nize the constraints imposed by the existence of separate executive branch departments with differing missions, statutory requirements, departmental policies, administrative procedures, organizational cultures, performance standards, and reporting requirements.

Other important contextual factors include the current degree of interdependence among DoD and VA facilities relative to collocation, current sharing of services, various informal arrangements, opportunities for medical and health professional education and research, and related factors. Other additional factors include the number of people served by the entities involved, their demographic characteristics and health needs, and the characteristics of the local private-sector health care marketplace. Further considerations include the strength of the local economy, the availability of workforce, and related resources. Relationships with medical and affiliated health professions schools are also an important consideration.

Despite the national policy challenges, the local context was quite favorable for the Lovell FHCC integration. For instance, the Navy and the VA facilities were located very close together, allowing the VA to accommodate Navy beneficiaries and improve the capacity of its medical facility and the Navy to save money by not having to replace its obsolete inpatient facility. In addition, the VA patient population offered a more varied and complex health care treatment mix to allow Navy clinical personnel to keep up their skills, while the overall increase in the number of patients created some economies of scale and staffing efficiencies. For the VA, in addition to increasing use, the larger and more varied patient base, including women and children, provided increased training and potential research opportunities for medical students and residents.

Into the future, changes in demand for both DoD and VA facilities will be an important consideration for the success of collaborative activities. The veteran population enrollment for VA health care services is projected to decline over the next decade, and immediate indicators suggest a reduced future demand. Another factor to be considered is the difference between the requirements of more standard health care operations as opposed to recruit training sites, such as that found in the Lovell FHCC merger.

The country’s slow economic recovery, the burden of debt, and related factors may also affect how the nation chooses to provide health care to its military personnel and veterans.

ORGANIZATIONAL CAPABILITIES AND READINESS

The second key component in considering future collaborations is a rigorous realistic assessment of the capabilities and readiness of the involved parties. While there are many important factors to consider, among the most critical are the governance and the stability of leadership of the



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