VETERANS BENEFITS ADMINISTRATION M a VETERAN r k
VETERANS BENEFITS ADMINISTRATION M a. VETERAN r k B i. Sl BENEFI o s z , TSAADMINISTRATION cting Director, Compensation Service CO NTROLLED U NC LASSIFIED INFORMATION The American Legion | February 22, 2016
VBA Missions & Service Offerings in FY 15 and FY 16 To Date COMPENSATION EDUCATION − Provided est. $12. 3 B to over 1 M beneficiaries in FY 15 − 4 M claims processed in FY 15 − Post-9/11 GI Bill paid $60 B to 1. 5 M students and schools sinception PENSION & FIDUCIARY − Paid $63. 7 B to nearly 4. 1 M Veterans in − Paid $5. 5 B in Pension benefits to over FY 15 − Completed record-breaking 1. 4 M claims 500 K Veterans & survivors in FY 15 − Paid est. $6. 3 B in DIC to an estimated in FY 15 386 K survivors in FY 15 − 3. 1 M non-rating end products − Over 183 K Fiduciary beneficiaries on completed in FY 15 – 15% higher than the rolls in FY 15 – 10 K more than FY 14 LIFE INSURANCE − Insured 6. 4 M beneficiaries in FY 15 − 11 th largest Insurance program in U. S. − Provides over $1. 3 T in coverage under 10 lines of protection − Paying insurance death claims in avg. of 3. 6 days at 98. 7% accuracy HOME LOAN GUARANTY VBA TRANSFORMATION − 22 K employees − $96 B in benefits distribution − $2. 5 B in general operating expenses TRANSITION & EMPLOYMENT − Over 2. 4 M home loans on the books − Guaranteed 631 K loans in FY 15 (44% − Held 55 K TAP events reaching 520 K Servicemembers & families in FY 15 more than FY 14) totaling $153 B − Lowest foreclosure rate for 25 of 30 − Veterans Employment Center hired 365 K+ Veterans; employers committed quarters to hire 668 K+ in FY 15 VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION VOCATIONAL REHABILITATION & EMPLOYMENT − Over 104 K Veterans received an estimated $1. 1 B in VR&E benefits in FY 15 − Nearly 132 K participants in FY 15 – 3% more than FY 14 BENEFITS ASSISTANCE SERVICE − Over 5. 3 M registered e. Benefits users − 461 K Facebook likes; 66 K Twitter followers to date − Over 50 K outreach hours and over 2. 15 M encounters with Veterans, family members & survivors in FY 15 1 *FY 15 estimated actuals
VBA’s workload has risen dramatically since 2009
VBA’s caseload has grown at an unprecedented rate since 2009 VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 3 6
VBA transformed service to the Veteran community in order to eliminate the backlog of disability claims • Completely transformed a complex, paper-bound, compensation claims process • Redesigned and deployed new national training program • Designed and deployed new quality assurance program and people • Designed, piloted, refined, tested and deployed – using agile development process – its first ever digital claims IT system – incorporating rules and tools for 30, 000 unique user accounts • Designed and deployed a complete paper to digits conversion system – turning 1. 9 billion images into data and high quality, searchable PDF used by the claims system • Designed and deployed Disability Benefits Questionnaires for physicians to capture evidence-based data • Designed concurrently a CRM, Unified Desktop, Knowledge Management capability to more than 1, 000 call agents • Designed a completely new online claims filing system – customer facing – with 55+ additional self-service features and drove adoption from 250 K to 5. 4 million users • Successfully completed over 1 million claims each year for the past 6 years • Less than 36 months from paper plan to reality – less than 18 months after full implementation • Reduced the backlog by 87%; the inventory by 60%; improved accuracy by 8% points – over 90% and 96%, claim and issue respectively; established records in productivity and performance on behalf of our Veterans, their Families and Survivors VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 4
2015 Transformation Goal: Backlog Reduction Thank you to The American Legion for your help
2015 Transformation Goal: 98% Quality Today, VA makes the correct decision 98 percent of the time in each of the eight separate categories measured within a Veteran’s disability claim, ensuring the following: • • All Claimed Issues Addressed All inferred Issues Addressed Al Development Letters Sent All Medical Exams Completed Service Connection Decision Correct Evaluation Percentage Correct Effective Date Correct Payment Rate Correct Rolling 12 -Month Cumulative Claimed Issues Addressed Inferred Issues Addressed Development Letters Sent Proper Development Correct Decisions Correct Evaluations Correct Effective Dates Correct Payment Rates Total Claim-Based 98. 6% 99. 1% 99. 8% 97. 2% 98. 4% 97. 9% 99. 2% 88. 8% Issue-Based 99. 5% 99. 8% 99. 9% 99. 2% 99. 5% 99. 2% 98. 7% 99. 8% 95. 7% VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 6
