The military medical infrastructure is a strategic national asset and enhances security by supporting the full range of military operations. It supports healing, training, research, and homeland security; and it represents our nation's tangible commitment to care for warriors and their families. Historic funding levels have been insufficient to keep pace with need to recapitalize almost $30B of plant replacement value. Evolving medical missions, threats, casualty care, technological innovations, new clinical practices, and patient/family expectations requires increased investment by the Department of Defense on its medical facilities. The primary challenge faced by the MHS facilities community was how to define, prioritize, and articulate the value of investing in new facilities across the system.

The Military Health System has also traditionally lacked of a coherent method to define and prioritize capital facility investments based on a system wide perspective and linked to strategic goals and objectives. This has proven problematic in terms of making convincing arguments for investment resources and defending those investments during budget reviews. The ultimate need was to develop a capital asset decision construct that would assist and inform key DoD decision-makers in determining where to place critical facility investments across the entire enterprise.

A number of such models exist and are used by organizations both within and outside the public sector. Although these models can take several forms, the model envisioned would inform decision makers on the best use of limited capital resources based on the degree to which the proposed investments support overall system wide strategic goals and objectives. Successfully navigating this transition required a robust methodology that could
1) identify capital requirements;
2) reliably prioritize and optimize potential investments based upon established criteria; and,
3) incorporate an executive review and approval process. Expected benefits included improved support of MHS wide strategic goals, development of a consistent basis for making capital investments, an improved focus for articulating Military Service investment candidates, increased probability of support from program review agencies, and quantifiable improvement of the health status of the MHS facility portfolio.

The initial challenge was defining the key principles and characteristics of a capital decision model. It would be rationale, consistent, and reproducible. The model and business processes would ensure that all reasonable alternatives are considered and provide for defining and weighting criteria. The model must also allow for a range of policy constraints.

The second challenge was to develop an effective instrument for the Services to submit capital investment proposals. A web-based Proposal Submission Tool was developed that allowed for the Services to enter summary information related to the specific criteria as well as reporting capability for the evaluators to access during its discussion and ranking activities.

The third major challenge was change itself — this was mitigated through numerous work sessions discussing both process and policy implications. Several "test" runs were conducted and analyzed prior to the actual scoring of capital investments.

The MHS Capital Investment Decision Model was employed to develop the Fiscal Year 10-15 Military Health Construction Program. The effort is facilitating the potential of approximately $11B investment over the next five years and has provided the ability to articulate and defend recommended requirements at the very senior levels of the Department of Defense. Over 112 facilities and 22 inpatient facilities are currently projected for new capital investment during this period. Future efforts are focused on refinement of criteria, evaluation process, and development of quantitative criteria measures.