[Joint House and Senate Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
FROM MONTHS TO HOURS: THE FUTURE
OF VA BENEFITS CLAIMS PROCESSING
=======================================================================
JOINT HEARING
BEFORE THE
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND
MEMORIAL AFFAIRS
AND THE
SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
FIRST SESSION
__________
TUESDAY, JUNE 6, 2023
__________
Serial No. 118-18
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
________
U.S. GOVERNMENT PUBLISHING OFFICE
52-877 WASHINGTON : 2024
-----------------------------------------------------------------------------------
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina MIKE LEVIN, California
MATTHEW M. ROSENDALE, SR., Montana CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa FRANK J. MRVAN, Indiana
GREGORY F. MURPHY, North Carolina SHEILA CHERFILUS-MCCORMICK,
C. SCOTT FRANKLIN, Florida Florida
DERRICK VAN ORDEN, Wisconsin CHRISTOPHER R. DELUZIO,
MORGAN LUTTRELL, Texas Pennsylvania
JUAN CISCOMANI, Arizona MORGAN MCGARVEY, Kentucky
ELIJAH CRANE, Arizona DELIA C. RAMIREZ, Illinois
KEITH SELF, Texas GREG LANDSMAN, Ohio
JENNIFER A. KIGGANS, Virginia NIKKI BUDZINSKI, Illinois
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
------
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MORGAN LUTTRELL, Texas, Chairman
C. SCOTT FRANKLIN, Florida CHRIS PAPPAS, New Hampshire,
JUAN CISCOMANI, Arizona Ranking Member
ELIJAH CRANE, Arizona CHRISTOPHER R. DELUZIO,
KEITH SELF, Texas Pennsylvania
MORGAN MCGARVEY, Kentucky
DELIA C. RAMIREZ, Illinois
------
SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
MATTHEW M. ROSENDALE, SR., Montana, Chairman
NANCY MACE, South Carolina SHEILA CHERFILUS-MCCORMICK,
KEITH SELF, Texas Florida, Ranking Member
GREG LANDSMAN, Ohio
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
TUESDAY, JUNE 6, 2023
Page
OPENING STATEMENTS
The Honorable Morgan Luttrell, Chairman, Subcommittee on
Disability Assistance and Memorial Affairs..................... 1
The Honorable Chris Pappas, Ranking Member, Subcommittee on
Disability Assistance and Memorial Affairs..................... 2
The Honorable Matthew M. Rosendale, Sr., Chairman, Subcommittee
on Technology Modernization.................................... 3
The Honorable Sheila Cherfilus-McCormick, Ranking Member,
Subcommittee on Technology Modernization....................... 4
WITNESSES
Mr. Raymond Tellez, Acting Assistant Deputy Under Secretary,
Automated Benefits Delivery, Veterans Benefits Administration,
U.S. Department of Veteran Affairs............................. 5
Accompanied by:
Mr. Robert Orifici, Director, Benefits and Memorial Systems
Portfolio, Office of Information and Technology, U.S.
Department of Veterans Affairs
Mr. David Bump, National Representative for National Veterans
Affairs Council, Second Vice President for Veterans Benefits
Administration at Local 2157, Portland, Oregon, American
Federation of Government Employees............................. 7
APPENDIX
Prepared Statements Of Witnesses
Mr. Raymond Tellez Prepared Statement............................ 37
Mr. David Bump Prepared Statement................................ 41
Statements For The Record
Foundation for American Innovation............................... 45
FROM MONTHS TO HOURS: THE FUTURE
OF VA BENEFITS CLAIMS PROCESSING
----------
TUESDAY, JUNE 6, 2023
U.S. House of Representatives,
Subcommittee on Disability Assistance and Memorial
Affairs,
Subcommittee on Technology Modernization,
Committee on Veterans' Affairs,
Washington, D.C.
The subcommittees met, pursuant to notice, at 10 a.m., in
room 360, Cannon House Office Building, Hon. Morgan Luttrell
[chairman of the subcommittee on Disability Assistance and
Memorial Affairs] presiding.
Present for Subcommittee on Disability Assistance &
Memorial Affairs: Representatives Luttrell, Franklin,
Ciscomani, Crane, Self, Pappas, Deluzio, McGarvey, and Ramirez.
Present for Subcommittee on Technology Modernization:
Representatives Rosendale, Self, and Cherfilus-McCormick.
OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN, SUBCOMMITTEE ON
DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
Mr. Luttrell. Good morning. I am a Navy man. We try to
start on time normally at 5 minutes before, but that usually
irritates everybody, so, we are going to start straight at 10.
Thank you everyone for coming today. The Joint Subcommittee on
Disability Assistance and Memorial Affairs and Subcommittee on
Technology Modernization hearing will come to order. Thank you,
Chairman Rosendale, Ranking Member Pappas, Ranking Member
Cherfilus-McCormick, for holding this hearing with me today.
We are here today to discuss the Future of the Department
of Veterans Affairs VA Benefits Claims Processing. Ten years
ago, VA underwent its first claims modernization initiative
when it transformed from a paper-based system to an electronic
claims environment. VA accomplished this through the
development of the Veterans Benefits Management System, or
VBMS. This was an important step for the VA to dig them out of
the last claims backlogs crisis.
Since VBMS was released, the private financial sector has
continued to leverage the latest technology to provide the best
experience for their customers and employees. Unfortunately,
Veterans Benefits Administration (VBA) has struggled to keep
pace with the private sector, resulting in unreliable and
outdated systems. Consequently, VA cannot handle the influx of
claims due to the The Sergeant First Class Heath Robinson
Honoring our Promise to Address Comprehensive Toxics (PACT) Act
thus far. The VA estimates that the claims backlog could peak
in 2024 at over 730,000 claims. This means veterans may have to
wait months, if not years, for a decision. I know that the VA
employees are doing their absolute best for our veterans and
they are not satisfied with the level of our customer service.
VA can always do better.
I was encouraged by the VA's 5-year--the VBA's Five-Year
Modernization Plan that we are here to discuss today. As part
of this plan, VA is piloting automation technology to help
decrease the time the process of a claim from months to days
and hopefully hours. I understand that the technology may not
be able to meaningfully reduce the backlog until 2 years from
now. However, some veterans do not have 2 years to wait for
this technology.
Therefore, I would like to learn more about the steps VA is
taking over the next 2 years to develop this technology and
whether or not VA can be more aggressive in its timeline. I
would also like to discuss how VA is prioritizing where to
invest its modernization efforts. I hope the VA is thoroughly
considering the pain points in the claims process and how
technology can help reduce the time and expense to complete
these tasks.
I also would like VA to provide the assurance that it is
investing in state-of-the-art technology that is agile and able
to modernize on a continual basis. Simply put, veterans and
employees deserve the best IT available in the technology
industry now and in the future. This is how VA prevents a
backlog and how veterans get decisions in hours instead of
months.
Thank you to all the witnesses for being here today and I
look forward to your insight and feedback on this issue. With
that, I yield to the ranking member for his opening statement.
OPENING STATEMENT OF CHRIS PAPPAS, RANKING MEMBER, SUBCOMMITTEE
ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
Mr. Pappas. Well, thank you very much, Mr. Chairman, and
thank you to our witnesses for being here today to help us
understand how VA intends to modernize VBA's IT systems and
improve the quality and timeliness of veterans disability
claims.
Now, the PACT Act is easily the most consequential piece of
veterans legislation in past generations, and it represents the
most significant expansion of veterans healthcare benefits in
decades. When Congress passed PACT, we recognized that it would
dramatically increase the number of claims that VBA would have
to manage. To date, veterans have filed almost 600,000 PACT Act
claims, in addition to the 1.1 million non-PACT Act claims
filed during the same period. The Department must invest
heavily in its IT and human infrastructure to ensure that these
claims are processed in a timely manner and that veterans do
not wait years for their benefits.
Claims examiners have repeatedly complained to us that
VBA's IT systems do not support the work that they do and
frequently make their jobs even harder. We have heard that VBMS
suffers from frequent system latency and downtimes, and that
system crashes sometimes make them lose their work and have to
start over. That was even before the additional crunch of
hundreds of thousands of PACT Act claims. This frustration is
compounded by the fact that lost productivity due to unstable
IT affects the employee's performance rating. VBA needs to
evaluate how its IT systems and related policies could be
negatively impacting its workforce. We can not afford to lose
skilled claims examiners because of poor IT systems.
When PACT was being drafted, we recognized the importance
of the IT systems. In Section 701 of the PACT Act, Congress
mandated that VA develop a plan for the modernization of VBA's
IT systems. The committee received the plan in March of this
year, and while there are a lot of good ideas in it, I have
questions about how they are going to fix the issues that we
have raised by VBA personnel--that we hear raised by VBA
personnel. Issues that predate PACT Act and yet continue to
this day.
In fact, in 2015, the Government Accountability Office
released a report on VBMS that indicated, in part, that VBA
would benefit from a customer satisfaction survey of VBMS end
users and incorporating that feedback into efforts to deploy
the system. I would argue that it would also be beneficial for
VBA to use a similar survey to guide any modernization efforts.
Unfortunately, when I asked about such surveys during our May
16 hearing, it did not sound like either VBA or Office of
Information and Technology (OIT) had been conducting them.
Nobody knows the disconnect between VBMS and the claims
workflows like the claims examiners, and it would be in
everyone's best interest if VA asked for their thoughts. I hope
to hear from the witnesses today how VA intends to incorporate
the feedback from frontline employees in its efforts to
modernize IT systems and how they intend to use technology to
address the growing backlog of benefits claims. With that, Mr.
Chairman, I yield back.
Mr. Luttrell. Thank you, Mr. Ranking Member. The Chair now
recognizes Chairman Rosendale for his opening statement.