2015 Transformation Goal: 125 -Day Processing Today, the average days a Veteran is waiting for a claims decision is 91 days – a 191 -day reduction from a peak of 282 days in March 2013 Average days it takes to complete a claim is 128 days – a 59 -day reduction from FY 14 • • VA employees are dedicated to getting Veterans the benefits they have earned and deserve as quickly and accurately as possible, but some claims will still take more than 125 days to process − VA’s open-ended duty to assist Veterans and Survivors in developing their claim prevents VA from deciding all claims within 125 days − VA will always consider additional evidence or new medical conditions added Examples of claims that could take longer than 125 days to process include: − Veterans who add a new disability to their claim or identify additional evidence well into VA’s processing of their claim − Veterans who are unable to make scheduled medical exams − In the process of deciding the claim, VA identifies additional disabilities related to the Veteran’s service-connected disabilities that the Veteran did not claim or additional entitlements, such as adapted housing benefits − Complex disability claims, such as radiation claims, that require scientific and medical data and opinions from experts − Difficulty in obtaining National Guard and Reserve records for still serving members or military personnel records required to make a character of discharge determination VETERAN S BENEFI TS ADMINISTRATION We will continue to work to drive down the number of claims pending more than 125 days – CO NTROLLED U NC LASSIFIED INFORMATION 7 thank you for your continued help filing electronic fully developed claims
We couldn’t have done it without The American Legion Total Rating Receipts from The American Legion Nationwide 250000 125, 000 200, 097 200000 150000 FDC Receipts from The American Legion Nationwide 140, 855 97, 898 100, 000 75, 000 100000 50, 000 50000 25, 000 0 0 FY 14 FY 15 49, 917 FY 14 FY 15 Nationally, nearly 50% of claims submitted by The American Legion in 2015 were FDCs VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 8
The time to modernize the appeals process is now • The current VA appeals process is broken and is providing a frustrating Veterans experience. We are failing Veterans. • The status quo isn’t acceptable for Veterans or for tax payers. • Veterans deserve an appeals decision within one year of filing. • The time to modernize the appeals process is now. • A Simplified Appeals Process is Timely, Simple, Fair, and Provides a Final Answer. VA is committed to working with stakeholders like you to improve the processes so appeals decisions are completed as quickly and accurately as possible, while VETERAN S BENEFI TS ADMINISTRATION still executing each legally required step in the process, and protecting the due CO NTROLLED U NC LASSIFIED INFORMATION process rights of each Veteran
We need your help educating Veterans about the difference between a claim and an appeal • A claim is submitted by a Veteran seeking VA disability benefits (or increased benefits) for one or more medical conditions the Veteran believes is related to his or her military service − VA has completed more than a million claims in each of the past 6 years at a 96% issuebased accuracy level − More than 100, 000 Veterans are receiving decisions on their claims each month − 52% of Veterans with pending rating-related claims are currently receiving Compensation or Pension payments • An appeal is filed by a Veteran or Survivor who is dissatisfied with one or more aspects of an initial decision on his or her claim for VA benefits − Approx. 11 -12% of VBA decisions are appealed, and only 4 -5% are formally appealed to the Board − While the appeals rate has remained steady at 11 -12%, appeals volume has increased proportionately as VA has increased the number of claims decisions over the past 6 years − Unlike other Federal and judicial processes, the current process allows Veterans or their representative to submit new evidence or make new arguments regarding the issue(s) on appeal any time in the appeal process − The average processing time for appeals resolved in FY 15 was 3. 1 years – 5 years for those that reached the Board − Nearly 74% of all Veteran appellants are receiving disability compensation and pension benefits VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 10
Way Forward: VBA’s National Work Queue • Allows VBA to prioritize and distribute the claims inventory to match work assignments with RO capacity and resources to address each Veteran’s claim as quickly as possible • Currently in Phase 1 rolled out to 8 stations: Indianapolis, Albuquerque, Oakland, Louisville, Detroit, St. Paul, New Orleans, and Jackson with nationwide deployment planned for FY 16 • In Phase 1, the RO in the state where the Veteran resides will continue to be the first filter for the Veteran’s claim as long as that RO has the capacity • There will be automatic routing of deferred claims that need additional work Specialized workload will still be routed to the appropriate location • • Improves quality and consistency of claims processing nationwide to ensure Veterans, their families and survivors receive timely benefits, regardless of where they reside VSOs will retain access to claims information for the Veterans they support through VBMS at each regional office and online through SEP. VETERAN S BENEFI TS ADMINISTRATION The. CO current between VSOs and RO managers will not change as a result of NTROLLEDrelationship U NC LASSIFIED INFORMATION 11 the National Work Queue.
