Update to the National Partnership Council NPC San

Update to the National Partnership Council (NPC) San Diego, CA January 12, 2016 1

The importance of clear communications… https: //www. youtube. com/watch? v=y. R 0 l. WICH 3 r. Y

Fulfilling our Mission To care for him who shall have borne the battle and for his widow, and his orphan. - Abraham Lincoln, 1865 Today, we say to care for those “who shall have borne the battle, ” and for their families and their survivors. 3

Living our Values Integrity Commitment Advocacy Respect Excellence 4

There amazing heroes amongst us, doing great things every day…here is just one example Instead of following the VA rules, these Professionals followed the principle of making sure Veterans get the support that they have earned. With their determination and the help of local law enforcement, a Veteran’s life was saved. “We are celebrating the kind of initiative displayed by these employees and herald their stories to inspire our other employees to be led by principles and values rather than rules and fear. ” 5

The My. VA aspiration… Whether or not we are each still here – we all want to proudly look back and say “I was part of the team that made this happen on behalf of our Veterans and those that serve our Veterans” 6

12 Breakthrough Priorities VA internal facing Veteran facing 1 Increase Access to Health Care 9 Staff critical positions 2 Implement Care in the Community 10 Transform OIT 3 Improve the Veteran Experience 11 Transform Supply Chain 4 Deliver a Unified Veterans Experience 12 Improve Employee Experience 5 Modernize our Contact Centers 6 Improve the Comp & Pension exam 7 Develop a simplified Appeals process (to include leadership development) (to include Veterans Crisis Line) 8 Continue to reduce Veteran homelessness 7

3 Improve the Veteran Experience 2015 Accomplishments 2016 Breakthrough Outcomes • VA named the Department’s first Chief Veteran Experience Officer and began staffing the office which will work with the field to set customer service standards, spread best practices, and train our employees on advanced capabilities such as Lean and Human Centered Design. • Strengthened trust in VA “to fulfill our country’s commitment to Veterans”; we currently measure this at 47% and we want it to be 70% by year end. • Establish a Department-wide customer experience measurement framework to enable data-driven service improvements. • Veterans Experience office will be fully operational. • Expand the network of Community Veteran Engagement Boards to 100+. • Fully staffed at the frontline with wellprepared employees who have been selected for their customer service orientation. • We are enabling a national network of Community Veterans Engagement Boards, designed to leverage all community assets, not just VA assets, to meet local Veteran needs. 36 communities are fully formed and 15 communities are in development. 8

Veterans Experience Operating Model ENTERPRISE OPERATIONS CUSTOMER INSIGHT Purpose: Provide to the Department the authoritative perspective of VA’s customers SERVICE DESIGN Purpose: Design scalable ‘interventions’ to improve service to VA customers Purpose: Deliver effective and easy customer experiences online and by phone FIELD OPERATIONS Purpose: Foster system-wide adoption of best practices in areas related to customer experience at the facility level 9

VE Field Operations District Veteran Experience Offices Key Tasks: - Foster system-wide adoption of best practices in areas related to customer experience at the facility level - Act as “connectors” and information conduits between and among facilities in the District - Coordinate with other national VA field teams (e. g. , VERC, FIT, NCOD) to support facility leadership - Collect “ground truth” regarding Veteran and employee experiences, identifying opportunities for improvement 10

District Veterans Experience Offices One team per VA District Team members based throughout the District Team Composition (18 Total): District Veterans Experience Officer Deputy District VE Officer Executive Assistant GS-13 Adminstrative Assistant GS-11 Relationship Managers (4) GS-15 Relationship Managers (2) GS-14 Field Consultants (4) GS-13/14 Field Consultants (6) GS-12/13 11

1 Increase Access to Health Care 2015 Accomplishments 2016 Breakthrough Outcomes • Increased the number of Veteran appointments by more than 1. 2 million. • When a Veteran calls or visits primary care at a VHA Medical Center, their clinical needs will be addressed that day. • Completed over 96% of appointments in October 2015 within 30 days of clinically indicated or Veteran’s preferred date. • Veterans will be able to conveniently get medically necessary care, referrals, and information from any VA medical center, in addition to the facility where they typically receive their care utilizing existing VISTA technology. 12

2 Implement Care in the Community 2015 Accomplishments 2016 Breakthrough Outcomes • Issued authorizations resulting in 12 million appointments in the community, thanks to the expanded flexibility of the Choice Act. • Improve the Veterans’ experience with Community Care. Pending legislation, VA will… • Begin to consolidate and streamline Community Care Network access and improve relationships with community providers and core partners. • Veterans will be able to see a community provider within 30 days of their referral • Community Care claims (clean) will be processed and paid within 30 days 85% of the time. • Claims backlog will be reduced to less than 10% of total inventory • Referral and authorization time will be reduced. 13

