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TESTIMONY OF
DAVID J. MCINTYRE, JR.
PRESIDENT AND CEO
TRIWEST HEALTHCARE ALLIANCE

BEFORE THE
SUBCOMMITTEE ON TOTAL FORCE
HOUSE ARMED SERVICES COMMITTEE
UNITED STATES HOUSE OF REPRESENTATIVES

REGARDING
DEFENSE HEALTH PROGRAMS

 March 18, 2004 

 

Introductory Comments

Mr. Chairman, and distinguished members of the House Armed Services Committee's Subcommittee on Total Force, I would like to thank you for the invitation to once again appear before you to discuss the state of the TRICARE program and TriWest Healthcare Alliance's role as the health services and support contractor responsible for the new, 21-state TRICARE West Region.

My name is David McIntyre. I am the president and CEO of TriWest Healthcare Alliance, a private, for-profit corporation that was formed in 1995 for the express purpose of bidding on the TRICARE managed care support contract in the 16-state area bid as Regions 7 and 8 and later consolidated to create the Central Region. After seven years of successfully providing world-class customer service and access to health care for TRICARE beneficiaries in this region, TriWest bid on and was awarded in 2003 the TRICARE Next Generation contract for the new, 21-state West Region. Soon, our company will serve more than 2.6 million members of our nation's military family across a geographic area that encompasses more than half of the landmass of the United States.

TriWest's Unique Business Model and Ownership Structure

When TriWest was formed in 1995, our singular focus was on developing a business model and ownership structure that would most effectively allow us to provide the best service and support to TRICARE beneficiaries in the Central Region.

A core group of individuals, including myself, worked together to solicit the support and backing of civilian health plans across the 16-state region. Based at the local level, this group of health care entities, each expert in their regional area, came on board with a dual purpose: to infuse capital and serve as TriWest's owners, and to serve as our subcontractors responsible for building and managing provider networks in each of their respective locations. This unique locally-based approach allowed TriWest to quickly form an experienced ownership team while, at the same time, develop a high-quality, capable provider network willing to serve TRICARE beneficiaries once the Central Region contracts commenced.

With our ownership structure in place, TriWest then reached out to regional and national military and civilian constituencies in the Military Health System (MHS) leadership, as well as to beneficiary organizations and Members of Congress, to determine each group's vision for the ideal TRICARE experience. Drawing on advice and recommendations from these key players, TriWest developed a business model for administering the TRICARE program that focused on doing whatever it takes to meet the needs of our nation's active duty and retired military members and their families. Our unique business plan and contract proposal met with approval from the Department of Defense (DoD), and secured the TRICARE Regions 7 and 8 (later the Central Region) managed care support contracts.

As a result, nearly eight years ago, TriWest became the first alliance of locally-based health care organizations to bid on and, in turn, deliver services under a TRICARE regional contract. And, we remain the only alliance-based company engaged in this business today. It is clear that one of TriWest's strengths has been our local-market approach to building and managing provider networks in what are clearly some of the most difficult markets for government programs in this country. Our success has been accomplished by leveraging the significant market presence of our owners and continually striving to make good on the promise of TRICARE for the deserving beneficiaries residing in our vast region.

TriWest Grows with Next Generation of TRICARE Contracts

It has been invigorating and inspiring to be in the business of TRICARE over these last few years, particularly as Dr. Chu, Dr. Winkenwerder and their team studied the state of the program and tackled the difficult task of constructing the best management structure and approach for successfully operating TRICARE well into the 21^st century. This task was critical, complex and enormous, and the solution these individuals proposed-consolidating the multiple managed care support contracts into just three health services and support contracts and carving out certain key elements of the program including pharmacy, marketing/education and appointing services-promises to deliver the best of TRICARE to the deserving military families across our nation and abroad.

