Solutions builder: Dr. "Paco" Trilla

DRIVING ACA-INSPIRED INNOVATION: Dr. Francisco "Paco" Trilla has used opportunities presented by the Affordable Care Act to help grow Neighborhood Health Plan of Rhode Island's reach and effectiveness. / PBN PHOTO/RUPERT WHITELEY
DRIVING ACA-INSPIRED INNOVATION: Dr. Francisco "Paco" Trilla has used opportunities presented by the Affordable Care Act to help grow Neighborhood Health Plan of Rhode Island's reach and effectiveness. / PBN PHOTO/RUPERT WHITELEY

CHIEF MEDICAL OFFICER

When the Affordable Care Act passed in 2010, Dr. Francisco “Paco” Trilla, chief medical officer of Neighborhood Health Plan of Rhode Island, saw a shining opportunity. Trilla, who was chief medical officer at Santa Rosa Community Health Centers in California, had already read the complete single-spaced act in its entirety “a couple of times.”

“The Affordable Care Act created a whole new series of rules and regulations that translated into new things, like accountable-care organizations. … It really allowed me to be more creative around that work,” Trilla said.

He proceeded to employ the act as a demonstration model to write a grant for the Santa Rosa Family Nurse Practitioner Residency Program. The grant, the first Trilla ever wrote, was approved in 2011 for $1.2 million over three years. It still exists, with six trainees per year, and is fully self-funded.

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While in California, Trilla learned about NHP’s work in Rhode Island with the state’s own community health care centers. To Trilla, it was “the perfect opportunity to leverage a well-run Medicaid program to obtain better coordination of services, enhanced health outcomes for patients, and increased value to taxpayers,” said Peter Marino, president and CEO of NHP.

Trilla, a native of Queens, N.Y., and graduate of Harvard Medical School, lobbied for a year for the position of chief medical officer at NHP. He had no experience in health insurance. However, the Affordable Care Act allowed for some flexibility. “The ability we have to do analytics and predictive modeling really made it much less important to have 10 or 20 years of experience than the previous models,” he said.

Trilla landed the job in 2013, moved back East, and jumped in.

There were data analysis challenges, both internally and externally. Trilla began rebuilding and streamlining the system from the ground up. He dealt with the IT department, directed HR to institute training seminars, introduced innovative software, created a committee to deal with business intelligence and data-governance systems, and expanded the team of data analysts from five to 25.

“Dr. Trilla has been a thought leader in innovating health care delivery design,” said Marino.

Trilla and his team then introduced provider-based care management to NHP.

Provider-based care management at Neighborhood was the first attempt at creating high-risk lists of patients for targeting interventions using predicative modeling and statistics,” Trilla explained. In its first year, the program reduced hospital admissions close to 25 percent, and emergency room visits by 15 percent.

In continuing to focus on prevention over cost reduction, Trilla also created Health@Home, a data-driven, home-based primary care program for high risk/high cost Medicaid patients. Health@Home reduced inpatient visits by 40 percent. More importantly, Health@Home increased the health of the patients to the point where they no longer needed the program: Nearly 90 percent of the initial patients became well enough to “graduate” out.

Since 2013, Trilla has been instrumental in leading NHP through its continued success and expansion, which, as a product of the Affordable Care Act and the choices of state leaders to widen coverage, has doubled staff, membership and revenue. Neighborhood is adequately prepared to accommodate its projected 18,000 new members who are expected to join by the end of 2017.

At work and in the community, Trilla is a strong leader. He has accrued a long roster of community leadership positions – treasurer of the Latino Health Institute in Boston, chairman of Inquilinos Boricuas en Accion (a Boston-based program to support creation of vibrant affordable housing communities), and as founder and a director for the Redwood California Community Care Organization, to name a few. He now heads a farm cooperative in Nicaragua, and introduced fresh water and a bus route in that village as well.

“It’s really given these people some livelihood. I would say I’ve gotten more out of it than they have in terms of enjoyment,” he said. “I’m very much a fan of direct action. … It’s great if you go down there and see what you can do. You have a much greater impact.”

Trilla’s engagement is aptly summarized by Marino: “With his strong leadership, quiet confidence, compassionate spirit and incredible mind, Dr. Trilla has been able to scrutinize the dynamic and daunting health care landscape to determine what challenges and opportunities exist for Neighborhood. When he does not see what the company needs, he builds it.” •

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