4 Deliver a Unified Veterans Experience 2015 Accomplishments 2016 Breakthrough Outcomes • On November 11, VA launched Vets. gov, a modern, mobilefirst, cloud-based website that will replace numerous other websites and will replace multiple website logins to a single easy to navigate location. • Vets. gov will be able to provide Veterans, their families, and caregivers with a single, easy-to use, and high-performing digital platform to access the VA benefits and services they have earned. • Developed with support from the U. S. Digital Services Team and with extensive feedback from Veterans, the website puts Veteran needs and wishes first. • The top 100 search terms will all be addressed within one click. • 100% of current content, features and forms from the current public facing VA websites will be redesigned, rewritten in plain language, and migrated to vets. gov prioritized based on Veteran demand. • Establish one authoritative source for Veteran contact information, military service history, and Veteran status. 14

5 Modernize our Contact Centers (to include Veterans Crisis Line) 2015 Accomplishments 2016 Breakthrough Outcomes • Veterans Crisis Line in Canandaigua, NY were featured in the Oscar winning documentary “Crisis Hotline: Veterans Press 1”. • By the end of this year, every Veteran in crisis will have their call promptly answered by an experienced responder at the Veterans Crisis Line. • The Veterans Crisis Line (VCL) answered over 490, 000 calls and initiated the dispatch of emergency services to callers in imminent crisis over 11, 000 times. VCL answered over 58, 000 and 16, 000 requests for chat and text services respectively. VCL provided over 81, 000 referrals to local VA medical facility Suicide Prevention Coordinators ensuring Veterans are connected to care in their community. • Veterans will be able to access the VA system 24 hours a day, know where to call to get their questions answered, receive prompt service and accurate answers, and are treated with kindness and respect. VA will do this by establishing the initial conditions necessary for an integrated system of customer contact centers. 15

6 Improve the Compensation & Pension (C&P) exam process 2015 Accomplishments 2016 Breakthrough Outcomes • VBA, VHA and our Veterans experience team worked together to redesign the C&P process using Human Centered Design and Lean techniques. • Improved Veteran satisfaction (baseline metrics in place by February). • National rollout of initiatives completed that demonstrate measurable impact on the Veterans experience. 16

7 Develop a simplified Appeals process 2015 Accomplishments 2016 Breakthrough Outcomes • Drove down the disability claims backlog to under 75, 000, from a peak of 611, 000 in March 2013. • Guaranteed a record 631, 000 home loans totaling $153 billion and assisted 90, 000 Veterans in avoiding foreclosure, saving taxpayers over $2. 8 billion. • Reduced the time for Home Loan Certificate of Eligibility processing from 26 to 2 business days • Automated the processing of dependency claims filed online, as well as burial and death benefits for certain surviving spouses. • Automated burial benefits were paid to surviving spouses within 6 days (down from 190 days). • Transitioned disability compensation claims processing from a paper-intensive process to a fully electronic processing system; 5, 000 tons of paper year were eliminated. • Decided 1. 4 million disability compensation and pension (rating) claims for Veterans and survivors. • Subject to successful legislative action, put in place a simplified appeals process, enabling the Department to resolve 90% of appeals within one year of filing by 2021. • Subject to additional resources being made available in 2016, increase current appeals production to more rapidly reduce the existing appeals inventory. 17

8 Continue to reduce Veteran homelessness 2015 Accomplishments 2016 Breakthrough Outcomes • Provided services to more than 365, 000 homeless or at-risk Veterans in VHA’s homeless programs. • Continue progress toward an effective end to Veteran homelessness by permanently housing or preventing homelessness for an additional 100, 000 Veterans and their family members by December, 2016. • Either placed in permanent housing or prevented from becoming homeless nearly 107, 500 Veterans. • Data collected during the 2015 annual Point in Time (PIT) Count estimates that the number of homeless Veterans has declined by 36 percent since 2010. This includes a nearly 50 percent drop in the number of unsheltered Veterans sleeping on the street. 18

9 Staff Critical Positions 2015 Accomplishments 2016 Breakthrough Outcomes • VHA hired 41, 113 employees, a net on board of 13, 940, a 4. 7% increase in healthcare staff, including 1, 337 physicians and 3, 612 nurses. • Achieve significantly improved critical staffing levels that balance access and clinical productivity, with targets of: • Several critical leadership positions filled to include the Under Secretary of Health, Chief Information Officer, and Veterans Experience Officer, among others. • 95% Medical Center Director positions filled with permanent appointments (not acting) • 90% of other critical shortages addressed – management as well as clinical. • Work to reduce “time to fill” standards by 30%. 19

