Cover: Enhancing Military–Civilian Medical Synergies

Enhancing Military–Civilian Medical Synergies

The Role of Army Medical Practice in Civilian Facilities

Published Jun 22, 2016

by Melinda Moore, Michael A. Wermuth, Gary Cecchine, Paul M. Colthirst


Download eBook for Free

Full Document

FormatFile SizeNotes
PDF file 3.8 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Synopsis

FormatFile SizeNotes
PDF file 0.1 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.


Purchase Print Copy

 Format Price
Add to Cart Paperback156 pages $24.50

Research Questions

  1. What is the state of Army medical practice in civilian facilities, including those that the U.S. Department of Veterans Affairs operates?
  2. What opportunities are there for greater synergies?

Army medical professionals must maintain the high level of proficiency required to fulfill the Army's medical missions of supporting military operations and providing beneficiary care. Because beneficiary care demands in a U.S. medical treatment facility (MTF) do not mirror those in a combat setting and sometimes can exceed the MTF's capacity, some MTFs enter into agreements with local civilian facilities to meet shortfalls in beneficiary care or training. The study's objective was to assess Army medical practice in U.S. Department of Veterans Affairs and non–Veterans Affairs civilian facilities and suggest opportunities for improving military–civilian synergies.

Key Findings

Stakeholders Widely See Resource-Sharing Agreements as Beneficial

  • MTFs and local counterparts that use such agreements universally find them mutually beneficial, although the MTFs find the guidance documents outdated, insufficient, and in need of updating.
  • Military stakeholders reported benefits to the Army that include better access, quality, and continuity of care for beneficiaries; proficiency maintenance and exposure to industry best practices for military professionals; and perceived cost savings to TRICARE.
  • Benefits that local civilian counterparts cited included revenue generation (TRICARE payment for beneficiary care) and more-productive utilization of their infrastructure by military personnel.
  • The strong consensus among military and civilian users and leaders regarding the benefits of external medical practice suggests that such practice is warranted when both the MTF and local partner can justify it in their respective business plans.


  • Update Office of the Surgeon General and U.S. Army Medical Command policy guidance for external resource-sharing agreements (ERSAs) and gratuitous training agreements.
  • Identify appropriate proponents for ERSAs and for gratuitous training agreements.
  • In the short term, identify potential untapped opportunities for external practice, especially ERSAs, and encourage their use when justifiable in MTF business plans.
  • For longer-term policy purposes, conduct a quantitative assessment of the costs and potential efficiencies associated with care provided in the Military Health System compared with those of different civilian options, such as those examined in this initial qualitative study.
  • If warranted following such analysis, encourage the expansion of agreements to include a wider range of Army medical professionals and medical teams.
  • Maintain the current decentralized management scheme, but consider a mechanism for central visibility of agreements.
  • Facilitate mechanisms to share experiences and learn lessons about different types of sharing and training agreements.

Research conducted by

This research was sponsored by the Office of the Surgeon General of the U.S. Army and conducted within the Personnel, Training, and Health Program, a part of the RAND Arroyo Center.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit

RAND 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.