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Cook County Health CEO's departure could slow efforts for big change

Wednesday, January 22, 2014
Crain's Chicago Business
by Kristen Schorsch

The innovations Dr. Ramanathan Raju sought or implemented during his two-year reign at the Cook County Health and Hospitals System could be slowed as he departs for a big promotion in New York.

Since he became CEO in 2011 of one of the largest and most financially challenged public health systems in the country, Dr. Raju embarked on a series of initiatives to make the Cook County system more financially stable. The system operates two hospitals — John H. Stroger Jr. Hospital on the Near West Side and Provident Hospital on the South Side — as well as Oak Forest Health Center and more than a dozen outpatient sites.He created a new Medicaid program with a vast network of contracted providers to treat people in the communities where they live.

He spearheaded a foundation to raise money for the health system to reduce its dependency on the annual subsidy from county taxpayers, which totaled $362.9 million in 2012, the lowest point since 2010. He had bold plans to act as both health provider and health insurer, selling insurance in the fall on the Illinois Health Insurance Marketplace created as part of Obamacare.Cook County Health board chairman David Carvalho said the health system's plans won't change. But whoever takes on the CEO role will have a big learning curve, and that will undoubtedly slow the transformation Dr. Raju sought.

“It's hard to imagine all the big plans are going to move ahead at the same pace as they would have moved,” said Margie Schaps, executive director of the Chicago nonprofit Health & Medicine Policy Research Group.

Dr. Raju yesterday was nominated by New York City Mayor Bill de Blasio to become president of the New York City Health & Hospitals Corp. If confirmed by the system's board, it will be a homecoming for Dr. Raju, who was chief operating officer there from 2006 to 2011 before taking the CEO role at Cook County Health.With a nearly $7 billion budget, the New York health system is roughly seven times the size financially than Cook County Health.In an interview with Chicago reporters yesterday, Dr. Raju said Mayor de Blasio called him last week about the job and that his wife, a physician, and elderly mother remained in New York while he led Cook County Health.“Family obligations,” Dr. Raju said. “That's the only reason I'm leaving.”Dr. Raju is to begin his new role in late March, a spokeswoman for Mayor de Blasio's office said in an email.


Dr. Raju leaves behind a system that health care experts say is better for his leadership. He's worked to overcome decades of politics, patronage and systemic inefficiency at the health system.

“He brought a confidence and vision that looked not just a year down the road, but way down the road to what a health care system could be,” said Lee Francis, president and CEO of Erie Family Health Center, a Chicago-based network of community clinics.

In one of his biggest efforts to change the way the health system delivers care, Dr. Raju in 2012 obtained federal approval to expand Medicaid coverage a year before the statewide expansion under the Affordable Care Act for up to 115,000.

The goal was to get federal dollars to help pay for care that was already being provided to uninsured patients but not being paid for. The idea is part of a push to treat patients in less expensive outpatient settings rather than in hospital emergency rooms. CountyCare enrolled only about 70,000 people, but it created a large network with more than 130 sites to see a primary care doctor and nearly 40 hospitals.

The fate of the program, which Cook County is banking on for much-needed revenue, will be tested now that its yearlong pilot phase is over and the system is tasked with managing those patients as a health plan with a fixed amount of money per patient per month.“I think that (Dr. Raju's) sheer force of personality made a lot of this happen,” said Pat Terrell, a Chicago-based managing principal at consultancy Health Management Associates.

“Now you have to have people who are going to step up who have those skills and ability to move this forward. I think it's very concerning.”The health system also faces a dearth of money for the foundation Dr. Raju helped launch to help pay for a range of projects that the county can't afford, including high-priced medical equipment, renovation projects and new patient beds.

So far, the foundation has raised $100,000 from gubernatorial candidate Bruce Rauner and has $250,000 in seed money from the health system. Barbara Otto, CEO of Chicago non-profit Health & Disability Advocates, noted that Dr. Raju assembled a strong leadership team that can carry on his ideas. He promoted or recruited nearly a dozen people from health organizations across the country as part of his reorganization of senior management in 2013.


Cook County Health officials appear confident they will be able to follow Dr. Raju's vision.In an email, Mr. Carvalho said Dr. Raju “has assembled an outstanding team and the board fully backs the strategy; we will continue with our plans.”A spokeswoman for Cook County Board President Toni Preckwinkle echoed his sentiments.

“Dr. Raju established a vision for the Cook County Health and Hospital System,” the spokeswoman said in an email. “He developed a strategic plan and brought talented people on board to realize it. The mission remains the same. We will build upon that success and continue the transformation of the health and hospital system.”

As for Dr. Raju, he said his most “unfinished business” remains improving the patient experience in a system often perceived as the last resort for the county's poor and uninsured patients. With the Medicaid expansion and previously uncovered consumers buying plans on the Illinois health insurance exchange created by the federal health care law, Cook County Health's patients now potentially could seek care elsewhere.“For the first time, these people have a choice,” he said.

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