Shinseki Vows to Reduce VA’s Claims Backlog

He’s counting on four pilot programs under way to help VA identify and break long-standing obstacles in providing veterans the benefits they’ve earned.

One, launched in Pittsburgh in January, seeks to fundamentally change the relationship between veterans and the VA, Shinseki said. VA gives the veteran a checklist of what’s needed to file the claim, and does its own digging to produce whatever documentation the veteran can’t find. This, Shinseki said, reduces dead time in putting together the claims package.

Once the paperwork is intact, VA then will “work with the veteran to put together the best and strongest argument to win the case,” he said.

That’s a major change, Shinseki noted, making VA the veteran’s advocate rather than adversary as the claim makes its way through the system.

“This is VA going to bat with itself – because we are then going to turn around and argue the case as it is being adjudicated,” he said.

“This is significantly different, and it changes our relationship with the veteran,” he continued. “So this, in the long term, could have a significant impact on how we are perceived by veterans and what our relationship with veterans is. It is about advocacy.”

Shinseki said he’s impressed by what he’s seen since the pilot program kicked off in January, and credits the self-named “Delta Team” there with showing solid progress in improving the claims process.

“Their processing time is collapsing, because they are putting together good arguments,” he said. “And the good arguments are having great outcomes.”

Another pilot program, under way in Little Rock, Ark., is focused on making claims processing more efficient.

“It’s a re-engineering process,” Shinseki said. “How do we simply the claims process? How do we get this down to the minimal number of keystrokes?”

And it aims to improve communication among the entities that process a claim to reduce procedural delays.

“How do we make sure that people working on each claim are looking at each other, rather than saying, ‘I’ve done my part,’ then putting it in transit?” Shinseki said. “It takes four days to get to the next site, and the guy sits there and looks at it and goes, ‘I wonder why they did that?’ So he puts the question on [the claim] and sends it back.”

A pilot under way in Providence will introduce new automated tools to make claims processing faster and more accurate, efficient and secure.

Shinseki emphasized, however, that he wants to get the bugs out of the claims process before increasing automation.

“We didn’t want to automate bad processes and just get lousy decisions faster,” he told the Paralyzed Veterans of America last month. “So we broke the complex, convoluted claims process down into its component pieces to improve each part before putting them back together again.”

Another promising pilot program, being tested in Baltimore, is taking best practices from the others to create what Shinseki called the “virtual VA regional office of the future.” Ultimately, he said, he expects it to be a model for 57 VA regional offices nationwide.

That effort, being conducted in cooperation with the Social Security Administration, is focused on creating a paperless claims process and bringing the new joint virtual electronic record that President Barack Obama announced online last spring. The new electronic record is designed to follow a servicemember from induction in the military, through retirement or discharge, and into the VA system.

Ultimately, Shinseki said, it will improve care and services to transitioning veterans by smoothing the flow of medical records between the Defense and Veterans Affairs departments. “Our long-term solution to claims processing is to operationalize the concept of ‘seamless transition’ between the two departments,” he said.

As he assessed initiatives to improve claims processing and eliminate backlogs, Shinseki conceded that no initiative will solve the problem overnight. VA completed 974,000 claims last year, he noted, but received about 1 million new claims during the same period.

Shinseki attributed the increase to two factors. VA rendered decisions this year that qualify more veterans suffering the effects of Agent Orange exposure to claim benefits. In addition, VA has expanded its outreach to veterans who didn’t know about or hadn’t previously taken advantage of the benefits they’d earned. Shinseki noted, for example, that only 8.1 million of 23 million U.S. veterans are enrolled in the VA health care system.

Shinseki said he’s committed to creating a disciplined, high-performing and transparent organization tailored being more responsive to the needs of these and other veterans.

He cited progress made over the past year, but said there’s more work ahead. “We still have a lot of deliveries to achieve,” he said.

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