OPENING STATEMENT OF MATTHEW M. ROSENDALE, SR., CHAIRMAN,
SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
Mr. Rosendale. I want to thank Chairman Luttrell, Ranking
Member Pappas, and Ranking Member Cherfilus-McCormick, for
organizing this hearing with me. Improving the disability
compensation claims process is one of my top priorities.
Millions of veterans around the country receive disability
benefits from the VA. These benefits are not some sort of
entitlement. They are compensation for the sacrifice of those
who serve this great Nation and carry with them illnesses,
wounds, and scars from their service. The Federal Government
also owes them an effective process to apply for and obtain
these benefits.
The Department of Veterans Affairs has a number of IT
projects that frankly do not make sense even on paper. We have
discussed them in our previous hearings. This effort is
absolutely where we should be concentrating time and resources.
Veterans deserve rapid decisions through a transparent
process. Unfortunately, they are struggling with 1950's era
procedures and the hodgepodge of dysfunctional IT systems. The
Veterans Benefits Management System is barely 10 years old, but
it needs substantial upgrades to keep pace with the VA's needs.
The Board of Veterans Appeals is still attempting to put an
end-to-end system in place. The VA started introducing some
basic automation a few years ago. That is without question the
right approach.
The only way to avoid another major claims backlog is to
give employees advanced automation tools to eliminate menial
tasks and boost productivity. However, the rudimentary
automation VA has today is closer to the state-of-the-art of
the 1990's rather than 2023. The automation still has a long
way to go to make a meaningful impact. We need to close the gap
very quickly in order to handle the title wave of claims
stemming from the PACT Act and prevent another huge backlog.
This committee required a Five-year Benefits IT
Modernization Plan in the PACT Act. This plan is meant to spell
out exactly how the Department intends to spend the Toxic
Exposure Fund dollars allocated to IT. We have seen the
consequences of handing over billions of dollars with no
strings attached before.
I am encouraged that the VA has submitted a serious,
detailed plan that lays out the 97 upgrades or projects over
the course of the next 5 years and estimates the cost of each
one. I have no doubt that if the plan can be accomplished, the
Veterans Benefits Administration would be in a much better
place at the conclusion. Unfortunately, we need those modern
systems and enhanced automation capabilities today because the
disability compensation claims from the PACT Act are already
starting to roll in. I appreciate our witnesses joining us
today for this important and timely discussion about the VA's
needs, and what to do to get this one right and make good on
the promise made to the veterans in the PACT Act. Thank you,
Mr. Chair. I yield back.
Mr. Luttrell. Thank you, Chairman Rosendale. The Chair now
recognizes Ranking Member Cherfilus-McCormick----
OPENING STATEMENT OF SHEILA CHERFILUS-MCCORMICK, RANKING
MEMBER, SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
Ms. Cherfilus-McCormick. Thank you.
Mr. Luttrell [continuing]. for her opening statement.
Ms. Cherfilus-McCormick. Thank you, Mr. Chairman. With the
passage of the PACT Act, Congress fulfilled its promise to
veterans to honor their service and recognized toxic exposure
as a cost of war. Included in the law is much needed funding
for modernization of Veteran Benefits Management System. This
is intended to benefit veterans and the VA employees alike. New
funding is meant to streamline claims processing for benefits
and improve antiquated systems that have been underfunded for
decades.
The Technology Modernization Subcommittee has conducted
extensive oversight of VA modernization and IT contracting. A
common thread has been a fundamental lack of planning,
budgeting, and adherence to contracting best practices by VA
and its contracting centers. VA acquisition management has been
on the Government Accountability Office's (GAO's) high-risk
list since 2019. GAO has cataloged issues with competition for
IT contracts. While VA's annual IT obligations have increased
from 4.2 billion in 2017 to 6.5 billion in 2021, the number of
companies receiving those awards has decreased.
We must ensure the VA does not make similar mistakes when
modernizing VBMS. The cost to the government and more
importantly the cost to our veterans are too high. VA must show
a commitment to planning, budgeting, and execution of
improvements that benefit veterans and the employees. As a
result, I have cosponsored Ranking Member Takano's IT
Modernization Improvement Act. This will require VA to contract
for independent verification and validation for these major IT
programs to include the Veterans Benefits Management Systems.
As we have seen with other failed modernization
initiatives, VA no longer gets the benefit of the doubt on
contracting process. We need this bill to provide checks and
balances on the acquisition process for modernizing VBMS.
Veterans and employees should not have to suffer for a lack of
successful modernization again.
While we work toward modernizing the IT system for
veterans, I also want to highlight the impact that antiquated
systems have had on the VA employees. Issues with
interoperability, issues with reliability, and basic
functionality have persisted for too long. We have an
opportunity to provide a system that enables our employees to
be more efficient and provide better service for our veterans.
This means that the VA needs to listen to their employees when
it comes to developing requirements for new systems. We have
seen what a lack of prior work to standardize workflows across
regional offices leads to. We need to hold the VA management
accountable for creating a system that works for all employees
and stops the silo of requirements development. With that, I
look forward to hearing from our witnesses and I yield back,
Mr. Chairman.
Mr. Luttrell. Thank you ma'am. Thank you. I will now
introduce the witness panel. Our first witness from the
Department of Veterans Affairs is Mr. Raymond Tellez, Acting
Assistant Deputy Undersecretary for Automated Benefits Delivery
with the Veterans Benefits Administration. He is accompanied by
Mr. Robert Orifici, Director of the Benefits Memorial Service
Portfolio for the Office of Information and Technology. We are
also joined by Mr. David Bump, National Representative for the
National Veterans Affairs Council and Second Vice president for
the VBA at local 2157 for the American Federation of Government
Employees. Thank you all for being here today. Mr. Tellez, you
are now recognized for 5 minutes to deliver your opening
statement.
STATEMENT OF RAYMOND TELLEZ
Mr. Tellez. Good morning, Chairman Luttrell, Chairman
Rosendale, Ranking Member Pappas, Ranking Member Cherfilus-
McCormick, and members of the subcommittee. We appreciate the
opportunity to appear before you to discuss VA's plan for
modernization of VBA's information technology systems. I am
joined today by Robert Orifici, Benefits and Memorial Services
Portfolio in VA's Office of Information & Technology. VBA and
OIT have a long history of partnering to deploy technology
solutions that improve claims processing to deliver benefits to
those who have served our Nation with honor and courage.
Before 2012, the floors at the VA regional offices were
buckling under the weight of paper claims folders and VA staff
physically boxing and shipping claims folders from regional
office to regional office. To address the situation, VA
underwent a historic transformation, moving from a completely
paper-based system to an electronic claims processing system.
The introduction of the Veterans Benefits Management
System, or VBMS, along with VBA's digitization of millions of
paper claims folders, was key to moving VA to an electronic
processing environment.
Today's VBMS has changed significantly from the start of
the digital journey. Every week, VBMS is updated with
enhancements and optimizations to improve system resiliency,
increase claims processors productivity, and modernize system
components. As a result of VA's continued investment in VBMS,
VBA's digitization of inbound paper mail and developing a
paperless claims process, VA maximized telework capabilities
during the COVID-19 pandemic to minimize employee impact while
still maintaining service to veterans.
The inability to conduct in person medical examinations and
access paper Federal records led to a temporary increase in the
claims backlog. VBA has reduced the backlog by approximately
100,000 in Fiscal Year 2022, and we continue to make progress
in 2023. Lessons from the global pandemic highlighted the need
for increased digitization of relevant paper records and
evidence, leveraging of data, and utilizing existing medical
evidence to avoid ordering unnecessary exam.
In December 2021, VBA established a proof of concept for
Automated Decision Support, or ADS. ADS leverages technology
automating administrative tasks and workflows in the claims
process by determining eligibility, gathering evidence, and
auto ordering exam when necessary for consistent, accurate, and
timely decisions. Based on the measured success of this site,
the automation capabilities were expanded to additional medical
conditions and eight regional offices.
On August 10, 2022, the passage of the PACT Act expanded VA
care and benefits to millions of veterans and their survivors,
resulting in a surge of claims as well as an increase in the
number of employees using VA IT systems to process these
claims. While VA has and will continue to hire more people to
process claims, adding more personnel is only one facet of the
solution. VA must equip our new and existing employees with the
right tools to enhance productivity.
Today, 57 automation eligible diagnostic codes, including
all 26 PACT Act presumptive conditions, have expanded to 16
regional offices. VBA is on track to expand automation to
additional 103 diagnostic codes related to some of the most
frequently claimed conditions, such as hearing loss, mental
health, and musculoskeletal conditions. Additionally, VBA and
OIT partnered to create VA's Five-Year Modernization Plan for
IT benefit systems to improve claims processing efficiency and
create more reliable and resilient systems where systems are
regularly improved with the most up to date technology.
VA will evolve its approach to leveraging data to
anticipate needs and proactively serve service members,
veterans, and their families. IT modernization is an ongoing
investment that will continue beyond the 5 years, allowing VA
to shift its focus from veterans requesting help to VA
providing a service. This includes simplifying the process of
submitting claims and proactively notifying veterans when they
are entitled to additional benefits and services.
The modernization of the VBA corporate data base and
transition of IT systems to the Cloud directly supports VA's
ability to respond to these challenges. Additional Cloud
resources have been added to VBMS, allowing the system to
handle the increased PACT Act claims and additional users. Many
components of VBMS have been completely modernized to use
modern tools and Cloud services, with efforts underway to
modernize the remaining VBMS modules. This will allow VA to
eliminate older inefficient legacy systems that fail to meet
VA's current needs.
VA is confident that the modernization roadmap will provide
a modernized enterprise and automated decision tools to ensure
VBA systems remain current, reliable, and flexible to meet the
critical needs of veterans. I want to express my appreciation
of your continued support of service members, veterans, their
families, caregivers, and survivors, and thank you for the
opportunity to appear before the committee today, and I look
forward to answering any questions that you may have.
