New Tests Deliver Health Care to Over-65 Retirees

The TRICARE umbrella now extends to military retirees under age 65 who for years couldn't get precious "space-available" appointments at military clinics. Retirees over 65 were left out until DoD started its first test, TRICARE Senior Prime, on Sept. 1, 1998 -- and immediately attracted more than 21,000 eligible retirees and family members.

This year, Congress has mandated DoD start two more demonstrations. Up to 66,000 beneficiaries will be able to participate in the second test, which will involve obtaining medical care through the civilian Federal Employees Health Benefits Program. Still others may get in on the third, a "Medigap" supplemental coverage test. DoD also is looking at how to provide pharmacy services to over-65 retirees.

The over-65 population "still presents a challenge for TRICARE," said Executive Director Dr. James Sears. But the trio of three- year demonstrations, particularly Senior Prime, show great promise, he said.

The tests, known collectively as "Medicare Subvention," allow the military facilities providing over-65 senior care to recoup expenses from Medicare. Current rules don't allow such reimbursements -- facilities provide care to the seniors at their own expense.

"We'd like to see that the demonstrations are very successful the first year and then expand them to the entire eligible population without waiting the full three years," Sears said. He and his staff are optimistic they'll accomplish this goal partly because of the way Senior Prime was organized.

"The Military Health System did a great job putting the demonstration together and standing it up," said Air Force Lt. Col. Frank Cumberland, communications and customer service director for the TRICARE Management Activity. "The job our medical people did across the country getting their programs certified has been really amazing."

The federal government's Health Care Financing Administration visited and certified each of the six sites selected for the demonstration, Sears said. "They were very impressed with how well organized the effort was. It reflects the integrated effort by the services, treatment facilities, TRICARE regional lead agents and contractors to put the program together."

Sears said he's even more impressed with how the demonstration is going. "We're very excited about the approach the sites are taking to care for these people," he said.

For example, Balboa Naval Hospital in San Diego set up "one-stop shopping" for demonstration participants in Southern California. "They set up pulmonary, cardiology, lab, X-ray and pharmacy services in one area, then bring in groups of patients, brief them about their health care and try to not let them leave without at least getting a flu shot," Sears said. "They've taken a very detailed approach to managing the care for these folks."

Before Senior Prime began, elderly patients could not expect continuity of care -- assuming they could get a space-A appointment to see a military doctor. "What they've now put together is a managed approach to keep these folks healthy and anticipate their health care problems," Sears said. "With this kind of approach, we think Senior Prime is going to be very successful."