10 Transform OIT 2015 Accomplishments 2016 Breakthrough Outcomes • In July, La. Verne Council was confirmed as our new Chief Information Officer (CIO). • Achieve key milestones on the path to creating a world-class Information Technology (IT) organization that improves the support to business partners and Veterans: • 50% percent of projects on time, on budget. • Stand up an account management office. • Develop portfolios for all Administrations. • 100% of supervisors and executives performance goals tied to strategy goals. • Close 100% of current cybersecurity weaknesses. • Develop a holistic Veteran data management strategy • Implement a quality & compliance office. • Deploy a transformational vendor management strategy. • Ensure implementation of key initiatives to improve access to care. • Strengthen EHR Strategy. • Finalize the Congressionally mandated Interoperability requirements. • La. Verne and her new team have developed a multiyear plan for creating a world class Information Technology organization. 20

11 Transform Supply Chain 2015 Accomplishments 2016 Breakthrough Outcomes • Consolidated Mail Outpatient Pharmacy (CMOP) received the highest customer satisfaction score among the nation’s public and private mail-order pharmacies for the sixth year in a row according to J. D. Power • Build an enterprise-wide integrated Medical-Surgical supply chain that leverages VA’s scale to drive an increase in responsiveness and a reduction in operating costs. • Maintained an average unit price far below national average in both branded and generic drugs. • $150 M + cost avoidance will be redirected to priority Veteran programs. 21

Our Pharmacy is best in class J. D. Power's Mail Order Pharmacy Overall Satisfaction Dept. of Veterans Affairs 871 Kaiser Perm. Mail Pharmacy Humana Right. Source. RX Walgreens Mail Service 822 Mail Order Average 800 810 820 Branded Drugs - Average Unit Price Savings to Taxpayer 840 850 860 870 880 Generic Drugs - Average Unit Price Savings to Taxpayer 71% 100% National Avg Drug Acquisition Cost 100% 38% 35% VA Average Price 830 Avg Wholesale Price (AWP) VA Average Price 52% National Avg Drug Acquisition Cost Avg Wholesale Price (AWP) 22

12 Improve Employee Experience (to include leadership development) 2015 Accomplishments 2016 Breakthrough Outcomes • Launched “Leaders • Continue to improve employee experience by developing Developing Leaders” engaged leaders at all levels, who inspire and empower all (LDL) which has already employees to deliver a seamless, integrated, and responsive trained 5, 000+ leaders VA customer service experience. on critical leadership • Over 12, 000+ engaged leaders skilled in applying skills. “Leader Developing Leaders” principles, concepts, and tools will work projects and/or initiatives to make VA a • To improve and more effective and efficient organization. encourage problem • Incorporate LDL principles into VA’s leadership and solving, we are already supervisor development programs. training critical pockets • Senior Executives will include in their performance of our workforce on plans an element that targets how to improve techniques such as Lean employee engagement and customer service. and Human-Centered • All VA employees will have a customer service standard Design. in their performance plans. VA will replace the current cumbersome paper process for individual development plans with a new electronic version, making it easier for both supervisors and employees. 23

Don’t underestimate the power of commitment… https: //www. youtube. com/watch? v=GPee. Z 6 vi. Ng. Y

Extra Slides (backup)

We are learning from the best… And many more… 26

We are working collaborative with all our partners We have been consulting with our key partners & stakeholders on how to implement change 27

NCA is the #1 rated customer service organization American Customer Satisfaction Index National Cemetery Administration (NCA) 96 Manufacturing / Durable Goods (Private Industry) Health Care / Durable Goods (Private Industry) Energy Utilities (Private Industry) Defense (Public Sector) State (Public Sector) 64 Federal Government Aggregated (Public Sector) 50 60 70 80 90 100 For the fifth consecutive time, the Department of Veterans Affairs’ National Cemetery Administration (NCA) has bested the nation’s top corporations and other federal agencies in a prestigious, independent survey of customer satisfaction. Source: The American Customer Satisfaction Index (ACSI) is the only national, cross-industry measure of satisfaction with the quality of goods and services available in the United States. www. theacsi. org 28

We are Capable of Great Changes 29

www. Vets. gov was “soft launched” on Veterans Day Vets. gov is a secure, cloud-based, single-platform website with a goal of meeting customers’ needs. Its strives to be a single, onestop shop for information and self-service features for Veterans and those who care for them. Approach - Veteran centered (panel of ~130 Veterans) - US Digital Service Team + VA collaboration - Agile “developing in the open” Improvements - Platform benefits - Mobile first - 508 compliant - Improved services (e. g. , GI Bill Comparison Tool) - Improved content Rave reviews (see govfresh. com article on “ 9 reasons why Vets. gov is the future of federal government websites”) 30