Early on, TriWest recognized the wisdom and foresight embodied in the plan to consolidate regions and contracts, as we had done so years prior at no additional cost to the government with the consolidation of Regions 7 and 8 into the Central Region, and we stood in support of Drs. Chu and Winkenwerder, and others on the conceptualizing team, as they brought their vision for the next generation of TRICARE contracts into focus. We recognized that, in order to make TRICARE work most effectively for beneficiaries, operational revisions were needed, and we were determined to be a part of that solution.

Drawing on our years of experience as the Central Region managed care support contractor, gleaning insight and support from our team of owners and bringing our best business practices to the table, TriWest submitted its West Region bid on Jan. 28, 2003, followed soon thereafter by a six-hour oral presentation. On Aug. 21, 2003, we received notification from the TRICARE Management Activity (TMA) that we had, indeed, been named the West Region health services and support contractor for this next generation of TRICARE contracts.

Not only was our contract proposal focused on operational and management approaches that are destined to improve customer service, access to high-quality health care and beneficiary satisfaction, but also on securing these very improvements in a manner most cost-effective for taxpayers and beneficiaries alike. Building on the foundation established when we were initially selected in the summer of 1996, TriWest added four new Blue Cross Blue Shield plans to our ownership ranks with procurement of this new contract, ensuring that the new states coming under our umbrella would have a voice in this organization and that the provider networks in these new areas would be managed in the same, proven fashion.

As you and other leaders are acutely aware, the success of TRICARE depends on securing and improving access to health care at the local level. Making this task doubly challenging, the majority of our military posts and bases are located in rural areas with minimal access to health care providers. TriWest's unique business model and network building efforts are focused on developing the most comprehensive networks possible in these areas while providing additional resources to our valued beneficiaries. This locally- based approach creates a home-town feel for a nation-wide system, helping ensure that TRICARE beneficiaries (regardless of where they reside) receive high-quality service and care.

National, Regional and Local Collaboration Define Our Vision for Success

As evident in our ownership structure and business approach, TriWest's foundation lies in our collaborative efforts at the local, regional and national levels. Our history of joining forces with our military/government counterparts at the leadership and military treatment facility (MTF) level in the Central Region is extremely strong, and, while we continue to enhance our existing relationships, we are quickly building new ones as we transition into the West. This innovative approach to making good on the promise of TRICARE has served our beneficiaries well, and has allowed TriWest to develop joint ventures in the civilian and military medical communities that help to increase the quality of health care and the convenience of access system-wide.

Our Blue Cross Blue Shield and university hospital system owners/network subcontractors continue to work diligently at the local level to maintain and expand our TRICARE networks across the region. Network development efforts in the new West Region states are moving along at a brisk pace, and our new owners are focused most attentively on securing a solid network of high-quality providers dedicated to serving our region's military families.

By maximizing the resources and expertise of our locally-based owners, each of whom has a long history of building strong relationships and maintaining substantial provider networks in their local communities, we are able to sustain a quality provider base for our deserving beneficiaries. In fact, working efficiently and proactively, our new owners have already established a significant number of provider contracts in our new West Region states, and are more than half way to our goal of matching by 85 percent the current high-volume network previously maintained by the region's outgoing contractor.

Similar progress is being made by our existing owners in our Central Region states. Our Central Region owners have most pointedly been focused on developing a network of providers for behavioral health care-services that were the responsibility of a behavioral-health subcontractor in our Central Region contract but will now come under our umbrella as we move into our West Region contract. More than six months before start of health care delivery in these states, our owners have already received 60 percent of the behavioral health contracts they submitted to providers across the region.

Contracting in the behavioral health arena will support our move to the first fully-integrated behavioral/medical-surgical operation of its kind in this space. Given the unique stressors faced by this beneficiary population-particularly during this time-we have decided to integrate the coordination of care and support for the entire spectrum of needs of the beneficiary.

