The project team examined the systems used by two Department of Defense organizations — the U.S. Military Entrance Processing Command and the Department of Defense Medical Examination Review Board — to medically screen enlisted and officer applicants to the armed forces. The findings and a recommendation to combine the two systems into a hybrid are detailed in this report.

Improving U.S. Military Accession Medical Screening Systems

Maria C. Lytell, Kimberly Curry Hall, Nelson Lim

ResearchPublished Oct 24, 2019

Responsibility for medically screening enlisted and officer applicants for the armed forces falls on two Department of Defense (DoD) organizations: the U.S. Military Entrance Processing Command (USMEPCOM), which screens mainly enlisted applicants at military entrance processing stations (MEPS) throughout the country; and the Department of Defense Medical Examination Review Board (DoDMERB), which contracts with civilian health care providers to screen officer applicants. Given the inconsistencies and inefficiencies of the two systems, the project team was tasked with exploring how best to reform the medical screening process. After conducting interviews, focus groups, and a workshop with key stakeholders; reviewing documentation on current policies and practices; and examining prior DoD efforts at improvement, the team developed three main courses of action (COAs) to reform the business models used for accession medical screening, considered the potential feasibility of implementing each COA, and identified the COA for a hybrid model of the two systems as presenting the least amount of risk while allowing for simultaneous testing of enlisted and officer applicants across the two systems. Because of the potential for major impacts of implementing the hybrid model COA, the team recommended that DoD conduct a pilot program involving a randomized control trial at four experimental sites in the United States. The program incorporates strategic elements of an accession medical screening system (regardless of business model) described by stakeholders, as well as findings from analyses of organizational and geographic-based features using a RAND-developed geographic information system tool.

Key Takeaways

Stakeholders identified challenges with the current systems:

  • Lack of consistency across MEPS sites and the time required to visit a MEPS for screening are key concerns about the USMEPCOM system.
  • Uncertain quality of reports from civilian providers is a main concern about the DoDMERB system.

Each of the three COAs for reforming the business models of the two systems could have major impacts:

  • A high outsource COA that puts all medical screening under DoDMERB would significantly affect USMEPCOM (as its medical screening function would drop significantly) and DoDMERB (which would need to significantly increase capacity for an influx of enlisted applicants).
  • A low outsource COA that puts all medical screening under USMEPCOM would not have a major impact on USMEPCOM given the size of its current mission, but it would effectively remove DoDMERB from the accession medical mission.
  • The third COA — a hybrid model, in which enlisted and officer applicants can go to DoDMERB or USMEPCOM — would have major impacts on capacity and create new information-sharing requirements.

The third COA is the least risky to adopt:

  • It will not significantly disrupt the organizational structures and staffing of MEPS or DoDMERB.
  • It will allow population cross-flows between systems.
  • It has a template in an existing Marine Corps accession program, although this program may not generalize to other accession sources as it is currently designed.

Recommendations

  • Test the hybrid COA prior to implementation.
  • Use randomized controlled trials at MEPS in four strategic locations (Louisville, Kentucky; Springfield, Massachusetts; San Diego, California; and Cleveland, Ohio).
  • Consider expanding an existing Marine Corps program to other accession sources if the pilot program is too costly.

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Lytell, Maria C., Kimberly Curry Hall, and Nelson Lim, Improving U.S. Military Accession Medical Screening Systems. Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR2780.html.
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This research was conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute (NDRI), a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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