Full Document

FormatFile SizeNotes
zip file 1.3 MB

The file(s) provided above are ZIP-formatted archives, which most modern systems can natively unpack. If your computer does not unpack the archive when you double-click it, you may need to use a separate decompression program such as UnZip.


Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback1 pages $10.00 $8.00 20% Web Discount

The Health Care Financing Administration (HCFA) and the Department of Defense (DoD) are testing the feasibility of making Medicare-covered health care services available to Medicare-eligible DoD beneficiaries in the TRICARE program at military treatment facilities (MTFs). This report evaluates the early implementation of TRICARE Senior Prime at six MTFs, financed by subvention (the transfer of funds from HCFA to DoD). It finds that enrollment rates in Senior Prime were faster than in many private health plans and beneficiaries were generally pleased with their care. However, sites are having difficulties caused by the complexity of payment methods and by uncertainty over whether they will ever see Senior Prime revenues—even if DoD obtains net payments from HCFA after each year's reconciliation. If a larger Senior Prime program becomes a permanent part of TRICARE, the following policy issues must be addressed: (1) balancing interactions between the readiness mission and Senior Prime; (2) structuring and managing Senior Prime effectively; (3) creating the desired financial incentives; and (4) achieving effective clinical and cost performance. Lessons learned include the importance of effective introduction of the program and orientation of beneficiaries; early identification of enrollees with existing treatment requirements; the importance of coordination of intake activities and follow-up visits; and the difficulty many beneficiaries have with automated appointment and customer service systems. In addition, DoD's health data system capabilities will need to be improved.

Table of Contents

  • Preface

  • Figures

    Figure and Tables

  • Summary

  • Acknowledgements

  • Acronyms

  • Chapter 1


  • Chapter 2

    Evaluation Methods and Data

  • Chapter 3

    Policy Framework for the Demonstration

  • Chapter 4

    The Subvention Sites and Senior Prime Enrollments

  • Chapter 5

    Early Experiences in the Demonstration

  • Chapter 6

    Preliminary Cost Studies

  • Chapter 7

    Implications and Issues for a Broader Senior Prime Program

  • Appendix A

    List of Questions for Site Visits

  • Appendix B

    Template for Site Visit Agenda

  • Appendix C

    Site Visit Reports

  • Appendix D

    Demonstration Areas

This report is part of the RAND Corporation Monograph report series. The monograph/report was a product of the RAND Corporation from 1993 to 2003. RAND monograph/reports presented major research findings that addressed the challenges facing the public and private sectors. They included executive summaries, technical documentation, and synthesis pieces.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.