As the post–Cold War Army shrank, the U.S. Army's
Health Services Command (HSC) decided to change the way it did business and operate more like a corporation. In 1992, HSC launched "Gateway To Care", a businesslike approach to health-care delivery. This was to be localized managed care, with improved quality, access and cost. In a design based more on catchment-area management than the previous "
CHAMPUS Reform Initiative" (CRI), U.S. Army hospital commanders received more responsibility and managerial authority. Eleven "Gateway to Care sites opened in the spring of 1992. By that fall, all HSC facilities had submitted business plans which were favorably received. Starting in 1994, "Gateway To Care" was gradually absorbed into a new regional
Defense Department tri-service managed-care plan called
TRICARE, which was modeled on CRI. In August 1993, the
U.S. Army Chief of Staff approved a plan to reorganize the AMEDD. The merger of several medical elements resulted in a new, expanded medical major command under the Surgeon General. In October 1993, the "U.S. Army Medical Command (Provisional)" began a one-year process of replacing HSC and absorbing other AMEDD elements. Surgeon General Lt. Gen.
Alcide M. Lanoue commanded the provisional MEDCOM, while Maj. Gen.
Richard D. Cameron continued as HSC commander. In November 1993, DENCOM and VETCOM were formed as provisional commands under the MEDCOM, to provide real command chains for more efficient control of dental and veterinary units—the first time those specialties had been commanded by the same authorities who provided their technical guidance. The next month, seven MEDCEN commanders assumed command and control over care in their regions. The new "Health Service Support Areas" (HSSAs), under the MEDCOM, had more responsibility and authority than the old HSC regions. In March 1994, a merger of
Medical Research and Development Command, the
Medical Materiel Agency and the
Health Facilities Planning Agency resulted in creation of the
Medical Research, Development, Acquisition and Logistics Command (MRDALC), subordinate to the provisional MEDCOM. The MRDALC was soon renamed the
U.S. Army Medical Research and Development Command (USAMRMC). Then, in June 1994, an additional HSSA was formed to supervise medical care in Europe, replacing the
7th Medical Command, which inactivated. That summer, the
Army Environmental Hygiene Agency formed the basis of the provisional
Center for Health Promotion and Preventive Medicine (CHPPM). Thus, in an unprecedented process of unification, U.S. Army medicine gradually came together in a new home under the command of the Surgeon General. Except for the field medical units commanded by the combat commanders, virtually all of Army Medicine became part of the MEDCOM. The MEDCOM became fully operational, dropping the "provisional," in October 1994. In 1996, the HSSAs were renamed
Regional Medical Commands and later in 2016, to Regional Health Commands.
Transition circa 2019 "The
Defense Health Agency is assuming administration and management responsibilities from the Army, Navy and Air Force for all military hospitals and clinics [as of] 1 Oct. 2019. Congress initiated this change in administration and management because they saw a need for a more flexible, adaptable, effective and integrated system to manage [U.S. military medical] facilities. DHA will initially oversee these facilities through a direct support relationship with the Military Medical Department intermediate management organizations. The DHA will relieve the Military Departments of this support during a transition period in which responsibility for specific health care and administrative functions are fully transferred from the Military Departments to the DHA. DHA is establishing a market-based structure to manage the hospitals and clinics. These market organizations will provide shared administrative services to the hospitals and clinics in their region. They will be responsible for generating medical readiness of active duty members and families in their regions, as well as ensuring the readiness of their medical personnel." Other responsibilities formerly assigned to MEDCOM have also been transferred, as of 1 October 2019. Logistics and materiel research and supply have been assigned to
United States Army Materiel Command, and medical training is now the responsibility of
Training and Doctrine Command (TRADOC). The
Army Medical Department Center & School (AMEDDC&S) has been renamed the Army Medical Center of Excellence. The Walter Reed National Military Medical Center, Bethesda, MD, was transferred to the direct control of the Defense Health Agency. Previous subordinate commands of MEDCOM also included the
United States Army Dental Command, Fort Sam Houston, TX. The
Army Medical Department ("the AMEDD") remains, as an overall administrative body, including the
Medical Corps,
Nurse Corps,
Dental Corps,
Veterinary Corps,
Medical Service Corps, and
Medical Specialist Corps. ==Structure ==