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Editorial: Next head of county health care system will have large shoes to fill

Thursday, January 23, 2014
Chicago Sun-Times
by Editorial

The next executive chosen to lead the third largest public hospital system in the U.S. will have awfully large shoes to fill following the departure of Dr. Ram Raju, who announced Tuesday he is leaving Chicago to run New York City’s hospitals.

“You’re looking for a miracle worker,” said Lewis Collens, a director on the hospital system’s board, which will soon launch a search to find Raju’s replacement. “There aren’t that many of those out there.”

In addition to navigating the layers of bureaucracy and adapting to shifts in how health care is provided under the Affordable Care Act, the next CEO chosen by the Cook County Health and Hospital System board also will have to grasp the complexities of Illinois politics.

“It has always been a very demanding position, perhaps the most demanding public service position in the region,” said Laurence Msall, president of the Civic Federation, a non-partisan think tank.

Msall added that because of Raju, “There is now proof you can effectively manage the county health system.”

But the next CEO of Cook County’s $1 billion-a-year public health system also will be tasked with finishing what is perhaps Raju’s most ambitious project: turning the hospital system — often associated with treating the destitute — into a health insurance provider.

The proposal has the potential to stabilize the historically cash-strapped system. County workers would be insured through the system and incentivized to get medical care at its facilities, redirecting money currently spent elsewhere back into the county.

While the details are still being crafted, the concept has the backing of Cook County Board President Toni Preckwinkle.

“It was a very ambitious plan, but it’s the best chance for the county to grow and stabilize itself,” Msall said.

Two big pieces will need to fall into place before it can be adopted, said David Carvalho, chairman of the hospital system board, which is independent from the county board that finances the hospital system.

County employees unions will need to negotiate and sign off on the change to their health benefits, officials said. Secondly, customer service and medical care at county hospitals will need to continue to improve in order to attract clients and make the benefits changes palatable to county employees.

“Change is hard. Maintaining the status quo is not an option for the long-term success of the organization. I think everybody understands that,” Carvalho said. “Wouldn’t it be neat if the folks who worked for the county would be able to get their care through the county?”

Finding a top-flight successor to Raju will hopefully be easier than in the past, board members said.

Several years ago, the hospital system was broken free from the county government and given its own governing board. While the Cook County president must sign off on directors appointed to the hospital system board, she must draw from a pool vetted by a group of civic leaders and health care professionals.

That change has helped remove political wheeling and dealing from the county hospital system, a former patronage dumping ground, officials said.

Additionally, during Raju’s tenure, he was able to attract talented people to the improving system.

“I think everybody who worked with Dr. Raju is disappointed that he’s leaving,” said Collens, who is on the board. “He’s done a great deal to solidify the financial structure, he‘s done a great deal to improve the efficiency and improve the quality… It’s just a much more attractive place than it was a few years ago.”

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