[The Prepared Statement Of Raymond Tellez Appears In The
Appendix]
Mr. Luttrell. Thanks you, sir. The written statement of Mr.
Tellez will be entered into the hearing record. Mr. Bump, you
are now recognized for 5 minutes, sir.
STATEMENT OF DAVID BUMP
Mr. Bump. Chairman Luttrell, Chairman Rosendale, Ranking
Member Pappas, Ranking Member Cherfilus-McCormick, and members
of the subcommittee, the American Federation of Government
Employees and its National Veterans Affairs Council (NVAC)
appreciate the opportunity to testify today. My name is David
Bump and I am a national representative for the National VA
Council and serve as a vice president for American Federation
of Government Employees (AFGE) Local 2157 in Portland, Oregon.
I have had the privilege of serving veterans in VBA for 21
years.
On behalf of the thousands of VBA employees AFGE
represents, over 50 percent of whom are veterans themselves, it
is a privilege to offer AFGE's views on the IT challenges
facing VBA and suggestions to address those problems and better
serve veterans. In regards to the VA's Five-Year Modernization
Plan, AFGE supports the use of technology to better enable
VBA's processors to improve their duties--I am sorry--to
perform their duties and best serve veterans.
However, we are concerned about the negative effect on
veterans of replacing human processors with technology. AFGE
strongly supports the work done by lawmakers to protect VBA
employees and to make sure that all claims have to be reviewed
at some point during the process by human claims processors. It
is important that our collective approach to the use of
technology emphasize that information technology supplement and
not supplant the VBA's workforce.
The main point I want to address today is the Veterans
Benefits Management System. While VBMS serves its purpose,
there is certainly room for improvement from the perspective of
the end user. The most serious problem that claims processors
raise about VBMS is its reliability, or lack thereof. The
system often crashes or requires rebooting, delaying claims
processors from doing their required work. Claims processors
justifiably fear when the system goes down that they may suffer
consequences to their performance metrics through no fault of
their own.
Another complaint about VBMS is its lack of
interoperability with other systems. A clear example of this is
provided by the Houston Regional Office is related to letters
that claims processors send to veterans to inform them of their
decisions. Many do not automatically populate information
requiring multiple data entry points and can often lead to
errors.
The process for getting a veteran service treatment record
is also clear examples of problems with inoperability. The
Portland Regional Office cited that VBMS will automatically
pull up Service Treatment Records (STRs) from a veteran who
served in a modern war from the Heath Artifact and Image
Management Solution (HAIMS) system. However, for veterans who
have served further in the past, VBMS makes a request for the
data from the older Personnel Information Exchange Systems
(PIES) system but does not record its own request. This leads
to the employee having to make a manual entry in VBMS, but may
also create duplicate requests in PIES, further wasting time.
The Cleveland Regional Office cited problems with the Joint
Legacy Viewer (JLV). When using JLV to view a veteran's record,
each document must be opened separately, saved, and then
uploaded into VBMS. Additionally, if a processor attempts to
upload too many documents at once, the system may not work and
the employee must start over.
Another key criticism of the system for Rating Veterans
Service Representatives (RVSRs) comes from the Pittsburgh
office. RVSRs in this facility identified that Veterans
Benefits Management System-Rating (VBMS-R) requires them to
enter multiple levels of special monthly compensation on a
veteran's claim. This requires multiple steps. VBMS will not
create the narrative for both levels of Special Monthly
Compensation (SMC) unless the employee uses the system this
way. This can lead to errors and can create over or
underpayments if not done correctly. Also, if SMC is awarded
temporarily, RVSRs must manually end the SMC even though they
initially entered an end date, because if they do not, the
veteran will never stop being paid.
To improve VBMS, it would be better if claims processors
could rate certain conditions at the same time and then be able
to merge them based on higher evaluation rules. Fixing these
problems would greatly reduce time spent on claims from
workarounds, reduce erroneous decisions, and deliver a higher
quality product to our Nation's veterans.
Another critical technology of the claims process is the
National Work Queue. AFGE strongly supports the use of a
special operations model for as many complex claims as the
system will support. VBA does this currently for military
sexual trauma, and Camp Lejeune water contamination claims,
among others, and AFGE encourages their expanded use.
AFGE also encourages the VA to modify the National Work
Queue so that cases remain with the same Regional Office (RO)
for employee review. Every RO, despite uniform rules, has its
own way of conducting specific tasks. Having employees who are
more familiar with each RO's standard procedures will help
process cases efficiently. Additionally, by better identifying
which employee worked on a particular claim, better
collaboration between employees can be achieved leading to time
savings.
Last, NWQ should be reprogrammed to allow Veteran Service
Representatives (VSRs) and RVSRs to always have access to all
readily available claims. Despite the national claims backlog,
it is a common refrain from employees that they do not have
enough work assigned to meet their production standards.
Although National Work Queue was designed in part to maximize
VBA's claim processing capacity, it is counterproductive to
deny employees access to all available claims when the
technology to do so already exists. Claims processors should be
focused on taking care of veterans instead of requesting work.
In conclusion, VBA must use employee feedback as it
modernizes its IT systems to help veterans. AFGE and the NVAC
stand ready to work with Congress and VBA to reach this goal.
Thank you, and I look forward to answering your questions.
[The Prepared Statement Of David Bump Appears In The
Appendix]
Mr. Luttrell. Thank you, sir. The written statement of Mr.
Bump will be entered into the hearing record. We will now move
to questioning. I recognize myself for 5 minutes.
Mr. Bump, I hope you share your statement with the two
gentlemen sitting to your right flank there. I am assuming both
of you were listening. That is an extensive laundry list of
issues that we need to be addressing. Is that going to be the
case, Mr. Bump?
Mr. Bump. Yes.
Mr. Luttrell. I am assuming that is not the first time we
have heard that, correct?
Mr. Tellez. Those specific issues, I would say probably
over time. I look forward to discussing with Mr. Bump his
testimony. Talk through some of those, but we do get employee
feedback often, yes.
Mr. Luttrell. One of the biggest feedbacks that I got
traveling around visiting the regional facilities was that
exact list, and it seems to be reoccurring. My point is, I keep
hearing the same thing over and over again, and that is
something we most certainly need to address moving forward.
This is for the panel, either one of you can answer this.
My concern is that there will not be enough oversight for the
implementation of this program and will end up being like the
Electronic Health Record (EHR) system, 20 years outdated and
billions of dollars over budget. Who of you or whom is
responsible for the oversight of the implementation of this
program?
Mr. Orifici. Sir, thank you for that question, Chairman. We
have tiered governance that is set up to oversee this program.
Mr. Luttrell. No, I need a name.
Mr. Orifici. So----
Mr. Luttrell. Do not give me that tiered government thing
because that means this is going to get lost in the
bureaucracy.
Mr. Orifici. Yes. I am the lead of the 701(b) execution,
Interpersonal Therapy (IPT) that is responsible for running
this plan and making sure that we have updates there. Then we
have the executive lead, George Waddington, who is my executive
lead over this IPT overseeing the 701(b) Modernization Plan.
Mr. Luttrell. Okay. Once we start implementing this, you
are who I am coming to if I need any questions answered?
Mr. Orifici. I am who you are coming to for any questions
that you need.
Mr. Luttrell. Can you give me an idea moving forward with
the amount of backlog that we have and then the timeframe of
implementation of this program, in parallel, I am assuming, as
our employees are working hard and diligently to make sure that
this backlog is taken away, can you give me an assessment,
because 2 years, it is quite a long time. As my colleague to my
right stated, they are the ones that are suffering. Can you
give me an estimation on when that backlog and how that backlog
will be reduced once this program is online?
Mr. Tellez. Thank you, Chairman. I think we are expecting
the backlog to grow a little bit through 2024 and then drop
dramatically in 2025. A lot of that is dependent on the
incremental releases as we adopt more technology, as we
implement some of the features that are in the 701(b) plan. We
do have some coming up that I think will be very impactful to
employees. Part of it is the ADS, the Automated Data Support
that I am driving for claims automation, which does a lot of
the automation for tasks associated with the claims process.
Our intent there is to use evidence of record, so ordering
exams, service validation, and then being able to present to
the employees the information they need to make the decision on
those issues faster.
We are also looking at technology that takes the veteran's
file and allows those claims processors to be able to search
the file much faster. We call that Smart Search. We are
expected to deploy that in summer. That will add some
tremendous value, reduce that claims development time as
employees are looking for the necessary records to determine
whether they need to order exam or make a claim ready for
decision for raters.
We have also got new technology we are testing now called
Automated Data Ingestion (ADI). That is where we are taking
veterans who have an exam, they see a provider, they get a
disability benefits questionnaire filled out and completed and
returned back to us. VBMS ingests the data, the computable data
from that Disability Benefits Questionnaires (DBQ) and we put
it into VBMS-R and we present it back to the employees, the
rater, for them to validate and help them make that decision,
that recommended decision for that.
That is some of the ways we are doing that. Two years I
think is the timeframe that we are looking at because of the
way that we release the technology for automated decision
support. We are factoring 2 years because of the sort of
conservative approach that we are doing for automation. Change
is hard. Our employees have been, through the last 10 years,
some huge transformation. We are being very thoughtful as we--
--
Mr. Luttrell. To that point because my time is running
short, sir. The one thing that I continually hear is training,
training, training. Once this program, this platform, is
implemented, are we training up for the initiation or are we
initiating and then training? Because when we implemented the
PACT Act, we put the cart before the horse, and we are
suffering because of it right now.
Mr. Tellez. I would say we are happening in parallel. As
new features are coming on board, we prepare the staff and we
train them when it is deployed so they have the tools and the
information necessary to do the work.
Mr. Luttrell. Okay, thank you. I now recognize the Ranking
Member Pappas for your line of questioning.