In other collaborative efforts focused on improving service and support to our new region, TriWest has developed a new relationship in the West Region in an effort to alleviate claims-processing challenges in this next generation of TRICARE. Determined to enhance the progress and proficiency of TRICARE claims processing, TriWest built into its West Region bid proposal an exclusive health services and support contract claims-processing relationship with Wisconsin Physicians Service (WPS) of Madison, Wisconsin. WPS has a long and successful history as a TRICARE claims processor, and TriWest's leadership team determined that the best way to promote timely, accurate claims processing and exemplary customer service for our providers and beneficiaries in the new, 21-state West Region would be to team with this respected organization.

WPS and TriWest have a strong and flourishing relationship. Not only are our two organizations developing claims-related policies and procedures together, but we also have been jointly educating existing providers about our relationship (and have plans to educate incoming providers as start of health care delivery nears) and are currently working cooperatively to complete the construction of a web-based claims-submission/claims-research system that will be available on our web site, www.triwest.com. These combined efforts will give our providers and beneficiaries access to experienced, capable claims-processing professionals who are as dedicated to TRICARE as are TriWest's devoted staff, as well as to a system that will optimally meet their needs. We are extremely pleased with this effort and look forward to the improvements it promises to bring to claims processing and provider and beneficiary satisfaction throughout the West Region.

We will also be continuing our existing Central Region resource-sharing relationship with Spectrum Healthcare Resources in our West Region contract. Spectrum has unmatched expertise in managing the provision of clinical support services which are critical to maximizing direct-care system resources, and we are pleased to be continuing that relationship-working together to assist MTFs in maximizing their capabilities. By supplementing the professional manpower in our West Region MTFs with cooperative and capable civilian providers, we are striving to create a means by which our beneficiaries receive the timely access to care and the focused health care services that they deserve.

At TriWest, we recognize that we (and, in turn, the TRICARE program) are only as strong as the sum of our parts-and those parts include the dedicated individuals under our corporate umbrella as well as those linked with our organization through collaborative relationships. Our philosophy is that, by bringing together a team of professionals, experts and supporters-each dedicated to improving the business of TRICARE-we can provide our region's beneficiaries with the best possible service, support and care available while encouraging others within the system to consider solutions inspired by our proven, best-business practices.

In that vein, we are pleased to see that the next generation of TRICARE contracts put at the head of each regional area a TRICARE Regional Office. Our initial joint initiative, which dates back to the beginning of our Central Region contract, was the development of a relationship with our military Lead Agency to consolidate once-separated regions (former Regions 7 and 8) and create a stand-alone regional office-a practice the DoD is now using throughout the system. We worked closely with our Central Region Lead Agency to develop a cooperative working relationship unlike that held by any other managed care support contractor, including the creation of the only combined web site from a contractor and its Lead Agency. Our joint efforts with the Central Region office enhanced the efficiency and effectiveness of our operations and resulted in savings to the government, and we are pleased to see this approach moving into the next generation of TRICARE.

In fact, we have already established a similarly strong relationship with the TRICARE Regional Office-West (TRO-West), which oversees our West Region contract. On Nov. 24, 2003, Rear Admiral James Johnson became full-time Regional Director over the TRICARE West Region. I couldn't be more pleased with his selection. He is focused, knowledgeable and very capable. While I know that his surrendering the command of Naval Center San Diego to take on this role may have appeared to some to be a step backwards, his presence and work on behalf of optimizing the operation of the West Region is going to go a long way in ensuring the region's success!

Admiral Johnson and I have brought our teams together to form a coalition dedicated to developing the best processes for our West Region beneficiaries, providers and military associates. We are now beginning to reach out to the leaders of the military's direct care system across the 21 states to invite them to join the coalition. I am pleased that Admiral Johnson is at the West Region helm and I strongly share his triple-tiered service and business philosophy:

• People are our most important asset,
• Beneficiaries are our focus, and
• Our success is judged by those we serve.

