One of the loudest conversations in clinical research right now is about patient representation. The quieter, harder conversation is about infrastructure: who actually builds the sites, trains the staff, and earns the patient trust that makes diversity enrollment possible in the first place. Patricio Casillas, CEO of Rovia Clinical Research, and his experienced team have spent years working on that second problem. Across 8 states such as Mississippi, Alabama, Missouri and Louisiana, largely in the Southeast and Midwest, Rovia operates in rural counties with smaller local populations and alongside federally qualified health centers and rural health systems that have limited clinical trial experience. The network's recent acquisition of a phase I to III facility in Aniston, Alabama adds early-phase capability to a footprint that was already doing something most sponsors struggle to replicate: enrolling underrepresented patients at speed, without trading one for the other. Casillas spoke with Vanguard about how the economics actually work, what sponsors are asking for in 2026, and why two decades of community relationship-building cannot be replicated overnight.
One of the loudest conversations in clinical research right now is about patient representation. The quieter, harder conversation is about infrastructure: who actually builds the sites, trains the staff, and earns the patient trust that makes diversity enrollment possible in the first place. Patricio Casillas, CEO of Rovia Clinical Research, and his experienced team have spent years working on that second problem. Across 8 states such as Mississippi, Alabama, Missouri and Louisiana, largely in the Southeast and Midwest, Rovia operates in rural counties with smaller local populations and alongside federally qualified health centers and rural health systems that have limited clinical trial experience. The network's recent acquisition of a phase I to III facility in Aniston, Alabama adds early-phase capability to a footprint that was already doing something most sponsors struggle to replicate: enrolling underrepresented patients at speed, without trading one for the other. Casillas spoke with Vanguard about how the economics actually work, what sponsors are asking for in 2026, and why two decades of community relationship-building cannot be replicated overnight.
Moe: How did your background on the commercial side at J&J and Lilly shape the way you think about site operations now?
Patricio Casillas: My experience at J&J and Eli Lilly was more on the commercial side, sales, marketing, product commercialization. Having said that, the industry has evolved tremendously over the past 20 to 25 years. Back then there was less focus on clinical operational efficiencies and quality in the sense that we have now. It was a lot of academic centers, urban facilities, and a lot of inefficient use of money on trials. The failure rates of phase 1, 2, and 3 trials are likely still at similar levels, but the costs and speed associated with them have improved over time. Things like trial start-up speed, quality, and enrollment have advanced over time. You weren't getting as much rural representation. Now, Rovia is uniquely getting access to underrepresented communities, but also doing that with start-up speed and enrollment velocity. For us, it's not one or the other. It's speed, enrollment, and quality, but doing it in spaces that haven't had research before.
Moe: How does your operational model differ between rural sites and urban ones?
Patricio Casillas: The operational backbone is the same in the sense that we've invested heavily in centralized teams that support our sites. That means it doesn't matter where they are geographically. We're providing central support and oversight with quality assurance, patient recruitment, regulatory, finance, budgets and contracts, and business development. That allows us to deliver good, consistent, predictable and reliable outcomes to our sponsors and patients regardless of site location. Having said that, there are definitely differences on the ground. In rural communities, your catchment area and population is smaller. Geographic distances are longer, so there's more friction on the travel side, and we do everything we can to accommodate and assist with travel to lower that friction as much as possible. On the urban side, distances are shorter and easier, but you're also going to have a lot more concentration of sites and a bit less patient loyalty to doctors and to sites. On the rural side, you get a lot of loyalty. A lot of these sites are the only research facilities in town. The staff and doctors have built really good relationships with the local community, word of mouth is strong, and patients trust the process more because of those stronger relationships. Another difference is cost. In urban areas, overhead and labor can be higher, whereas in rural communities you're going to get lower labor and lower overhead costs. The key there is finding the appropriate talent and partners and having good training programs to build a strong workforce.
“It's not one or the other. It's speed, enrollment, and quality, but doing it in spaces that haven't had research before.”
Moe: How does a commercial trial enrollment agreement actually work inside a federally qualified health center?
Patricio Casillas: Rovia contracts with the sponsor directly. We then have an arrangement with CommuniHealth in Northern Louisiana where we pay fair market value to them for their investigator’s time and the space we use. There is no cost to the patient. In fact, patients receive expense reimbursement and any incentive associated with the actual trial, which is provided by the sponsor. So it's clean from that perspective. What the partnership gives us is a federally qualified facility serving patients who are very underserved, from pediatric to adult to senior across a lot of different specialties. It's a great partnership for the community, and it gives us access to those patient populations and those physicians, with expert support from the Rovia teams that have done this for a while.