My. VA Communities • VA is increasing its presence and collaborative efforts at the local level through My. VA Communities • In some areas, VA has joined or increased participation with existing groups, and in other areas, VA has helped spark the establishment of new groups • My. VA Communities are designed to promote and support positive outcomes, develop local solutions, and improve the Veterans’ experience • My. VA Communities enable Service members and Veterans to easily identify and reach all of the resources available to them, voice their opinions, and provide valuable feedback Inclusive Accessible Community-Driven Flexible Integrated 31

My. VA Communities Update 36 Boards Fully Formed as of 1/11/16 v v v v v AK - My. VA Alaska Forget Me Not Coalition (Anchorage)* AZ - Arizona’s Military/Veteran Community Network (Phoenix) CA - San Diego One VA Community Advocacy Board* CT - Connecticut Community Veteran Engagement Board (Hartford) CO - My. VA Pikes Peak (Colorado Springs) DE - My. VA Community Delaware (Wilmington) FL - Mission United (Orlando)* FL - St. Petersburg/Bay Pines My. VA Community Engagement Board HI - Hawaii Veterans Advocacy Board ID - Boise My. VA Community* IN - Joining Community Forces Indiana (Indianapolis)* KS - Wichita My. VA Community LA - New Orleans My. VA Community Council Manila - Veterans Advocacy Board MD - Maryland My. VA Community Board (Baltimore) ME - Putting Maine Veterans First (Togus) MI - Michigan Military Resource Group (Ann Arbor)* MN - St. Paul Beyond the Yellow Ribbon Steering Committee* MT - Lewis and Clark County Joining Community Forces Initiative (Ft. Harrison)* 15 additional sites have co-chairs and boards in development Internal Use Only v v v v v NC - My. VA Winston-Salem ND - ND Cares Coalition (Fargo)* NM - New Mexico My. VA Communities (Albuquerque) NV – Truckee Meadows Veteran Community Collaborative NY - New York City Community Engagement Board OH - Greater Miami Valley My. Veteran Community Board (Dayton) OK - Oklahoma Veterans Council (Muskogee)* OR - My. VA Cascadia (Portland) PA - Still Serving: Military and Veterans in Greater Pittsburgh RI – TBD (Providence) SD - MILVETS: My. VA Communities Committee* TN - Nashville Serving Veterans Community Board TX - Military and Veterans Community Collaborative (San Antonio)* TX - North Texas My. VA Communities Board (Dallas) VT - My. VA Community Connection (White River Junction) WA - My. VA Puget Sound Community Engagement Board (Seattle) WV - Veterans Committee for Civic Improvement (Huntington)* *13 pre-existing collaborative groups 32

RAMMP – eliminating bureaucracy Examples of “Rattlesnakes” that have been “killed’ Reports Approvals Measurements Meetings Policies VHA – Category: Meetings - Stand-ups - cancel the practice or more predictive frequency VBA - Category: Reports - Eliminate the daily report, automated burials and DIC processing, provided to OFO/OC NCA - Category: Approvals - Eliminate the currentlyrequired staff office concurrences prior to the Under Secretary for Memorial Affairs signing notification letters of Veterans cemetery grant awards NCA - Category: Approvals – Eliminate the requirement for approved NCA Major Construction projects to go through the Capital Projects review process a second time when it is determined that the number of future available gravesites is greater than the original estimate.

Progress: Enhancing Strategic Partnerships • Strengthening and reinvigorating existing partnerships, e. g. , Walgreens • New partnerships, e. g. , Elks, Wounded Warrior Project, Team Rubicon • Veterans Economic Community Initiative (VECI) • Brain Health summit coming in 2016 • Creating tools to make it easier to partner (e. g. , MOA template, 101 training, relational database) • Completed “Summer of Service” campaign — spotlighting VA Volunteers. 34

My. VA mission is to modernize VA’s culture, processes, and capabilities in order to put the needs, expectations, and interests of Veterans and beneficiaries first… …by empowering employees to deliver excellent customer service to improve the Veteran experience. …by improving or eliminating processes that impede great customer service. …by rethinking our internal structures and processes to become more Veteran-centric and productive. 35

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Transformation takes time and effort The most general lesson to be learned from the more successful cases is that the change process goes through a series of phases that, in total, usually require a considerable length of time. Skipping steps creates only the illusion of speed and never produces a satisfying result. John P. Kotter Renowned management scholar SOURCE: Kotter (2007). Leading Change: Why Transformation Efforts Fail. Harvard Business Review.

Resources My. VA Intranet Site: https: //myva. gov/ VA Pulse (join the conversation!) https: //www. vapulse. net/ My. VA Integrated Plan Overview: http: //www. va. gov/opa/myva/docs/myva_integrated_plan_overview. pdf My. VA Integrated Plan: http: //www. va. gov/opa/myva/docs/myva_integrated_plan. pdf Idea. House: https: //vaideahouse. ideascale. com 38