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Multi-Service Markets

Multi-service markets are geographic areas where at least two medical hospitals or clinics from different services have overlapping service areas. There are 15 multi-service markets around the world; 11 in the United States and four overseas.

Enhanced Multi-Service Markets

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

eMSM map


Frequently Asked Questions


What are eMSMs?


Enhanced Multi-Service Markets (eMSMs) are Multi-Service Markets identified by the Deputy Secretary of Defense in his March 2013 memorandum. These markets are provided with “enhanced” authorities that include the authority 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, and direct the movement of workload and workforce between or among the medical treatment facilities. These authorities are effective October 1, 2013.

There are two distinguishing features of the enhanced Multi-Service Market: 

  • a single market manager, and 
  • a unified business performance plan.  

Within each eMSM, an appointed market manager has the authority to: 

  • Manage the allocation of the budget for the market 
  • Direct common clinical and business functions for the market 
  • Direct the movement of workload and workforce among the medical treatment facilities 
  • Develop, execute and monitor the business performance plan 

Within each eMSM, Market-based business performance plans will be:

  • Fully-integrated across the entire market and will replace current MTF based business plans. 
  • Based on a 5-year planning cycle. 
  • Aligned with budget execution process.

How were these Markets selected for enhanced authorities?


The markets were selected based on careful review of a number of different characteristics by the MHS Governance Implementation Planning Team. All of these markets share several important factors, including readiness support, market complexity, large TRICARE eligible population, multi-Service provider footprint, recapture potential and GME programs.


What is the strategy for eMSMs to recapture care from the private sector?


Each market is creating a five-year Market-focused business performance plan that will outline the strategies each particular market will implement to improve performance, improve outcomes, and recapture care. There are a variety of strategies that the markets will employ – and will feature both internal process reengineering to improve utilization of existing resources, as well as externally facing efforts to attract and retain beneficiaries to use our services. The eMSM Offices will monitor workload, appointing, and referrals across MTFs in the market. The eMSM Offices will analyze and direct the movement of personnel to most effectively and efficiently meet the market workload needs and reduce unnecessary referrals to the Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care system.


Are eMSMs collaborating with the VA and other federal health partners?


The five-year market based business performance plans crafted by each market will take into account federal partners within their respective market areas, particularly to include the visbility and utilization of VA medical capabilities. The level of coordination will necessarily vary from market to market based on a number of variables.

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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.

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