Moe: Are sponsors still prioritizing diversity in site selection in 2026, even with enforcement mechanisms limited and federal guidance in political limbo?
Patricio Casillas: Diversity and patient representation definitely matters still. At the end of the day, it's not a political thing. It matters from just getting good scientific outcomes that are representative of the population. Robust trial designs require representation across populations and geographic regions, it's not just ethnicities. Social determinants of health are very different from state to state, city to city, and comorbidities are different from region to region. So we look at those metrics as well as ethnicities, and across all of our areas we have really good representation. We're across 8 states, largely in the Southeast and Midwest, and sponsors really value that versus a high concentration of clinical sites in one particular space. You're also getting patients who aren't competing with each other to do clinical research. And again, it's not one or the other, speed or representation. You want to deliver on what we call the 4 pillars: patient representation, speed, enrollment achievement, and quality. We're able to achieve that in these rural areas with the strong standard operating procedures, great leadership, ongoing training, and central support teams.
“We're providing central support and oversight with quality assurance, patient recruitment finance, budgets and contracts, and business development. That allows us to deliver really good, consistent, predictable and reliable outcomes to our sponsors and patients regardless of site location”
Moe: How does phase I infrastructure like safety monitoring, informed consent, and volunteer recruitment actually function in a market the size of Aniston?
Patricio Casillas: The infrastructure doesn't get built overnight. In a place like Aniston, which is rural, their phase I capability, 20 beds with state-of-the-art equipment, was built over 25 years. You're not standing something like that up overnight. From a personnel perspective, they've had staff there for 10, 15, 20 years who are of the highest quality in the industry. Having that retention, combined with consistent, good quality outcomes, is how you build a very good phase I facility over time. You also have strong relationships locally, and that helps with finding talent, with patient and physician recruitment. They've built those relationships over two decades. On population size, the catchment area around Aniston is about 120,000 people in the county. So there is a big enough patient base to perform well.
Moe: Why does the patient experience in a community that has never been offered a trial require a different approach than what most sites already do?
Patricio Casillas: We think about it in terms of three key areas, and this goes for any site, rural or urban. The first is showing empathy. We track the patient experience very closely. We measure patient satisfaction scores and net promoter scores, and we send surveys to patients after every visit. Making sure patients feel like they're an N of 1, not one of many and that they feel like they are being listened to goes a very long way. Doing research with kindness is one of our mottos and we are delivering 82 Net Promoter Scores vs the healthcare benchmark of 38. The second is reducing friction: friction in terms of time, travel, and money for patients. We try to accommodate as much as possible. The third is transparency. Making sure patients clearly understand the informed consent in plain language, what they're getting into, and that we keep them informed of upcoming visits and what the whole trial is going to look like. At the beginning, it starts with a Rovia specialist or investigator having a transparent and honest conversation with the patient and explaining the protocol at a high level. Our clinical care coordinators follow up with detailed education around the protocol and informed consent. Then patients come in for their visits, and we make sure we give them reminders and stay in close communication.
Moe: How do you want sponsors and CROs to understand what Rovia is actually built to deliver?
Patricio Casillas: What we have found our customers want, sponsors and CROs, is predictability, reliability, responsiveness, and transparency. That's something we've really focused on: delivering predictable, reliable, consistent results while being responsive to customers. And we're able to do that in a way that lets us tap into underserved markets. That's not just patients who haven't had access to research, but also physicians. The industry needs more principal investigators. With our infrastructure, expertise, support and training, we can bring more principal investigators and rural health systems into the research arena.
“It's not just patients that haven't had access to research, but also physicians. We need more principal investigators. With our infrastructure, expertise, support, and training we can get more principal investigators and rural health systems into the research arena.”
Patricio Casillas is CEO of Rovia Clinical Research.
Moe Alsumidaie, MBA, MSF, is founder and Chief Editor of Vanguard Publications, which publishes Clinical Trial Vanguard, Pharma Vanguard and BullScope, and Head of Research at CliniBiz. He has two decades in clinical trial operations and data science, with earlier roles at Genentech, Abbott Vascular and Stanford University Medical Center, and is a guest lecturer in clinical trial sciences at Rutgers University.