Mr. Pappas. Thank you very much, Mr. Chairman. Mr. Tellez,
if I could start with you. Committee staff recently visited
both the Columbia, South Carolina and Chicago regional offices
and heard uniformly from frontline employees that IT systems do
not support their work. We heard about that directly today from
Mr. Bump, and that substantiates long-standing complaints from
across the country.
At our hearing on PACT Act implementation last month, I
asked Under Secretary Jacobs about this issue and about how we
can capture user satisfaction information through surveys of
VBMS users. Secretary Jacobs was not aware of any and promised
to get back to me. Can you comment on the evidence that such
surveys are happening? Is there a reason that VA would not want
to hear from end users about their experiences?
Mr. Tellez. Thank you, Congressman. I am not aware of any
specific direct users, but we do often engage with frontline
employees as we do new releases. We engage with them prior to
release. We engage with them after the release to measure how
effective was that particular release. One of the things that
we are looking at since the hearing is a change management
contract where we can adopt on the VBA side a survey, if you
will, for a lot of things that we are deploying to measure the
success of the efficiency of those tools that we are deploying.
Mr. Pappas. Short of sitting next to a frontline worker at
a congressional hearing, how can you capture feedback in a way
that is going to inform changes in an efficient manner?
Mr. Tellez. Thank you, sir. With automated decision
support, we have 16 regional offices right now. We have
dedicated weekly calls with the employees there to get their
direct feedback on those specific automation tools. We have a
tracker that employees are allowed to use or encouraged to use.
As they are working claims and there is something that they
want to report as a ticket or issue, they support it. We have
weekly calls with them and we have weekly engagements. I would
say regular touch points with the field frontline staff. We
have optimization champions that we check in to see the areas
that we can identify opportunities for optimizations inside.
Mr. Pappas. Well, I appreciate that information, but I
think something more systemic that is also forward leaning and
proactive would provide the Department the information it needs
to really understand the full picture there.
Mr. Bump, if I could turn to you. Thanks for, you know,
chronicling some of the pain points that you experience in your
work. We are really grateful for the work that you do to
support our veterans. I am wondering if you can comment on what
avenues end users have of these systems to raise their concerns
related to IT issues.
Mr. Bump. Thank you, Congressman. The ways that we have to
interact that Mr. Tellez described, they are all after the
fact. What would help and I think help the process and of
course then help employees serve veterans better, would be if
we were in before these things were designed and before they
were implemented as opposed to afterwards. A lot of the time
when new systems are deployed, what VBA employees end up doing
is beta testing software. That has been the case, I have been
with VA for 21-plus years, and that was the case on day one. It
is the case now. We need to be involved on the front end as
opposed to the back end.
Mr. Pappas. Do you think there are ways that VBA and the
unions specifically can work together?
Mr. Bump. Oh, certainly. I think now that we finally have a
confirmed under secretary, who I would like to thank him
personally for attending our latest Labor Management Forum
meeting. He listened and asked thoughtful questions on how not
only unions, but the employees who we represent can better
interact with VBA's management staff that puts these things
together.
Mr. Pappas. Okay. Now, Mr. Tellez, one thing that Mr. Bump
mentioned that we have heard from employees on is this issue of
needing to reboot systems. They freeze up. There is significant
downtime and instability in VBMS. Do you know what the cause of
those issues might be? It could be a case-by-case issue but is
there something more systemic that we should be concerned
about?
Mr. Tellez. I think it is probably more on a case-by-case
basis. We have had some issues, but I am not sure that I would
say that there is a consistent trend for that to happen. I
could certainly take that back and go through that. Rob.
Mr. Orifici. If I could add, we do track that. We do know
by a case-by-case incident what causes that. Every time there
is an outage or something like that, we do a root cause
analysis. We do go in and we investigate what caused that
incident, and we link it back to either a specific thing. It
could be network. It could be something with the system itself,
a defect or a change that had happened and did not work as
expected. We do maintain that list for every outage and every
incident, and we do an investigation to find out what happened
and to prevent it from happening in the future.
Mr. Pappas. Okay. I yield back my time.
Mr. Luttrell. Thank you, ranking member. Chairman
Rosendale, you are recognized, sir.
Mr. Rosendale. Thank you very much, Mr. Chair. Mr. Orifici,
Mr. Tellez just referenced the Automated Data Ingestion System,
which is an extension of the Google Chrome browser that pre-
populates information for the claims raters into VBMS. This
costs less than $2 million, and 400 employees are using it. Do
you agree with Mr. Tellez that ADI is a success and that it
should be continued?
Mr. Orifici. Sir, thank you for that question, Chairman. I
think ADI has been a success in getting functionality to the
users quickly. It has been a way of getting features into the
hands to help them process claims faster and more efficiently.
At the same time, it has given us great input into how we could
provide those features into VBMS, which, as you know, takes
more time and costs more money. This was a great way of being
able to test this functionality and see whether it will work
and to be able to bring that into the VBMS in the future as we
move forward.
Mr. Rosendale. If it is a success, are you planning on
continuing its use or are you planning on pulling the plug on
that system?
Mr. Orifici. We plan on continuing the use until its
features are built into VBMS. It is a browser extension, and so
it is not meant to be as robust and long lasting as something
that is built into the actual software.
Mr. Rosendale. What kind of timeframe do you think it is
going to take for this to be phased out, shall we say?
Mr. Orifici. We have the first parts of this starting to
phase into VBMS this summer. We are looking at rolling out
through probably second Fiscal Year of second quarter of the
Fiscal Year 2024.
Mr. Rosendale. Okay. What I am making sure that we do not
run into is the exact same problem that we are experiencing
with Oracle Cerner, EHR, Veterans Health Information Systems
and Technology Architecture (Vista), where we have a system
Vista, that is working. It is functioning. It is helping the
facilities across the Nation, and yet we have spent billions of
dollars for the Oracle Cerner system that is not functioning,
okay? Even in the five facilities that it is currently at. Yet
we have got billions of dollars going out the door to try and
create that new system when we have one that is being utilized
right now to deliver those services to those facilities, to the
veterans.
What I do not want to see is this dual track investment or
drain of resources when we have a system that is already
working. We had IT people before us about a week and a half ago
and said that the problem with VA is that they continue to try
and consolidate these IT systems and make them larger and
larger and larger. And they have proven that if they keep them
smaller with the vendors, that they have been much more
effective, okay? We are going to be tracking that to make sure
that we do not continue to dump money into vendors to continue
to make them big while we have a system that is currently
functioning.
Mr. Orifici, I also want to get into as I look at this
report on page 28 out of 106, where we look at the chart that
shows how a claim is handled. One of the things that most of
the people, I think, sitting at this dais and in this audience
would recognize is these automated decision support systems,
okay? When you call in and get a recording and you are supposed
to start hitting numbers to find out where you are going to be
directed to and that automated system is trying to resolve your
problem, most of us get really frustrated, ok, dealing with
that system.
What I am trying to figure out from you or even Mr. Bump,
you might have an idea about this, what are the triggers or
keywords that are being utilized to make sure that this thing
gets rapidly transferred to a real person to deal with our
veterans? What kind of time does that take to get them over to
a real person?
Mr. Orifici. Sir, thank you for that question. I do not
have an answer on hand for that. I will have to take that back
for the record.
Mr. Rosendale. Mr. Bump, do you have any insight to that?
Mr. Bump. The time it takes to get to a real person?
Mr. Rosendale. Mm-hmm.
Mr. Bump. That I do not. Oftentimes the problem that we
have in the call centers is the time limitations that the
employees have to actually speak to a veteran or their spouse
once they actually get to a person. The VA limit, the
performance standards are set so that time is limited to, I
believe it is roughly about 8 minutes.
Mr. Rosendale. How long they are----
Mr. Bump. How long they----
Mr. Rosendale [continuing]. are allowed to speak to----
Mr. Bump. How long the----
Mr. Rosendale [continuing]. one of the veterans calling in?
Mr. Bump. Right.
Mr. Rosendale. Okay. This is going to go to my other line
of questioning. I am going to give my time back. I am out. I
have got a whole other round of questioning, sir, to get into
this.
Mr. Luttrell. Thank you, Mr. Rosendale. The chair now
recognizes Mrs. Cherfilus-McCormick for her line of
questioning.
Ms. Cherfilus-McCormick. Thank you, Mr. Chair. Mr. Bump,
one of the most striking statements made in your testimony is
that its common refrain from VSRs and RVSRs that they do not
have enough work assigned to them to meet their production
standards and that they have no constant--and that they have to
constantly request new work from their coaches. Considering the
size of the backlog, this is quite concerning. Do you know if
there are any technological or functional impediments to the
National Work Queue that caused this problem? Do you have any
suggestions on how we can solve and help employees serve
veterans more effectively and efficiently?
Mr. Bump. Thank you, Congresswoman, for that question. The
National Work Queue, the way it works is it assigns work to a
particular regional office based on an algorithm that
calculates how many employees work in that office. What always
seems to happen, though, is it does not assign enough work to
the office to keep folks busy throughout the day. Once it gets
that work to those offices, the individual supervisors assign
work to the individual employee's work queue. They hold some of
it back intentionally so that when folks run out of work, they
can then go to their supervisor and get more work.
Further exacerbating that problem is when there is no more
work left in the station's work queue. While VA tells its
employees, do not wait until you are out of work, let me know
as a supervisor, let me know when you have got one or two
claims left in your work queue. Then that supposedly gives your
supervisor time to find more work for you to do. If we could
open up the National Work Queue so that employees have full
access to all the claims that are out there, you would not have
to have all those steps where an employee gets assigned not
enough work to meet their performance standard on a given day.
Then they have to go back to their coach. Their coach has to
find work. Meanwhile, that could result in the employee sitting
idle for, you know, who knows how long.
Ms. Cherfilus-McCormick. Mr. Bump, would you mind giving
the committee some perspective on the age of the IT system that
make up VBMS?
