “Make sure to add to its legacy and its ability to serve.”