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Multi-Service Markets: Our Pathway to the Health Care Market Structure

The Military Health System is continually evolving to become a more integrated system of readiness and health. On March 11, 2013, the Deputy Secretary of Defense issued a memorandum outlining the implementation of MHS governance reform as it was outlined in section 731 of the National Defense Authorization Act for Fiscal Year 2013. While the centerpiece for this reform as the establishment of the Defense Health Agency as a Combat Support Agency, this memorandum also established the multi-service market areas which served as a stepping stone to the DHA’s current health care market structure.

Multi-service market areas, or MSMs, were geographic areas where at least two military medical hospitals or clinics from different military Service branches – Army, Navy or Air Force – had overlapping service areas. There were 15 MSMs around the world; 11 in the U.S. and four overseas.

Enhanced Multi-Service Markets

Six of these markets were considered "enhanced" because of several factors, including overall size, medical mission and graduate medical education capacity. 

eMSM map
  • Colorado Springs, Colorado
  • National Capital Region
  • Oahu, Hawaii
  • Puget Sound, Washington
  • San Antonio, Texas 
  • Tidewater, Virginia

These eMSMs were also provided with “enhanced” authorities to:

  • Manage the allocation of the budget for the market
  • Direct the adoption of common clinical and business functions for the market
  • Optimize readiness to deploy medically ready forces and ready medical forces
  • Direct the movement of workload and workforce between or among the military medical hospitals and clinics within the market

DHA Health Care Market Structure

Today, the DHA has established a market-based structure to manage the military medical hospitals and clinics using lessons learned from the MSM and eMSM processes and procedures. >>Find out More about the DHA’s Health Care Market Structure

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Local military medical units combine into medical market

Article Around MHS
Leadership unfurls the DHA guidons during a ceremony

The 96th Medical Group at Eglin Air Force Base in Florida and Defense Health Agency leadership marked the forming of a new military medical organization during a market establishment ceremony on Nov. 15. This new Florida Panhandle Market is a transformation of northwest Florida-based military treatment facilities into a market, or group of military medical facilities working together within the military health system.

Hawaii Market Strengthens DoD’s Medical Readiness & Patient Experience

DHA Assistant Director Dr. Brian Lein (left), and Hawaii Market Director Col. Martin Doperak (right) prepare to unfurl the flags during the formal Hawai'i Market Establishment Ceremony.

The Defense Health Agency (DHA), and the new Hawaii market director, Army Col. Martin Doperak, hosted a ceremony at Tripler Army Medical Center on October 20, 2021, ushering in the new Military Health System market.

DHA establishes Central Texas Market to improve health care delivery

Unfurling of the flags during the ceremony of the Central Texas Market

The Central Texas Market will enable greater collaboration across military hospitals and clinics in the Central Texas region to strengthen the medical readiness of service members and enable these facilities to deliver better care and a better patient experience.

Defense Health Agency Formally Establishes Low Country Medical Market

Military personnel uncasing the DHA Low Country Market colors

The Low Country Market was introduced Sept. 2 in an establishment ceremony hosted by the Defense Health Agency (DHA) and Winn Army Community Hospital.

Puget Sound Military Health System Certified by Defense Health Agency

Photo of a shuttle bus

The Puget Sound market leaders are responsible for managing all health care for its military population within Western Washington.

New Markets, MHS Transformation and You: What Does it All Mean?

Team members of the Fort Belvoir Community prepare for the start of a new day

With ten new markets launching, U.S. Public Health Service Capt. Tracy Farrill, talks about what this means for beneficiaries.

San Antonio Market to Standardize, Optimize Local Healthcare

Military personnel unveiling flags

The Defense Health Agency’s San Antonio Market is the seventh market to stand up over the past year, and is designed to standardize, optimize local healthcare.

Defense Health Agency Continues Transformation with Colorado Market

Military personnel unveiling flags

The Colorado Military Health System officially stood up June 22.

DHA stands up new market in Tidewater region of Virginia

Military health personnel wearing masks holding up a flag

Tidewater Market is on the leading edge of the Military Health System’s historic change, following its certification by the Defense Health Agency on April 19, 2021.

Tidewater set to become fifth Military Health System market

Military health personnel reading a medical machine

The Tidewater Military Health System market in southeast Virginia is scheduled to officially stand up April 19.

MTF facilities, markets set to resume transition heading into 2021

A military nurse, wearing a mask, prepares a needle for a vaccination

Butler says transition on track.

Plan for Reform of the Administration of the Military Health System


HR 4310, NDAA Conference Report for FY 2013, 112-705, Sec. 731

Implementation of Military Health System Governance Reform


This memorandum directs implementation of the Military Health System (MHS) governance reform outlined in my memorandum of March 2, 2012, "Planning for Reform of the Governance of the Military Health System," and affirmed by section 731 ofthe National Defense Authorization Act for FY 2013.

  • Identification #: OSD002010-13
  • Date: 3/11/2013
  • Type: Memorandums
  • Topics: N/A
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Last Updated: April 21, 2023
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