Mr. Bump. Well, as I believe it was Chairman Luttrell said,
VBMS is at least 10 years old. The advances in computer
processing and how the private sector does things, we are
behind. One anecdote that I always think of when I am asked
that question, or when I think about that question, is when I
started with the VA nearly 22 years ago, in September, it will
be 22 years, I was told that Benefits Delivery Network (BDN)
was going to be going away. Well, here we are 22 years later,
BDN is still there, and it informs I am not sure of the actual
interactions it has, but it is still there for a reason, and it
still interacts with VBMS. Not only do you have VBMS that is 10
years old, you have other legacy systems that are even older.
VBMS itself, you know, for a system as old as it is, we are
able to work in it, but we could be doing better.
Ms. Cherfilus-McCormick. How does the age affect your work
product and productivity?
Mr. Bump. Well, every time VBMS gets upgraded, there are
workarounds that result. Those workarounds, not only do you
have to remember what all of them are, but they add to the time
that it takes to process a claim because you have to, in some
cases, manipulate VBMS. As I mentioned with the example, with
the RVSRs, you have to manipulate the system to get it to
provide the right result, as opposed to it just providing the
right result.
Ms. Cherfilus-McCormick. Do you feel that employees
actually have a seat at the table as the VA plans to modernize?
Mr. Bump. Not enough of one. As I mentioned earlier, we
need a seat at the table as these things are being developed,
not after they are developed. Then we just end up testing them
and telling VBA what does not work.
Ms. Cherfilus-McCormick. My last question, in your time at
the VA, do you feel that the acquisition and the procurement
process--I will yield back and ask this later. Thank you.
Mr. Luttrell. Thank you, ma'am. Mr. Franklin, you
recognized, sir?
Mr. Franklin. Thank you, Mr. Chairman. Thank you to our
panel for being here today. Mr. Bump, my line of questioning
really is going to follow up on what you were just touching on
about how antiquated VBMS is now and really how do we get to
where we need to be? I appreciate you chronicling in your
testimony the challenges that we are facing. I read all these
and candidly, what dismays me is just seeing the level of
problems we are having now and where I think we need to be and
the fact that, yes, and just in looking at the vernacular that
the VA is using, we are talking automation, decision support
systems, these are things that the private sector figured out a
generation ago. Now that is aspirational it seems like for us
to try to get there.
From our folks from the VA, I would love to hear, we have
got a freight train coming down the track. We are behind now,
woefully behind, I think in where our technology ought to be.
It is going to get worse. We are not doing right by our VA
employees. Even worse, we are not doing right by our customers.
Personally, from having been in the military, but also the
private sector side, I think your customer should be the one
defining what is acceptable. To me, I do not think 125 days
should be defined as a backlog. To me, that is an absolute
failure. If we give people a pat on the back for meeting, you
know, because I got it in 124 days, shame on us.
How do we get to a point where when we have big data, Cloud
computing, predictive modeling, data analytics, are we ever
going to get there with VBMS? How do we fix these programs to
where we are out there proactively, you know, helping our
veterans? It ought to be, to me, we ought to have systems that
would say a veteran comes off of active duty, goes into the VA
system. We know based on where they have been, what they have
done, what they have been exposed to, these are the types of
things that they are probably going to face down the line. How
do we get out there ahead of that and help them? Or are we
going to be talking about automation 20 years from now when the
rest of the world has passed us by? I would love to yield the 3
minutes I have to the two of you to tell me how we are going to
do that better.
Mr. Orifici. Yes, sir, thank you for that question,
Congressman. There are a lot of components that we are working
on today that will start to enable those features. We have come
from a background when VBMS first started that this was one
giant application and so to touch any component you were
reworking all of VBMS to make sure that was working.
The plan outlines how we are continuing the journey of
breaking VBMS into smaller pieces. As we talked to, we could
send that work off to other places or we can modernize smaller
pieces and work with a more diverse group of providers in order
to make sure those capabilities are modern and up to date.
As part of that work, we are also decommissioning a lot of
our legacy systems that we have out there. We have components
of VetsNet that we are modernizing into new modules within
either part of VBMS or standalone modules by themselves that
interact across the other work type modernization that we are
doing. Which is making it simpler for employees as they do not
have to switch between tools, but also enabling future work in
which we can connect those big data to make sure all the
systems can use that data that is available and that we could
integrate with other service providers like VBA is doing on the
automated decision support, so we could bring those new
capabilities to bear.
Right now, it is very difficult to do that with some of the
environment that is still outstanding from our legacy updates
and so within 2 years, the plan is really getting us off those
legacy components to enable that work. We are not really happy
with how fast we are going but we appreciate the support that
we have gotten around PACT Act and this is enabling us to
accelerate a plan from 10 years down to 5. We are always
looking for opportunities to accelerate that further and see
what we could provide faster.
Mr. Tellez. Sir, I would just like to add on the VBA side
for we are using a professional services contract provider to
help us with the claims automation. They are bringing to bear
the latest technology automation tools to help us as we are
accelerating the claims processing time to get to a rater so
they can make a decision faster for veterans.
Mr. Franklin. Mr. Bump, what is your take on what you hear?
Mr. Bump. Thank you, Congressman. VA has always been kind
of slow with adapting to change and the common refrain, and
this goes back to at the very least General Hickey, when she
was the VBA under secretary. It is a big ship and it takes a
long time to turn it around. I hope that we get it right, but I
also hope that we keep in mind the people who are doing this
work and that we train them on these new systems, and that we
involve them in the design of the new systems. That is what I
do not see enough of right now is the involvement in as we are
designing these things. The people who use these systems are
the ones who are probably best informed as to what they should
contain and how they should work.
Mr. Franklin. Thank you. I am over my time. Hope is not a
plan of action, and that is why we look to the gentlemen to
your right for that. Thank you Mr. Chairman, I yield back.
Mr. Luttrell. Thank you, Mr. Franklin. Mr. McGarvey, sir,
you are recognized.
Mr. McGarvey. Thank you, Mr. Chairman. Mr. Orifici and Mr.
Bump, at a hearing last month on the implementation of the PACT
Act I raised concerns that were voiced by the local out of my
region, AFGE Local 611, which represents the VBA regional
office in my hometown of Louisville, Kentucky. As you all know,
what we talked about that Rating Veteran Service
Representatives, or RVSRs, do not get production credit when
they defer a case as not ready to rate. There are multiple
problems that go along with this because including the concern
that an RVSR may not get the case back once more information is
available on the claim.
To do right by our vets, we have got to make sure the
people handling their claims are given all they need. I had a
town hall last Friday in Louisville. I had several former
Marines show up. They might argue that there is no such thing
as a former Marine, but I had several Marines show up who are
dealing with the issues of having been at Camp Lejeune. One guy
was stationed there for 3-1/2 years. Incidentally, Louisville
is where the Camp Lejeune claims are being handled. We have
done a really good job resolving those claims. Is a resolution,
though, that some of the claims are being denied when maybe
they should not, and maybe they are being denied because they
do not have the tools right now to further investigate claims
and they come back as a denial.
You know, we are trying to make sure, especially with the
Camp Lejeune claims, that honestly, the government that exposed
them to these hazardous materials is more speedy and more
efficient in helping them out. Mr. Orifici, a question for you
given this background of what we know is going on since the
PACT Act. Is the lack of RVSR production, credit for deferred
claims, and the inability to get the case back once more work
has been performed on the claim a technological limitation of
the National Work Queue? Or is it a management decision to
handle claims this way?
Mr. Orifici. Yes, thank you for that question, Congressman.
Right now, NWQ is able to route the work according to the
rules, so that is not a technology issue.
Mr. McGarvey. What can we do then to help resolve these
claims for the tens of thousands of Marines at Camp Lejeune?
Mr. Tellez. Sir, we will continue to process those in a
priority manner as much as we can, but otherwise, I will have
to take that question back for you and get you a response to
that.
Mr. McGarvey. I appreciate that.
Mr. Tellez. You are welcome.
Mr. McGarveY. Mr. Bump, what other changes should the VBA
implement to the National Work Queue to make it easier for
claims processors to perform their duties and get the credit
they have earned?
Mr. Bump. Thank you, Congressman. In addition to what you
mentioned about returning deferrals to the rater who originally
looked at the claim, one suggestion, again, would be to open up
the National Work Queue more so employees do not have to spend
valuable time looking for work instead of serving veterans. If
we would have a system where, you know, all of the work was
available all of the time, instead of assigning work to a
regional office and then manually assigning that work to
individual processors, I think that would go a long way to
speeding up the process.
Mr. McGarvey. What is keeping that from happening right
now?
Mr. Bump. Much like the deferral issue, I do not believe--
these gentlemen can correct me if I am wrong--but I do not
believe it is a technology issue. It is a management decision
to utilize the National Work Queue in the way it is being
utilized right now.
Mr. Tellez. Sir, I think what we have is a national
distribution of work based on a lot of different factors per
regional office. Then locally, they have the right to
distribute the work as they see fit for the thing. I think one
of the opportunities we have, sir, is this NWQ modernization
that we have in the 701(b). NWQ was designed at a different
time. Here we are today. We have an opportunity to look at how
can that work be distributed much more in an agile fashion than
maybe we do today. NWQ modernization is one of the efforts we
have identified as a 701(b), a critical element to deploy as
part of 701(b).
Mr. McGarvey. Thank you. In my remaining seconds, all I
will say is this committee works well together to protect our
veterans as we see right now. However, we can help you to speed
this up because these men and women, in some cases, their
literal lives depend on it. Thank you all very much.
Mr. Luttrell. Thank you, sir. Mr. Self, you are recognized.
Mr. Self. Thank you, Mr. Chairman. As has been mentioned
before, the PACT Act was obviously passed with no thought about
the infrastructure needed to be in place to service it. Down
the line, did you raise this issue prior to the passage of the
PACT Act? Mr. Tellez first.
