Mark Bilosz, Acting Director, Compensation Service - PowerPoint Presentation

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Mark Bilosz, Acting Director, Compensation Service

The American Legion | February 22, 2016Slide2

VBA Missions & Service Offerings in FY15 and FY16 To Date

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TRANSITION &

EMPLOYMENT

Held

55K

TAP events reaching

520K

Servicemembers

& families in FY15

Veterans Employment Center hired

365K+

Veterans; employers committed to

hire

668K+

in FY15

COMPENSATION

Paid

$63.7B

to nearly

4.1M

Veterans in FY15Completed record-breaking 1.4M claims in FY153.1M non-rating end products completed in FY15 – 15% higher than FY14

HOME LOAN GUARANTYOver 2.4M home loans on the booksGuaranteed 631K loans in FY15 (44% more than FY14) totaling $153BLowest foreclosure rate for 25 of 30 quarters

LIFE INSURANCEInsured 6.4M beneficiaries in FY1511th largest Insurance program in U.S.Provides over $1.3T in coverage under 10 lines of protectionPaying insurance death claims in avg. of 3.6 days at 98.7% accuracy

EDUCATION Provided est. $12.3B to over 1M beneficiaries in FY154M claims processed in FY15Post-9/11 GI Bill paid $60B to 1.5M students and schools since inception

PENSION & FIDUCIARYPaid $5.5B in Pension benefits to over 500K Veterans & survivors in FY15Paid est. $6.3B in DIC to an estimated 386K survivors in FY15Over 183K Fiduciary beneficiaries on the rolls in FY15 – 10K more than FY14

BENEFITS ASSISTANCE SERVICEOver 5.3M registered eBenefits users461K Facebook likes; 66K Twitter followers to dateOver 50K outreach hours and over 2.15M encounters with Veterans, family members & survivors in FY15

VOCATIONAL REHABILITATION & EMPLOYMENTOver 104K Veterans received an estimated $1.1B in VR&E benefits in FY15Nearly 132K participants in FY15 – 3% more than FY14

22K employees$96B in benefits distribution$2.5B in general operating expenses

VBATRANSFORMATION

*FY15 estimated actualsSlide3

VBA’s workload has risen dramatically since 2009Slide4

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VBA’s caseload has grown at an unprecedented rate since 2009

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Completely

t

ransformed a complex, paper-bound, compensation claims processRedesigned 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 b

illion images into data and high quality, searchable PDF used by the claims systemDesigned and deployed Disability Benefits Questionnaires

for physicians to capture evidence-based dataDesigned concurrently a CRM, Unified Desktop, Knowledge Management capability

to more than 1,000 call agentsDesigned a completely new online claims filing system – customer facing – with 55+ additional self-service features and drove adoption from 250K to 5.4 million users

Successfully completed over 1 million claims each year for the past 6 yearsLess 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

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VBA transformed

service to the Veteran community in order to eliminate the backlog of disability claimsSlide6

2015 Transformation Goal: Backlog Reduction

Thank you to The American Legion for your helpSlide7

2015 Transformation Goal: 98% Quality

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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 AddressedAl Development Letters Sent

All Medical Exams CompletedService Connection Decision Correct

Evaluation Percentage CorrectEffective Date Correct

Payment Rate Correct

Rolling 12-Month Cumulative

Claimed Issues Addressed

Inferred Issues Addressed

Development Letters Sent

Proper Development

Correct Decisions

Correct EvaluationsCorrect Effective DatesCorrect Payment Rates

TotalClaim-Based98.6%

99.1%

99.8%97.2%98.2%98.4%

97.9%99.2%

88.8%Issue-Based99.5%99.8%

99.9%99.2%99.5%

99.2%98.7%99.8%95.7%Slide8

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 2013Average days

it takes to complete a claim is 128 days – a 59-day

reduction from FY14

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 addedExamples 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 examsIn 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 expertsDifficulty in obtaining National Guard and Reserve records for still serving members or military personnel records required to make a character of discharge determination

7We

will continue to work to drive down the number of claims pending more than 125 days –

thank you for your continued help

filing electronic fully developed claimsSlide9

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We couldn’t have done it without The American Legion

Nationally, nearly

50%

of claims submitted by The American Legion in 2015 were FDCsSlide10

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.The time to modernize the appeals process is

now

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 still executing each

legally required step in the process, and

protecting the due process rights of each VeteranSlide11

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% issue-based 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 benefitsApprox

. 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

yearsUnlike 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 processThe average processing time for appeals resolved in FY15 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

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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 FY16In 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

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VSOs will

retain access to claims information for the Veterans they support through VBMS at

each regional office and

online through SEP.

The current relationship between VSOs and RO managers will not change as a result of the National Work Queue.

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 resideSlide13

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

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Way Forward: Improving

the Veteran experience

with the Compensation and Pension examination processSlide14

Dependency

Processing

Goal: By end of FY17, reduce overall inventory of dependency claims to

100K (currently 211K) 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 systemVA

trained call center agents to input dependency claim data to enable RBPS to

automate dependency adjustments13

Way Forward: Dependency Claims Processing

FY17 budget includes 300

FTE / $

29.1M to “right-size” the Compensation and Pension workforce to meet timeliness expectations for non-rating claims workSlide15

Drive to 100% electronic service treatment records and separation health assessment exchanges with DoD

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Expand

employment

& educational opportunities for

Veterans

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Drive and improve adoption of

electronic filing

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Give Veterans

full access to

their own eFolders

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One authoritative source for Veterans contact information (address, email, cell phone, self-service input

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Move VBA intake & customer service to more community sites - on campus, at medical centers

, CBOCs, storefronts, online, SSA, military bases, museums, memorials

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Improve quality and consistency of C&P exams

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Optimize and automate claims workflow and

implement predictive modeling

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Redesign performance management systems and align employee performance standards with a

Veteran-centric approach and expanded telework capacity

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Increase Resource Capacity for Non-Rating and Appeals through

additional people, system

and

process efficiencies

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Redesign the C&P exam process to improve the Veteran experience

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Ensure

seamless and effective

transition for

Servicemembers

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Transition Call Centers

to Service

Centers for easy claims

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Provide VBA presence with C&P clinics

to improve disability exam process

and sustain Doctors in ROs

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Way Forward: VBA priority actions to achieve

MyVA

vision

Legend

Aligns with VA Goal 1

Aligns with VA Goal 2

Aligns with VA Goal 3Slide16

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 daysThank you for your continued partnership:

Continue to show leadership in your submission of FDCs –

nearly 50% in FY15Make sure you’re

filing online – not in paper

The time to modernize the appeals process is nowWe need your help educating Veterans about the difference between a claim and an appeal

Let us know when you see a problemThank you for

working with us day in and day out

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