These critical statements define the focus of TriWest and TRO-West, and reflect our joint dedication to serving and supporting the individuals within our regional fold. It is from this base that we have developed a joint strategic plan that will guide our work as we seek to accomplish a seamless transition through the implementation of the next generation of TRICARE in the West Region.

With the changing face of our nation's military and TRICARE's expansion of programs and services for Reserve and Guard members and their families, TriWest has also taken a renewed interest in forming relationships that allow us to optimally serve and enhance access to services for these important members of the TRICARE family. The needs of our nation's Reserve and Guard families are unique, and we are determined to provide the same quality of services to these beneficiaries that we strive to provide for all others who utilize the TRICARE program.

In one such effort, TriWest has built a relationship with the National Committee for Employer Support of the Guard and Reserve (ESGR) organization. ESGR was established in 1972 to promote cooperation and understanding between Reserve Component members and their civilian employers, and to assist in the resolution of conflicts arising from an employee's military service. The DoD has tasked the ESGR to ".promote both public and private understanding of the National Guard and Reserve in order to gain U.S. employer and community support through programs and personnel policies and practices that shall encourage employee and citizen participation in National Guard and Reserve programs" (DoD Directive 1250.1). Determined to be a part of any solution that supports the men and women wearing our nation's uniform, TriWest is pleased to have been identified by the ESGR as an employer that supports the Guard and Reserves.

While reaching out to America's Guard and Reserve component, TriWest also recognizes the needs of other uniformed services members, including those in the United States Public Health Service. TriWest keeps these and other uniformed services-based organizations in mind while making key strategic decisions.

We also welcome and anticipate the opportunity to serve the Coast Guard through the next generation of TRICARE contracts. To facilitate our understanding of their needs, we have already been hosted by the Coast Guard leadership in Kodiak, Alaska, North Bend, Oregon, and elsewhere in the Pacific Northwest and along the coast of California.

In addition, we continue to expand our work with the Department of Veterans Affairs (DVA) in order to maximize the use of federal resources throughout our region and system-wide. Fostering collaboration and coordination among the DoD, DVA, the Regional Director's office and TriWest is the focus of our Joint Strategic and Operational Planning Process (JSOPP) initiative. The successful outcomes of our original DoD/DVA collaborative initiative-the Central Region Federal Health Care Alliance-led TriWest to focus on deploying this strategy across the new West Region through the JSOPP. This joint effort in strategic and operational planning maximizes the resources available to military family members, enhances benefit allocation, optimizes network management, streamlines administrative processes and improves joint short- and long-term system planning. It is built from the successful base of our multi-year focus on enhancing the working relationship between the DoD, DVA and private sector in several areas of the TRICARE Central Region.

Managing health care costs associated with the TRICARE program in an efficient, value-added manner is one of TriWest's primary objectives. Collaborating with the DoD, DVA and others through JSOPP enables TriWest to develop new strategies and programs that will help provide the best service and options for military families. By doing so, TriWest will help minimize health care costs across both the private and public sector.

Beyond JSOPP, we continue to focus in the critical area of maximizing the coordination of care for the beneficiaries whom we are entrusted to serve. As we roll out this new contract, we are further enhancing our medical management focus with the latest tools available in the marketplace.

Optimizing Service Through Modifications to Operational Approach

While TriWest has made modifications to some of our current operational approaches for the West Region, we have built these changes on a strong base and out of a long and successful history of operating optimally in the Central Region. By taking concepts that have worked for us in the past and making improvements for the growing demands of the future, we are confident of our continued success as we transition into the West.

For instance, to further focus on service at the local level, TriWest has opted for a dual-headquarters approach for the next generation of TRICARE. Once headquartered only in Phoenix, Ariz., with TRICARE Service Center (TSC) customer-care locations at each base/post within the Central Region, we have now divided our headquarters operations between Phoenix and San Diego.