Mr. Tellez. The infrastructure system, I think we probably
raised some concerns with overall. I think one of the ways we
were addressing that is using our professional managed services
to automatically do some of those simple tasks so that we can
get this----
Mr. Self. I just asked, did you raise the issue, Mr.
Tellez?
Mr. Tellez. I will have to go, I will have to get you a
response to that, sir. I am not sure.
Mr. Self. Okay.
Mr. Orifici. I know we had some feedback that we provided
around this infrastructure's ability to support, but we also
did start preemptively increasing some of the infrastructure in
anticipation of the PACT Act being done. I think up to 18
months before passage, we did start on increasing some of the
capacity of training environments, of ability of VBMS at scale.
Mr. Self. Okay. Mr. Bump, how about the council?
Mr. Bump. I am sorry?
Mr. Self. About the council?
Mr. Bump. Infrastructure to do our jobs is always a
concern. My biggest concern with the PACT Act is training. If
you think of, you know, employees as human infrastructure, we
did not do a good job----
Mr. Self. Okay.
Mr. Bump [continuing]. with the training aspect.
Mr. Self. Thank you. Mr. Tellez, you said that you were
confident of the system in your testimony. When are you going
to be confident of the system?
Mr. Tellez. Sir, I would say I am confident in the system
now. I think the process that we have for deploying automated
decision support tools has high quality. We do have user
frontline employees involved in that process. We use the human
set.
Mr. Self. Mr. Tellez, what are the metrics that you use to
say the system is getting better? I mean, I think all of us
would question what are the metrics that you use? We have gone
from 65,000 pre-pandemic to what today, over 400,000 by you
all's testimony. It is going to peak at over a million when we
get to the Terra and non-Terra. What are the metrics you use to
tell us that the system is getting better? Is it numbers of
days, the 125 days that we can take down to what? What are the
metrics that you are going to use?
Mr. Tellez. I think the metrics that we use are the metrics
that we report to this committee on the average days to
complete, the average days pending. For automated decision
support, we are still in preliminary stages. We hope as we
deploy those nationwide, you will really see the true benefits
of how automation can reduce the decisionmaking for veterans,
and we can get those decisions and benefits earlier to
veterans.
Mr. Self. Last question. When will we get back down to
65,000 backlog?
Mr. Tellez. Sir, as we are projecting to have that backlog
increase, our projection now is about 400,000, between 2024. We
start seeing that backlog drop down in 2025 below 100,000.
Mr. Self. Okay. Thank you. Mr. Chairman, I yield back.
Mr. Luttrell. Thanks, sir. Mr. Crane?
Mr. Crane. Thank you all for coming today. Mr. Tellez, I am
going to start with you. Right now, the VA is about 4 months
behind and our wait time in processing claims are 125 days. By
April 2024, it is projected that the VA's backlog will peak at
about 730,000 PACT Act claims. Knowing this, what do you think
the wait time is going to be come April 2024 when we have the
peak of the PACT Act claims?
Mr. Tellez. Sir, we are projecting our backlog to be about
400,000 between now and 2024. I do not have the data with me on
what we are projecting for what we think the wait times. I will
have to get that back for you, sir.
Mr. Crane. Okay, but you would say a substantial increase
in wait time just based on the numbers now, and then the
increase then?
Mr. Tellez. I think with the increase of the backlog to
about 400,000 I think there will be some increased time. As we
are deploying more and more automated decision support tools,
adopting more technology, I hope to prevent that happening for
more. That is on us.
Mr. Crane. Okay. Mr. Tellez, you seemed a little upset when
Mr. Bump spoke about the need for instructive feedback on the
front end of the system design, not beta testing on the back
end. I kept seeing you reach for your little talking button
there. Can you go ahead and address that?
Mr. Tellez. Sure. Yes. Really what I would like to
highlight for here so the employees are not absent in the
process. When we come up with new ideas and things, we bring in
subject matter experts and we bring employees from the field.
We hold requirement sessions with employees along the way,
sometimes several times. We invite employees for what we call
user acceptance testing. Hey, we heard your requirements. Here
is how it is in the system. Does it work? We get that direct
feedback. Then before we deploy new functionality, we have
users also test the system to make sure it works.
Mr. Crane. Thank you. Thank you. Mr. Bump, what do you have
to say to that, anything? Any feedback?
Mr. Bump. Thank you, Congressman. There is simply not
enough of it.
Mr. Crane. Okay.
Mr. Bump. That is what I would say. We select a small
number of employees and have them test things out. Those
employees are not often of the same experience level or of an
appropriate experience level. There is just not enough of it.
Mr. Crane. Do you think if that was done within the
parameters of what you are suggesting, we would be having less
problems now?
Mr. Bump. I think we would because I think we would have
less workarounds after the fact.
Mr. Crane. You know, Mr. Bump, I found it pretty
interesting when you made the comment, if we were to open up
the National Work Queue, it would drive productivity and
decrease the backlog. Mr. Tellez, what do you think about that
suggestion?
Mr. Tellez. I think it is a great suggestion. As I
mentioned, we are looking to modernize NWQ. I think we have a
lot of opportunities to look at how work is distributed in a
much more agile fashion. I do not have the answer for you
today, sir, but I can commit that is part of the 701(b) plan.
We are committed as an effort to modernize the NWQ and figure
what opportunities there are to make that process better.
Mr. Crane. That does not seem like something that you would
need to modernize. That seems more like a command decision.
That does not seem like something that is technology or needs
to be modernized, right? That just seems like something that
the individual at the top actually needs to say, hey, we want
to decrease the backlog we have here. Mr. Bump made a pretty
good suggestion. Why do not we try that and see if it actually
decreases the backlog?
Mr. Tellez. Sir, I will take that back for you and get you
a response.
Mr. Crane. Okay. Who is making that call? Mr. Tellez, who
makes that call?
Mr. Tellez. Our fielder operations leadership.
Mr. Crane. Who is the name? Give me the name.
Mr. Tellez. I believe it would be Willie Clark.
Mr. Crane. Who?
Mr. Tellez. Willie Clark.
Mr. Crane. Willie Clark.
Mr. Tellez. Deputy Under Secretary, sir.
Mr. Crane. All right, Mr. Tellez, last question for you.
What do you think the biggest difference is between how the VA
operates and how the private healthcare system operates?
Mr. Tellez. I am sorry, sir, I do not have--I will have to
get you a response to that. I do not work in the healthcare, so
I am not sure I am able to answer that question.
Mr. Crane. No problem. Mr. Bump, you want to take a shot at
that one, the differences, private sector and VA?
Mr. Bump. My experience with the private sector healthcare
system, when I go for a test or see a doctor or something like
that, the very same day, I can see and interact with not only
my records, I should say I can interact with my records, but
also my physician can see those same records. That is not
always the case in VA.
Mr. Crane. Yes. One of the big problems is and this is a
problem that many of us on this committee have with the VA and
its desire to basically have everything under its own roof and
really try and halt, you know, veterans from going out in town
and getting care is one of the biggest differences in the
private sector, if you have a backlog or you are not performing
well, you go out of business. In the VA, that is not the case.
We just keep appropriating more money to you guys, and there is
really never any accountability. That is one of the things that
I want, you know, you guys to understand, is that is why so
many of us want to see veterans be able to go out into the
private sector and get care out in the private sector. Not
dismissing the VA completely, because we know that there is a
time and a place for VA healthcare. This is part of the
problem. In the private sector, you do not have these type of
problems, because if you consistently have these type of
problems and are behind, like Mr. Bump has testified to today,
you go out of business. Thank you. I yield back my time.
Mr. Luttrell. Thank you, Mr. Crane. Mr. Deluzio, you want
me to move over? Take your time.
Mr. Deluzio. Mr. Chairman, I am ready. I appreciate it.
Mr. Luttrell. Yes, sir, you are recognized.
Mr. Deluzio. Okay. All right. Thank you. Good morning,
everybody. I want to start Mr. Bump with you, sir. As you know,
you know, I am proud to represent many VBA employees who work
at the Pittsburgh VBA regional office represented by AFGE Local
1627, their President, Michelle Fisher. Reading your testimony,
I was pleased to see some of the concerns coming out of the
workers in that office raised, but frustrated to learn that
claims processors, as you describe it, and as they have talked
about, have to employ a bunch of workarounds to get veterans
correct monthly compensation. Not to mention how error prone
that usage of the VBA management system is.
Mr. Bump, my question is, could you explain for my
colleagues and me how an innocent error could negatively impact
a claims processor's performance, and what that impact might be
for them.
Mr. Bump. Thank you, Congressman. I am good friends with
Michelle. We know each other well, have known each other for
nearly a decade. If there is an error on a claim, it affects
your performance standard, no matter what kind of an error it
is. It could be something as simple as a portion of the
veteran's service record not being correct in the system. All
of these workarounds that we have to do to get the correct
result for a veteran, they are all points in which an error can
be made. The more times that you have to manipulate the system
to do what it--to provide the result that it is supposed to
provide, that is more opportunities for an error in either data
entry or the system not capturing the data correctly.
You know, the employees who work for this agency they do
their best. Again, more than half of the folks who work in VBA
on the front line are veterans themselves. They are committed
to getting things right for veterans and getting veterans the
benefits that they deserve and that they have earned. I believe
it was Chairman Luttrell who, or no, it was Chairman Rosendale
who mentioned that these are not entitlements. These are
benefits that are earned, and we need to make the system work
better so we do not have to do things in the manner that
Michelle described when she was asked about this.
Mr. Deluzio. Well, and I should say the obvious piece, in
addition to affecting performance, slows down decisions for
veterans, as folks who are processing these claims have to
spend more time to get it right to avoid errors that, again,
will also negatively impact veterans who are waiting for
decisions here.
