Hudak Ronald P, Russell Rebecca, Toland P Paul
Defense Health Agency, 7700 Arlington Blvd, Falls Church, VA.
Office of the Assistant Secretary of Defense (Health Affairs), 7700 Arlington Blvd, Falls Church, VA.
Mil Med. 2018 Jul 1;183(7-8):e291-e298. doi: 10.1093/milmed/usx064.
The evolution of governance models for the Military Health System's (MHS) large hospitals, called medical treatment facilities (MTFs), has culminated with the effort to implement Enhanced Multi-Service Markets (eMSM). The term eMSM refers to two separate concepts. First, MSM refers to those geographic areas, that is, markets, which have the following characteristics: they have MTFs that are operated by two or more Department of Defense (DoD) Services, that is, Army, Navy, or Air Force; there is a large beneficiary population; there is a substantial amount of direct care (i.e., beneficiaries are treated at MTFs instead of TRICARE's purchased care from civilian providers); and there is a substantial readiness and training platform. Second, the term "enhanced" refers to an increase in management authority over clinical and business operations, readiness, and MTF workload.
A retrospective review was conducted to study the evolution of military and civilian health care delivery models for the purpose of understanding how governance models have changed since the 1980s to design and manage MTFs with overlapping catchments areas. Primary and secondary data sources were analyzed through a comprehensive literature review.
Since the 1980s, the MHS governance models have evolved from testing various managed care models to a regionally focused TRICARE model and culminating with an overlapping catchment area model entitled eMSMs. The eMSM model partially fulfills the original vision because the eMSM leaders have limited budgetary and resource allocation authority.
The various models sought to improve governance of overlapping catchment areas with the intent to enhance medical readiness, community health, and individual health care while reducing costs. However, the success of the current model, that is, eMSMs, cannot be fully assessed because the eMSM model was not fully implemented as originally envisioned. Instead, the current eMSM model partially implements the eMSM model. As a result, the current eMSMs operate solely through cooperation and collaboration, without directive authority. Nevertheless, there have been some market-specific initiatives. Further analysis is necessary in the event that eMSM market managers are granted governance authority. This authority would include the ability to allocate the overall market's budget, determine common clinical and business functions, optimize the readiness of both the medical and the operational forces assigned to the market, and reallocate resources to optimize MTF workload. The results of this analysis may determine whether the fully implemented eMSMs optimize patient-centric initiatives as well as improve the market's efficiency and effectiveness.
军事卫生系统（MHS）大型医院（即医疗设施（MTF））治理模式的演变最终促成了实施增强型多服务市场（eMSM）的努力。术语“eMSM”指两个不同的概念。首先，MSM指那些具有以下特征的地理区域，即市场：它们拥有由两个或更多国防部（DoD）军种（即陆军、海军或空军）运营的MTF；有大量受益人群；有大量直接护理（即受益人在MTF接受治疗，而非通过TRICARE从 civilian 提供者处购买护理）；以及有一个重要的战备和训练平台。其次，“增强型”一词指对临床和业务运营、战备状态及MTF工作量的管理权限增加。
进行回顾性研究以考察军事和 civilian 医疗服务提供模式的演变，目的是了解自20世纪80年代以来治理模式如何变化，以便设计和管理具有重叠集水区的MTF。通过全面的文献综述分析主要和次要数据源。
自20世纪80年代以来，MHS治理模式已从测试各种管理式医疗模式演变为以地区为重点的TRICARE模式，并最终形成了名为eMSM的重叠集水区模式。eMSM模式部分实现了最初的愿景，因为eMSM的领导者在预算和资源分配方面的权力有限。
各种模式旨在改善对重叠集水区的治理，目的是提高医疗战备水平、社区健康和个人医疗保健水平，同时降低成本。然而，当前模式即eMSM的成功无法得到全面评估，因为eMSM模式并未按最初设想完全实施。相反，当前的eMSM模式只是部分实施了eMSM模式。因此，当前的eMSM仅通过合作与协作运作，没有指令权。尽管如此，还是有一些针对特定市场的举措。如果授予eMSM市场管理者治理权，则有必要进行进一步分析。该权力将包括分配整个市场预算的能力、确定共同的临床和业务职能、优化分配到该市场的医疗和作战部队的战备状态，以及重新分配资源以优化MTF工作量。该分析结果可能会确定全面实施的eMSM是否能优化以患者为中心的举措，以及提高市场的效率和效益。