To capitalize on the level of commitment, experience and dedication we have in our established Phoenix-based staff, Phoenix will remain our Operational headquarters where all primary functions (and the leadership team that oversees them) will be housed. To maximize our relationship with the TRO-West and increase the opportunities for continued development of our growing relationship through geographic proximity, San Diego will serve as our Strategic and Policy headquarters. In this manner, TriWest and TRO-West leaders will be, literally and figuratively, side by side as we launch into our new West Region community.

All told, our operational approach under the new West Region contract will be even stronger than before. Recognizing the strength in a centralized approach to operations and a local approach to service, we have established six hub locations (in Tacoma, San Diego, Phoenix, Colorado Springs, Honolulu and Anchorage) where optimization, clinical and customer service functions will be performed. Each hub will oversee such responsibilities as provider network development and relations, case management and clinical inquiries, enrollment and customer service functions, and field operations and market area planning and management. Each hub will also house an arm of TriWest's call center operations, and beneficiaries will be routed to the appropriate hub call center for service based on details provided through our interactive, comprehensive telephone system. This approach to service will offer the region's beneficiaries customer service in their own backyards-service that is local in focus and will best suit their needs.

In a continued approach to providing focused local service, TriWest's TSC locations under the West Region contract will be available exclusively for walk-in beneficiary inquiries and requests for assistance. Under the first generation of TRICARE contracts, our TSC employees were available for both in-person and telephonic assistance, but this approach divided our customer service representatives' attention and forced them to struggle to meet the needs of both face-to-face and telephone service requests. By separating self-service (via hubs and our interactive telephone system) and in-person (via TSCs) support functions, TriWest is confident that our West Region beneficiaries will receive the customer care they need in the manner with which they are most comfortable.

We are equally confident that by adopting responsibility for administering all facets of TRICARE's behavioral health coverage (duties that, as noted previously, were managed by a TriWest subcontractor in our first-generation TRICARE contract), we will succeed in providing our region's beneficiaries with access to high-quality behavioral health care from an extensive network of dedicated providers. We have assumed claims-processing, network-development, utilization-management, case-management and beneficiary and provider education responsibilities for behavioral health services, and believe that by centralizing management of all medical/surgical and behavioral health care services under one roof, we will be able to provide our deserving beneficiaries with consistent, high-quality service and care across the full range of TRICARE coverage for which we are responsible.

West Region Transition Continues TriWest's Trend Toward Success

Transitioning into the West Region is a monumental task for which TriWest has created a detailed strategy. In all, 45 transition projects (and 91 sub-projects) are currently underway, spanning all functional areas of TriWest's operations.

To help measure the progress of our transition initiatives, TriWest has broken the projects down into "green," "yellow" and "red" progress categories. Green projects are on track and progressing as expected (80 percent of transition projects fall in this category); yellow projects are facing slight challenges and are being approached with slight caution (just 20 percent fall in this category); and red projects are expected to fail without immediate, conscious attention. TriWest is pleased to report that at this time none of our transition initiatives are in the red category, and that action plans for securing success of yellow projects are in place and all concerns are being thoroughly addressed.

Recognizing that there are only a few short months until health care delivery under the new contract commences (June 1 in Oregon, Washington and Northern Idaho and July 1 in Alaska, California and Hawaii), several key transition projects have been completed or are near completion, and our team is meeting major milestones on our way to full preparedness for launching services in the West Region.

For instance, our claims initiatives are making impressive strides. In fact, earlier this month we completed benchmark testing of our joint claims-processing system at WPS. During this benchmark testing, not only did we take our conceptual medical/surgical claims (80 percent) procedures and analyze how they function in the real-world environment, but we analyzed the functionality of our behavioral health claims (20 percent) as well. Taking our conceptual claims procedures and analyzing how they function in the real-world environment, the TriWest and WPS claims team found no major issues with functionality, efficiency or process. These findings reinforce our confidence and keep us focused on successfully improving claims processes as we enter the West Region.