Mr. Bump. Definitely. The more steps we have to take that
lengthens the time that it takes to process a claim.
Mr. Deluzio. Well, about a minute and a half, and so, I
realize this is a big question, but what do you think VBA needs
to do to modernize here to make this work better for veterans,
for the folks who are working, both?
Mr. Bump. Well, there are things that system enhancements
could do. Automation, I think, will help at some point. I do
not believe we are anywhere close to where we need to be with
that. There are management decisions as well, and one of them
is opening up the National Work Queue, assuring that raters get
a case back after they have to defer it.
Additionally, if we could change something so that a claim
stays in the same office once it is started, because right now,
you know, we have a system where I could work on a claim in
Portland, do what I need to do, send it back up. Then the claim
goes to Pittsburgh or Denver or St. Petersburg. Every time that
an employee touches a claim, they have to go through it from
the beginning, because if there is an error and they do not
catch it, that is their error.
In order for employees to meet their performance metrics
and feel good about the job they are doing and, you know,
keeping their career, they have to almost rework a claim from
the beginning every time they touch it to prevent getting an
error.
Mr. Deluzio. Thank you. Thank you, Mr. Chairman. I yield
back.
Mr. Luttrell. Thanks, sir. Mr. Ciscomani, you recognized,
sir.
Mr. Ciscomani. Thank you, Chairman Luttrell and Chairman
Rosendale for holding this important hearing. Thank you to the
witnesses for coming in. The United States has seen how far
technology has come and advanced technology will continue to
make our constituents lives easier and our country better.
However, Department of Veteran Affairs, along with many other
government entities, are struggling to keep up with the modern
times and the technology that provide in the private sector
that companies can utilize there.
Back home in Tucson, I met with a local American Federation
of Government Employees union in March and learned about the
complexity in the claims process and the innovation being done
in the private sector to help veterans within this claim
process. I know that the dedicated men and women at the VA are
working to help our veterans, but outdated technology and quite
frankly, bureaucracy serve as roadblocks for those who put
their lives on the line for this country.
Unfortunately, it seems that some businesses have built a
business model based on bureaucratic incompetence. That was my
takeaway from this meeting. As we are looking at the investment
in Veteran Affairs, you may know this, I am also on the
Appropriations Committee. My questions are very interested in
the investment in VA here, making sure that our veterans have
the right tools so that there is the right accountability on
those resources as well.
Mr. Tellez, based on the Veteran Benefit Administration's
Five-Year Modernization Plan, Department of VA is requesting
125 million to modernize the VA.gov platform. How will these
changes to VA.gov improve the veteran facing aspects of the
website and specifically the benefit claims?
On the same vein, here, requesting also 36-1/2 million for
improving its National Call Center. I am very interested in
seeing not only anecdotally how this will improve, but how will
you keep track of this and what is the accountability that
these funds will actually produce the results that you are
intended for them to produce?
Mr. Tellez. Thank you, sir, for the question. The
enhancements of the VA.gov portal are really important to
veterans because it allows them to interact with us better. It
allows them to do more work with VA, exchange information with
VA, submit more claims through the VA.gov portal, and more
importantly, allows us to deliver more information to them as
well, such as decision letter downloads, which we delivered
last January.
We will continue, expand on that, expand on the ability for
the veteran to choose their mode of communication, whether it
be a text, email, or whatnot. From our perspective it has a
better experience for the veteran. Automation is a factor in
that too. I think when you think about automation from the
veteran perspective and the employee perspective, it really
just creates a better experience altogether when we can have
those pieces. We measure that by the usage of the tool and then
the success of the implementation of that measuring along the
way. I can not speak to the National Call Center (NCC)
directly, but I will have to get you a response to that for
that.
Mr. Ciscomani. Thank you. I would like a response to that.
When we look at, as I mentioned at these investments that we
want to make sure that our veterans are taken care of, we have
pledged to uphold the line on the resources here to Veteran
Affairs. We want to continue to make sure that these funds are
being used for its intended purpose, but also that they produce
the results that we need them to.
I have got another question that will probably change
topics and take a little longer with the amount of time we have
left. I just want to dig in a little deeper on this
conversation. If you can just go again a little deeper on how
the results would be measured and what would claim success with
these resources? What would you say that is exactly the
intended purpose, and that we can claim success, and how long
do you think that would take us to get there?
Mr. Tellez. Thank you, sir. I think one way I would measure
success is more claims submitted through VA.gov than paper.
Right now, even though we are seeing an increase in veterans
submitting claims through VA.gov, we still get a fair number of
paper. I have to convert paper, I have to scan it, I have to
digitize it, and that is not always a perfect thing. I would
say one way we would measure success there is more veterans are
using VA.gov.
I would also measure the success of the interactions with
the number of veterans that use the site for those tools and
resources, such as the number of decision letters that are
downloaded and accessed each month. We have a number of those
metrics to measure the success of that, making sure that
veterans find trust in the system and that they are finding it
useful and they will keep coming back to engage with VA that
way as well.
Mr. Ciscomani. Well, those are good, Mr. Tellez, and I
agree with them. You know, one thing that I keep hearing is the
wait time on these claims. Obviously, the paperless claims
hopefully speed up that time and the wait time for our veterans
keeps on reducing. That will be a measurement that I will be
very interested in you pursuing and tracking so that we can
make sure at the end of the day we can make all these changes
from paper to electronic. If the process is not sped up and our
veterans are waiting the same amount of time for whatever other
reason, then I would not call that success. In my mind, success
would mainly revolve around the wait time that our veterans are
waiting for these claims. I yield back. Thank you, Chair.
Mr. Luttrell. Thank you, sir. That concludes our first
round. We are going to move directly into the second round. I
recognize myself for 5 minutes. Mr. Tellez, you said, is it
Under Secretary Clark is the manager of the PQS, or, I am
sorry, the NWQ? Do you work directly? Do you answer to him? My
concern is if we are onboarding this new platform that is
supposed to assist claims and decrease a backlog, but it seems
to me that the National Work Queue is one of the major problems
in this chain of command, if you will. Then we have stations
that do not have work because the National Work Queue does not
deliver claims. Am I understanding that correctly from my
colleague over here? She stated that earlier.
Mr. Tellez. I think that is what I heard. I have to get
back to you on a response to that.
Mr. Luttrell. It seems to me that we need to address the
National Work Queue because I think the backlog, from what you
said, next year at 100,000 will be substantially higher. Now,
if we are onboarding this new platform in parallel, I think it
is still going to be problematic because packages are not being
disseminated properly and then everyone's being penalized if
they are not conducting proper oversight on each packet. Does
that hold water to you?
Mr. Tellez. I am not aware that there is challenges with
distribution of work to the regional offices. I will have to
come back to you with a response on where there may be
opportunities. I am not aware of any, sir.
Mr. Luttrell. Okay. Please do. Sir? I recognize a ranking
member.
Mr. Pappas. Thank you, Mr. Chairman. I just want to follow
up on one issue that I had raised in the first round. Mr. Bump,
if I can direct this to you. I was asking about system
disruptions, which you highlighted in your testimony, and
wondering if you can just talk about how these issues might
affect VBA personnel and around the issue of not being granted
or potentially being granted relief for lost time due to these
system disruptions.
Mr. Bump. Well, thank you, Congressman. When VBA employees
are not processing claims, they are not able to earn the
appropriate number of work credits or transactions that they
need to meet their performance standard. VBA, in the nearly 22
years that I have worked there, the same position has been held
about what is called excluded time. It is granted by your
supervisor. That said, VA has I will call it limited, sort of
subversively limited. I do not mean that in a bad sense, the
use of the word subversive.
What they do from the national level is if a particular
station has too much what they perceive to be too much, or over
a limit of excluded time that they grant, they have to answer
for it. What that leads to is that leads to a very conservative
approach when it comes to granting or not granting excluded
time. Excluded time is meant to account for the time when VBA
employees can not do their job because of system issues or, in
some cases, extraordinarily complex claims. If we are not
granted the appropriate amount of excluded time to cover the
time that we have lost due to system issues, the only negative
effect to the employee is it is harder to meet your performance
standard.
Mr. Pappas. There are times when that is the case, when you
are not granted the relief because of an issue that is out of
your hands with respect to the system.
Mr. Bump. Definitely. Definitely that happens. Some offices
are better than others, but it is, you know, it is something
that each individual office controls. It is dependent on the
leadership in that office as to what their philosophy on
granting that time is. It is inconsistent.
Mr. Pappas. Thank you. Mr. Tellez, do you think that is
fair, that employees could be adversely impacted in terms of
reviews and credits based on a system issue that is out of
their hands?
Mr. Tellez. Well, as you know, we are in a completely
digital operating environment. When we have a system issue that
happens occasionally from time to time, there is an impact to
our productivity, and we have ways around addressing that. We
offer training. There are other ways we can fill our time for
employee stuff.
To your specific question of how it is happened at local
regional offices versus national, I will have to get you back a
response to that. I am not aware that there has been a
disparity in how that is approved or disapproved.
Mr. Pappas. Okay. Well, we would like more information on
that.
Mr. Tellez. Of course.
Mr. Pappas. I yield back my time.
Mr. Luttrell. Thank you, sir. Mr. Rosendale, you are
recognized.
Mr. Rosendale. Thank you very much, Mr. Chair. I would like
to make a reference to a movie I saw recently. It is called
Ford v. Ferrari. In the course of the movie, in this one scene,
Carol Shelby is sitting out in the lobby of Ford Corporation
waiting to visit with Henry Ford II. He watches a file come in,
and it goes through five sets of hands and then goes into the
office, and someone hands it to Henry Ford II before he
actually takes a look at it. It had been looked at by 20 other
people before it even arrived on what they called, I think, the
9th floor.
