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Organizational Histories

As the post-Cold War Army shrank, it wastime for a new way of doing business and business was the way. HSC would operatelike a corporation. In 1992, HSClaunched Gateway To Care, a businesslike approach to health-care delivery. Itwas localized managed care, intended to give quality care with better access andless cost. In a design based more on catchment-area management than CHAMPUSReform Initiative, Army hospital commanders got more responsibility andmanagerial authority. Eleven Gateway to Care sites opened in spring 1992. Byfall, all HSC facilities had submitted business plans. Initial results wereexcellent. Starting in 1994, Gateway To Care was gradually absorbed into a newregional Defense Department triservice managed-care plan called TRICARE, whichwas modeled on the CHAMPUS Reform Initiative. Meanwhile, healing work continued.Hurricane Andrew slammed south Florida. Army troops moved to assist and ArmyMedicine was there. From early 1993 to early 1994, HSC people participated inOperation "Restore Hope" supporting American troops in Somalia. Nowthe AMEDD's effort to "heal itself" by becoming more efficient andforestalling the break-up of medical unity bore fruit. In August 1993, the Armychief of staff approved a plan to reorganize the AMEDD. Heart of the plan was tomerge several medical elements into a new, expanded medical major command underthe command of the surgeon general. In October 1993, the U.S. ArmyMedical Command (Provisional) began a one-year process of replacing HSC andabsorbing other AMEDD elements. Surgeon General Lt. Gen. Alcide M. LaNouecommanded the provisional MEDCOM, while Maj. Gen. Richard D. Cameron continuedas HSC commander. In November 1993, U.S. Army Dental Command (DENCOM) and U.S.Army Veterinary Command (VETCOM) were formed as provisional commands under theMEDCOM, to provide real command chains for more efficient control of dental andveterinary units-the first time those specialties had been commanded by thesame authorities who provided their technical guidance. Next month, seven MEDCENcommanders assumed command and control over care in their regions. The newHealth Service Support Areas, under the MEDCOM, had more responsibility andauthority than the old HSC regions. In March 1994, a merger of Medical Researchand Development Command, Medical Material Agency and Health Facilities PlanningAgency created the Medical Research, Development, Acquisition and LogisticsCommand, subordinate to the provisional MEDCOM. The command shortly got a newand less formidable moniker: Medical Research and Materiel Command. Then in June1994, an additional HSSA was formed to supervise medical care in Europe,replacing 7th Medical Command, which inactivated. That summer, the ArmyEnvironmental Hygiene Agency formed the basis of the provisional Center forHealth Promotion and Preventive Medicine. Bit by bit, Army Medicine was comingtogether in a new home under the command of the sameman who was the surgeon general-unifying the leadership and management of ArmyMedicine more than ever before. Except for the field medical units commanded bycombat commanders, virtually all of Army Medicine as now part of the MEDCOM. TheMEDCOM became fully operational, dropping the "provisional," inOctober 1994. In 1996, the HSSAs were renamed Regional Medical Commands.