Transition achievements in the area of facilities are also progressing smoothly. Several of our West Region TSCs are already fully wired and online with TriWest's data and phone networks. Renovation of our Tacoma hub location is also underway and will be ready for occupancy early next month. In an unprecedented cooperative effort with Health Net Federal Services, the outgoing contractor in our new West Region states, TriWest will utilize several existing Health Net facilities for our West Region operations and we have made arrangements to procure much of the hardware and furnishings already available in these office spaces as well.

Our technology initiatives are also briskly moving forward. Establishment of information technology (IT) infrastructures at new West Region locations is on track, and benchmark testing of these vital functions is being performed. Our IT team has worked diligently to build relationships with various technology vendors in these areas to secure optimal functionality of our data and communications as each of these locations begins operations.

Another key area of IT progress is our now-operational "Provider Automation" process. Working closely with TriWest's Provider Services department and WPS, our IT division has developed a comprehensive solution to provider contract processing and storage that improves efficiency in a virtually paperless fashion. This process allows for the scanning of incoming provider contracts that can be verified, approved and stored electronically without requiring extensive paperwork, additional storage space or manpower to maintain files.

In the areas of recruitment and hiring, we are again seeing significant progress. As we transition into our West Region contract, we will double both our company size and our employee numbers, growing our operations to meet the expanded needs of this new region. Nearly 80 percent of employees for our Oregon, Washington and northern Idaho operations have been hired to date. Recognizing the value of trained personnel dedicated to the promise of TRICARE, TriWest has worked with Health Net to transition some of its employees into our corporate ranks. We are pleased to have developed this relationship with such a strong and dedicated organization as Health Net and look forward to welcoming these transitioning employees into the TriWest family.

Although we are meeting some recruitment challenges in hiring clinical staff in California, primarily due to a nursing shortage resulting from the new state legislation on nurse-to-patient ratios, we expect to meet our staffing requirements long before this segment of the region becomes operational. Several job fairs have been scheduled for both California and Hawaii, and we anticipate significant response through these events.

As we near the launch of operations in northern Idaho, Oregon and Washington in April, we are eagerly anticipating the beginning of health care delivery in the remainder of the region in the coming months. Our transition plans were developed at the same time as our West Region contract bid, ensuring that efforts to make our operations functional could commence immediately upon contract award. We are pleased to report that this prior planning has made preparations for our journey into the West Region run smoothly and successfully.

A Collective Approach to Improving TRICARE: Addressing Policy Issues as a Team

At TriWest, we are dedicated to establishing innovative approaches to providing the best possible service and access to health care to TRICARE beneficiaries. We strive to think outside the box and develop initiatives and solutions that improve beneficiary satisfaction and, in many cases, health care outcomes. It is important to TriWest to share our initiatives with the entire TRICARE community in the event that programs and services that have proven successful in our realm may be beneficial to other regional contractors as well.

Because TriWest is not content to let processes that are not functioning at optimal levels suffer from lack of attention, it is our mission to address TRICARE issues as they surface. For this reason, I would like to share a number of policy issues currently facing the program that I hope, as a team, we in the business of TRICARE can respond to together.

First, we recognize that there will continue to be a need in the coming years for refinement of benefit design to meet the goals of Congress, the Administration and, as always, the beneficiaries of this great program. At the same time, we see a need to ensure ample focus on maturation of the entire health care system as TRICARE moves forward through the transformation of services, base realignments and closures and TRICARE refinement.

Second, as illustrated in our business approach and our growing relationship with ESGR, we see a need to optimally serve all military families, active duty and retired, as well as Guard and Reserve families now under the TRICARE umbrella. We as a nation are increasingly relying on these individuals who are dedicating their lives to our country's military causes and we need to develop system-wide approaches that focus on providing these men, women and children with service and support that exceeds their expectations. We at TriWest stand ready to support the DoD in this most important matter and are eager to participate in collaboratively-developed pilot projects intended to find the right solution to the challenges of enhancing the health care available to the Guard and Reserves and their families.

