# 99014. New Tests Deliver Health Care to Over-65 Retirees

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By Douglas J. Gillert
American Forces Press Service

WASHINGTON -- Two new TRICARE demonstrations promise expanded 
health care at least temporarily to thousands of military 
retirees and eligible family members over age 65.

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."

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