TriWest Set to Provide Health Care to Military Community

TriWest Set to Provide Health Care to Military Community



Company Has 5-Year Contract to Provide Service in California

BY MARION WEBB

After 10 months of planning, TriWest Healthcare Alliance’s representatives are gearing up to provide services to hundreds of thousands of eligible local military personnel, family members and retirees throughout San Diego.






As of July 1, Phoenix-based TriWest and its partner, BlueShield of California, manage military health care for some 400,000 San Diegans.






TriWest takes over for Woodland Hills-based health insurer HealthNet, which TriWest outbid in August for a five-year, $10 billion contract to direct military health care in California.






It’s all part of the Department of Defense’s efforts to consolidate its health care program, called Tricare, from 12 regions down to three nationwide.






TriWest chose San Diego as its strategic and policy headquarters because of the large local military presence in the area.






It is one of five regional hubs, said David J. McIntyre Jr., TriWest’s president and chief executive.






The bulk of TriWest’s 163 local employees, mostly service reps, work at the company’s Kearny Mesa hub, with others running storefront offices at the Naval Medical Center San Diego, Camp Pendleton, North Island Naval Air Station and MCAS Miramar. Services range from enrolling beneficiaries and processing claims to managing behavioral care and pharmacy needs.






“If you need help with a bill, you walk down the hall and see someone at the TriWest center. If you have questions, (want) to sign up with a doctor, or send an e-mail, it goes directly to our customer service center,” McIntyre said.






Most local phone calls are directed to the San Diego call center, the largest of TriWest’s six centers.






The company couldn’t give a figure on enrollees as of last week, but McIntyre says TriWest’s plans are competitive, offering good benefits at a reasonable price.






“Very few people chose not to participate,” he said.






Military members can choose from three plans: A managed care plan (HMO), a preferred provider option (PPO), and a fee-for-service plan.






Under the HMO plan, active-duty family members pay no annual enrollment fees or co-payments for doctor visits. Individual retired service members pay an annual fee of $230 or $460 to enroll families; a $12 co-pay for outpatient visits, and $11 daily for hospital stays.






To enroll in the PPO and fee-for-service plans is free for active-duty family members and retired service members. Both, however, require a deductible payment and co-pay for doctor visits, hospital stays and mental health care.






Under the system, part of the care is delivered through the military treatment facility, while the other part is delivered by the civilian community through the BlueShield provider network of about 2,500 doctors.






“If the military doesn’t have the capacity or capability, we serve them,” McIntyre said.






He anticipates TriWest’s role to grow given the current military climate.






“Across the country, 30 to 40 percent of health care is delivered in the private sector (by TriWest) and the number is growing due to the current situation in Iraq,” he said. The reason for that is that many military doctors are being sent overseas to support foreign deployments.






McIntyre admits to some startup problems in San Diego, pointing to hiring more than 100 people in a relatively short time, and getting them up to speed with a variety of things.






TriWest spent $2 million to install its new voice-over Internet system. McIntyre plans to improve the system in the coming year so that when customers send e-mails or faxes, they can expect to hear back instantaneously.






“It takes, on average, three days to respond to an e-mail,” McIntyre said about the current status. “Our goal is to give responses as fast as if someone calls in on the phone.”






But he has plenty of other things on his plate too.






Last week, McIntyre spent time at TriWest’s Honolulu hub to get things up to speed there. The company’s other hubs are in Phoenix; Tacoma, Wash.; Colorado Springs, Colo.; and Anchorage, Alaska.






A former vice president of Blue Cross/Blue Shield of Arizona, McIntyre formed TriWest in 1996 after the Defense Department called for bids to manage the Tricare program.






It is owned by 15 Blue Cross/Blue Shield plans and two university hospital system, but remains independent.






McIntyre said earlier that TriWest has been profitable since 1996.






He expected the new contract to give TriWest’s annual revenues a boost , from $1 billion now to $2 billion by October.






But it was only recently that things looked up.






Given that the old contract would have expired in October 2004 and TriWest focuses entirely on military clients, the company’s own well-being depended on winning the new contract.