Third, it is important that we join together to get a better grasp on the outlook for current and future health care spending. With the assistance of the Congress, the DoD has made significant progress over the past few years in improving its ability to anticipate health care costs and to provide realistic budget estimates for the Defense Health Program. That being said, it is clear that the current budgetary imperatives occasioned by the liberation of Iraq and the continued efforts to support the growth of democracy in Bosnia, Kosovo, Afghanistan and other places will have implications for the Defense Health Program and on TRICARE budgeting. I believe it is necessary for those of us in this business to determine how to make collective choices that ensure the best balance of access to care, use of the program and impact on taxpayer dollars. Here also, we at TriWest look forward to working with the DoD to meet the challenges and to ensure that both the near-term and long-term allocation of resources is available to support the optimization of the MHS, the satisfaction of all our beneficiaries and the best value to the government.

And, fourth, in an effort to grow the services and programs available under TRICARE, we also recognize the need to continue leveraging the bricks/mortar and personnel resources currently available throughout the MHS and make them work most efficiently for our military families. This includes addressing resource-sharing needs to optimize available care within the MHS while ensuring that the continuity and quality of patient care in the MTFs is not placed at risk, as well as focusing on technology issues-most prominently, the Enterprise-wide Referral and Authorization System (EWRAS)-to help ensure that our valued beneficiaries receive timely access to quality care and that providers are supported with efficient tools. It is our responsibility to make certain that the military families entitled to TRICARE receive optimal service, and we can do that by leveraging the MHS resources that are already available to us all.

A Strong Team, A Strong Next Generation of TRICARE

I believe that one of the measures that will ensure success in the short- and long-term is the way in which the three organizations that secured next-generation TRICARE contracts work together for the betterment of the system. I am pleased to report that the future is very bright!

As we have secured the contract for the West Region, our colleague Health Net is now headed north where I believe they will do a solid job in delivering on the promise of TRICARE. I wanted to take this opportunity to applaud my colleague Jim Woys of Health Net and his entire team for the collegial way in which they have worked with me and my team through this entire transition. They are a class act, and their selfless efforts have gone a long way in minimizing the difficulty that we and the beneficiaries of the West Coast states could have faced during this transition.

I also want to share with you that Jim Woys, Dave Baker, our colleague from Humana, and I have begun to regularly meet to discuss common issues of interest as we move through the implementation of these new contracts. We believe that by coming together on a regular basis and defining some common priorities on which to apply effort that we will be able to effectively do our part to support the further maturation of this critical program.

Concluding Remarks

In closing, we at TriWest have a history of doing right by TRICARE beneficiaries and of being the right partner for the DoD. We look forward to continuing to provide outstanding service and support as we transition our responsibilities into the West Region where we are fortunate to serve an expanded 2.6 million beneficiary base. Like the pioneers of the past, we are taking our journey west in search of an opportunity to provide incredible service to our deserving beneficiary population and to proudly support the men, women and children in America's military family.

We are an ambitious team at TriWest and we are dedicated to analyzing the needs of our beneficiary customers and implementing the programs and services that best meet those needs. It is my pleasure to work with such a focused group of individuals whose hearts are in the right place, whose intentions are commendable and whose efforts to improve TRICARE are ever increasing. With pride, we have taken what could have been a daunting challenge and turned it into a successful opportunity to provide the best possible service under the TRICARE program.

As President Theodore Roosevelt once said, "Far and away the best prize that life offers is the chance to work hard at work worth doing." That is how we at TriWest look at our work with the TRICARE program. It is our privilege and honor to provide service to the brave men, women and families of our nation's past and present military community, each of whom has sacrificed so much in defense of our freedom. We salute America's military families and march into our new West Region territory with the confidence that we can provide these deserving individuals with the support and care they so admirably deserve.