A Department of Defense plan to put the Army in charge of all military medical training and research could be pulled soon in favor of establishing a new Defense Health Agency to handle those responsibilities, senior officials have told the DOD Task Force on the Future of Military Health Care.

In addition, the proposed Defense Health Agency would manage Tricare and take on responsibility for some "shared" medical activities across the services.

The Tricare Management Activity would form the foundation of the new agency. The Army, Navy and Air Force, however, would continue to run separate medical departments and retain control of their medical personnel and most facilities.

The DHA concept — seen as an incremental step toward dramatic streamlining and greater efficiencies projected from creating a unified medical command — has been endorsed by senior medical leaders. It awaits final approval of Deputy Defense Secretary Gordon England.

Dr. Stephen L. Jones, principal deputy secretary of defense for health affairs, said England still might decide to stick with an alternative "governance plan" for the military health system that he endorsed last year.

But that plan, which would give the Army responsibility for all medical training and research, has raised worries over "preserving service equities," Dr. Michael P. Dinneen, director of strategy management for the military health system, told the task force last week.

The DHA, Dinneen said, would be "a neutral party" for delivering "support functions ... in an equitable manner across the three services."

Unveiling of the agency's concept surprised several task force members.

"I hope I wasn't asleep and missed it but I was expecting a briefing on the joint medical command," retired Army Maj. Gen. Nancy Adams, former commander of Tripler Army Medical Center in Hawai'i, told Jones. She asked him to explain why DOD officials had abandoned plans for a joint command.

The Army, Navy and Joint Staff had backed a unified medical command, saying it would make medical care more effective and save several hundred million dollars a year. The Air Force opposed the idea, citing clash of cultures that could weaken medical support of missions.

Jones ignored these conflicts in answering Adams.

"DOD leadership, when presented with the unified medical command, kind of saw that as moving all the way. And, of course, within the system, there are pros and cons for doing that."

The "conservative" alternative England embraced last year would move to selective joint oversight. It would put the Army Medical Research and Materiel Command at Fort Detrick, Md., in charge of all military medical research. It would use the 2005 Base Realignment and Closure Commission's call for a joint center of enlisted medical training at Fort Sam Houston in San Antonio to give Army responsibility for all medical training.

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