The Cook County Board of Commissioners on Thursday voted unanimously to fill one of the most important roles in county government: CEO of the public health system.

In a 17 to 0 vote, commissioners picked Israel Rocha Jr., who comes from New York City’s public health system, where he oversees two hospitals in the biggest public hospital network in the U.S. He’ll replace Debra Carey, who became interim CEO of Cook County Health after the health system board last year voted not to keep then-chief executive Dr. Jay Shannon.

During a virtual board meeting, commissioners touted what Rocha brings to the table: experience in public health and running hospitals that treat many people with no health insurance.

“Most importantly to me, he also brings an absolute commitment to diversity,” said Democratic Commissioner Bill Lowry.

In the middle of the COVID-19 pandemic that’s infecting Black and brown people the most, Rocha would take over a big public health system that largely treats people of color. Cook County Health includes John H. Stroger Jr. Hospital on the Near West Side, Provident Hospital on the South Side, a group of clinics and a Medicaid insurance plan with some 375,000 enrollees who are low-income or disabled. The plan is called CountyCare.

Cook County Health treats far more uninsured people than any other hospital in the region. But its mission to treat anyone who needs medical care cripples the county’s finances. And that impacts the county’s overall budget, which is proposed to be nearly $7 billion in 2021.

This is among the biggest challenges for Rocha. Cook County Health expects to provide about $418 million in medical care in 2020 that it won’t get paid for, and around $487 million next year. This is known as uncompensated care, and it’s made up of two buckets: treating uninsured people without getting reimbursed, and not collecting bills from other patients, including those who have insurance.

It could have been much worse. Last year, Shannon predicted the tab of uncompensated care would be nearly $600 million in 2020. Health system leaders say that’s expected to be less because since mid-March, when COVID-19 started raging here, Cook County Health has seen fewer patients overall.

But the pandemic also cost the county some paying customers as well. Expecting a crush of people sick with the new coronavirus, hospitals around Illinois canceled elective surgeries, which bring in crucial dollars for hospitals, and switched from in-person to video visits with patients. WBEZ documented how people in Cook County delayed medical care, potentially contributing to the coronavirus death toll. Doctors say patients are starting to come back.

Another challenge for Rocha: wooing more patients who have private insurance and CountyCare members who now mostly choose other doctors in the vast insurance network instead of at Cook County Health.This would keep more money within the health system.

Rocha’s plans for Cook County Health

In an interview Thursday afternoon, Rocha, 42, did not lay out specific details about how he’d tackle the challenges ahead, saying he hasn’t yet started the job.

But he talked about some key strategies that would help generate revenue for Cook County Health. Focus on patient safety, he said, and make it as easy as possible for patients to quickly see a doctor. That will keep them coming back.

He said it’s important too to see if patients who don’t have health insurance qualify for a program to help cover the cost of their care, and make sure doctors document every service they provide, so that the health system gets paid for them. Rocha also plans to scrutinize the types of services Cook County Health offers to see what else the system could offer.

“We have to make sure we are fiscally and financially resilient to be able to chart a future that isn’t in days or years, but in decades,” Rocha said.

Cook County Board President Toni Preckwinkle often says other hospitals in the region need to treat more uninsured patients. On Thursday, she once again sounded that alarm, and named several prominent hospitals or their CEOs who she said she met with before COVID-19 struck.

“I put them on notice,” Preckwinkle said, adding that she told the hospitals once a new Cook County Health CEO was hired, they’d be back.

Rocha said he favors rekindling those types of conversations.

“It’s difficult, but it starts with coming to a table and to decide, OK, what are you willing to provide so that we help more patients,” Rocha said.

When Elmhurst Hospital in New York City, which he runs, had a $100 million budget deficit, Rocha said he was able to break even in less than three years. He said he did so by looking at every cost, department by department. He reinvested any savings by hiring more doctors and adding more services.

“Those services, in turn, bring in more revenue,” Rocha said. “You can grow your way out of a shortage if you make the strategic investments.”

For now, he said he’s doing lots of research to create a roadmap of sorts to help him get to better know Cook County Health.

Rocha grew up in the Rio Grande Valley in South Texas and graduated from Columbia University and New York University. Since 2017, Rocha has been a vice president at the NYC Health + Hospitals system and CEO of the group’s OneCity Health, which implements various programs, like helping find housing for patients.

The New York City health system is vast, with 11 hospitals, five long-term care facilities, dozens of community clinics and a health plan that covers more than 500,000 people.

Before running hospitals, Rocha worked his way up to deputy chief of staff for U.S. Rep. Ruben Hinojosa, a Democrat in Texas. Rocha spent seven years working for the Congressman.

To run Cook County Health, Rocha will be paid $650,000 a year, $30,000 in moving expenses and is eligible for a 10% annual bonus. He would receive 20 weeks in severance pay if he left. Rocha would make more than Shannon, but would get less in severance. Even though it was part of his contract, Shannon’s severance deal set off a firestorm.

Rocha said he plans to start at Cook County Health in December.

Kristen Schorsch covers public health on WBEZ’s government and politics team. Follow her @kschorsch.