Way Forward: Improving the Veteran experience with the Compensation and Pension examination process • Problem Definition: Research and direct communications revealed that some Veterans are frustrated or confused by the Compensation and Pension exam process, which can lead to distrusting the exam results and higher rates of appeals • First Steps: An initial set of easy-to-implement solutions, pilot tested with Veterans and employees, that measurably improve the Veteran experience during select touch points between the Veteran and VA • Strategic Objective: Measurably improve the Veteran experience, and by extension the employee experience, of the Compensation and Pension exam process by selecting solutions that are replicable across facilities VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 12
Way Forward: Dependency Claims Processing Dependency Processing Goal: By end of FY 17, reduce overall inventory of dependency claims to 100 K (currently 211 K) and improve the ADC for dependency claims Dependency Strategy • Approx. 70% of the 4. 1 million Veterans currently receiving compensation are eligible for this additional benefit – nearly 45% more than those eligible for the same benefits just 5 years ago • VA engineered a rules-based processing system (RBPS) that is designed to complete most dependency claims and hired a contractor to take the data from its legacy, paper-based dependency claim inventory and input this data into the rules-based processing system • VA trained call center agents to input dependency claim data to enable RBPS to automate dependency adjustments VETERAN S BENEFI TS ADMINISTRATION FY 17 budget includes 300 FTE / $29. 1 M to “right-size” the Compensation and Pension CO NTROLLED U NC LASSIFIED INFORMATION 13 workforce to meet timeliness expectations for non-rating claims work
Way Forward: VBA priority actions to achieve My. VA vision Ensure seamless and effective 13 transition for Servicemembers Transition Call Centers 14 to Service Centers for easy claims Expand employment & 2 educational opportunities for Veterans Drive to 100% electronic service treatment records 1 and separation health assessment exchanges with Do. D Provide VBA presence with 3 C&P clinics to improve disability exam process and sustain Doctors in ROs Redesign performance management systems and align employee performance 12 standards with a Veteran-centric approach and expanded telework capacity 4 Increase Resource Capacity for Non-Rating 11 and Appeals through additional people, system and process efficiencies 5 Redesign the C&P 10 exam process to improve the Veteran experience Legend Aligns with VA Goal 1 Aligns with VA Goal 2 Aligns with VA Goal 3 Move VBA intake & customer service to more community sites - on campus, at medical centers, CBOCs, storefronts, online, SSA, military bases, museums, memorials 6 Improve quality 9 and consistency of C&P exams Optimize and automate 8 claims workflow and implement predictive modeling 7 One authoritative source for Veterans contact information (address, email, cell phone, selfservice input Give Veterans full access to their own e. Folders Drive and improve adoption of electronic filing 14
Conclusion In Summary… Transformation reaped significant results: • Claims backlog is down 87% from peak • Quality is 98% in all but one of eight categories (one at 97. 5%) • Average days pending is 91 days Thank you for your continued partnership: • Continue to show leadership in your submission of FDCs – nearly 50% in FY 15 • Make sure you’re filing online – not in paper • The time to modernize the appeals process is now • We need your help educating Veterans about the difference between a claim and an appeal • Let us know when you see a problem • Thank you for working with us day in and day out VETERAN S BENEFI TS ADMINISTRATION CO NTROLLED U NC LASSIFIED INFORMATION 15
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