It seems to me that this is the problem that we are having
with this processing. Everything that Mr. Bump is describing
and that the other two gentlemen are describing this
information is going through a lot of hands. The way that I
think it is evidenced is, again, look at the Benefits Delivery
Information Technology Systems report that you all provided. If
we look at page 13, it talks about the development of the plan
taking 90 days, intake, 1 day rating, 5 days, authorization and
award, 5 days, development, 90 days. If that file is being
handed off to different people before it is even completed, as
Mr. Bump referenced, or if there is someone sitting there that
can not get that information in a timely manner, this is the
crux of this entire problem that we are dealing with.
Mr. Tellez, Mr. Orifici, your plan says automation is the
key to speeding up processing, and successful automation relies
on access to all veterans' relevant data, better quality data
that computers can read directly, improved infrastructure, and
supportive policies. None of these conditions are in place
today. Please tell me, how are you going to implement these
fixes and how will your process and the results be different as
we go forward?
Mr. Tellez. Thank you for your question, Congressman. One
of the things I would highlight here is our automated decision
tool. As a result of the pandemic and our inability to access--
--
Mr. Rosendale. I am tired of hearing about the pandemic. I
will be honest with you. I have got veterans that can not get
their benefits right now because they are being required to use
mask mandates, okay, in our veterans facilities. We do not even
want to go down that trail.
Mr. Tellez. One of the principles of 701(b) is leveraging
data. One of the things we are doing at claims intake when
veterans file a claim is we are automating those steps that you
just highlighted there. A claim comes in for PACT Act claims
right now.
Mr. Rosendale. Intake, it does not seem to be a problem. We
are looking at the development----
Mr. Tellez. Correct.
Mr. Rosendale [continuing]. of the claim.
Mr. Tellez. Correct. Correct. One of the things we are
looking at is being able to obtain the medical evidence from
our inter-agencies. From Veterans Health Administration (VHA),
from Department of Defense (DoD), from Community Care, and we
pull those records in. If we are able to rate that decision
based on the evidence of claim, we will hand it to a rating, an
RVSR in the house.
Mr. Rosendale. How are we going to improve that? Okay, I
understand.
Mr. Tellez. Yes.
Mr. Rosendale. How are we going to improve this going
forward to take this 90 days and narrow it down and somehow
make sure that that claim is kept in one person's hands instead
of being distributed in different locations?
Mr. Orifici. Yes, Thank you for that question, chairman. We
have a lot of pieces that all come together to help address
this. We had questions about the VA.gov portion at the very
beginning. It starts with how we receive the claim from the
veteran and making sure that we have all the relevant data. And
then the connections to the various systems to make sure that
we are pulling the service treatment record completely, whether
that is a modern record or a legacy, more legacy record from an
older theater of duty, and that we have all that data coming
together. The plan outlines how we are putting those into
interactive services that other providers like ADS can use to
have all that ready----
Mr. Rosendale. What tools are lacking right now, okay, that
we are not able to gather that information and get it into a
claims processor or an underwriter's hand so that we can
deliver the benefits to the veterans? What is lacking? What
systems are failing? What do we need to do going forward?
Mr. Orifici. Right, so the first thing that we are really
addressing is our corporate data base, which has all of our
data around the benefits claims rating, historical data around
it, and that is a monolithic data base that is not structured
properly to enable the support that we have. One of our first
key activities is updating this massive data base of veteran
data in order to make it more accessible and to have new
technologies that could interoperate off of that new and
modernized data platform.
Mr. Rosendale. Mr. Chair, I am down to 19 seconds, so I am
going to yield back. I got deep water to go into yet.
Mr. Luttrell. Yes, sir. Thank you. Mrs. Cherfilus-
McCormick, you are recognized.
Ms. Cherfilus-McCormick. Thank you, Mr. Chair. Mr. Bump, I
want to pick up where we left off. In your time at the VA, do
you feel that the acquisition of procurement IT systems have
been done in a thoughtful manner?
Mr. Bump. Thank you, Congresswoman. I truly believe that
the VA has the best intent as to how it modernizes its systems.
What I think might be lacking outside of what I have already
testified to as to more employee involvement earlier in the
process. What I see as a problem is in connection with all of
that is that some of the people who are putting these things
together from, you know, what platforms we use, to how they are
designed, those are not folks who have done the work. Those are
not frontline employees who have, you know, been trying to get
benefits to veterans as quickly as possible as their job. There
are obviously limits to how much that can be done.
I think we can do many things better with not only our IT
systems, but, as Congressman Rosendale was mentioning, how we
reduce the development time. One of the things that was going
through my head as Mr. Tellez and Mr. Orifici were answering
those questions, if we could get to a point where we did not
have to request that information, where as soon as a veteran
files a claim or more to the point, as soon as they are
discharged that data was already there. Right now, we have to
go and make requests to whether it is HAIMS or PIES or Defense
Finance Accounting Service (DFAS) for personnel records. If we
did not have to request those things, if it was automatically
provided, that would reduce the development time and it would
reduce the backlog because we would not be waiting for those
records.
Now, some of those records you can get in less than a day,
but many of them you can not. I think to answer the question
about thoughtfulness, if we would think about those things
instead of technical requirements, I think we would be a lot
further into the process.
Ms. Cherfilus-McCormick. Thank you, Mr. Bump. My next
question is for Mr. Tellez. VA has a long history of failed
modernization attempts, everything from health records, to
supply chain, to financial management. At the core of this
issue is the lack of comprehensive thought and planning at the
beginning of the acquisition program. Last Congress, our
committee passed the IT Reform Act to begin to address the
challenges with IT programs. This Congress, I have cosponsored
a bill to require independent verification and validation of
large program including VBMS. What process are you currently
using to plan for and award contracts to address the new
automation initiatives?
Mr. Tellez. Thank you Congresswoman. For automated decision
support, we do have an independent verification validation
vendor that validates the automation logic as it is in
production. We do use that as a validation and I think I will
pass it to Mr. Orifici who can speak to you on the IT side of
the house.
Mr. Orifici. Yes, ranking member, thank you for that
question. We are also interested in Independent Verification
and Validation (IV&V). This past March we awarded an IV&V
contract which covers all the products within the band
portfolio. We are working on making sure that we have IV
coverage for all of our major projects, including VBMS.
Ms. Cherfilus-McCormick. How do you intend to measure
success? Specifically, what kind of variables are you using to
measure success?
Mr. Orifici. For the IV&V?
Ms. Cherfilus-McCormick. Mm-hmm.
Mr. Orifici. Yes, so, for the IV&V, it is product by
product basis, but it looks at the requirements as they are
delivered and the outcomes that are supposed to be delivered
for that product. The IV&V contractor goes to their test suite
to ensure that those requirements are being met and that those
outcomes are also delivered by the system.
Ms. Cherfilus-McCormick. Now, do you have any specific
measures that you are looking at?
Mr. Orifici. I would have to go back and bring those back
to the record.
Ms. Cherfilus-McCormick. Thank you. Mr. Chairman, I yield
back.
Mr. Luttrell. Thank you ma'am. Mr. Crane, you are
recognized, sir.
Mr. Crane. Thank you, Mr. Chairman. Mr. Bump was talking a
second ago and he was talking about why claims are going from
Portland to Pittsburgh and getting kind of farmed out. Why is
that happening, Mr. Tellez? Why is not one processor being able
to handle a claim all the way through?
Mr. Tellez. Thank you Congressman. It is my understanding
that the claim typically stays with a regional office. There
might be opportunities where for reasons that the capacity is
at a different regional office. Otherwise, I have to get you a
response to that.
Mr. Crane. Mr. Bump, do you have any idea why that is
happening?
Mr. Bump. When the National Work Queue was originally
designed and implemented, what the messaging around it was, was
to have the next available person ready to take the next
action. What was not thought about was how that works with
employee performance standards and, you know, what it actually
takes to do things that way. There are differences in the way
regional offices operate and frankly train their employees, you
simply can not trust what was done before. If we could change
how we manage the National Work Queue to allow a claim to
perhaps not stay, it would not necessarily have to stay with
the same employee, but if it could stay within the same office,
instead of having to, you would have more confidence in the
work that was done before you, because you would be working
with people who were trained the same way you were by the same
people. You understand what the employee who went before you
did and why they did it the way they did it.
Mr. Crane. Does that make sense, Mr. Tellez?
Mr. Tellez. Again, I think it is really about capacity. I
think the intent is to try to keep the claims at the local
regional office for processing. Again, I think there are times
when capacity says that we might have more capacity at a
different regional office to do it. I think the training is
pretty standardized across VBA, so I do not know that there
would be significant nuances from regional office to regional
office processing claims the same way. I would expect again,
the intent is to keep it with the regional office unless there
could be an opportunity to make a decision on that veteran at a
different regional office faster.
Mr. Crane. Mr. Bump, you were shaking your head as if you
do not agree with the training being centralized.
Mr. Bump. When an employee onboards at VBA, the VA made a
conscious decision a few years ago to shorten the amount of
time that the training is done centrally. It used to be where
folks went off to what was called challenge training and you
were there for challenge training itself was 10 weeks. You had
4 weeks of sort of learning the lingo, I will say, and then you
had 6 weeks where you traveled and you were all trained
together by national level trainers.
Now, what we have transitioned to is 4 weeks total of
national training, and then you are sent back to your regional
office where you are trained by regional office personnel. To
say that it is standardized, perhaps the material, and the
manuals, and things like that are standard, but the way you are
taught to do things varies from office to office.
Mr. Crane. Thank you. Last question, Mr. Bump. You said you
have been working with the VA for close to 20 years, is that
correct?
Mr. Bump. Twenty-two years this September, sir.
Mr. Crane. Twenty-two years. Has anybody explained to you
why they do not open up the work queue so that the VA staff is
more efficient and not sitting around as much?
Mr. Bump. No. The answer to that question has never really
been explained.
Mr. Crane. Have you asked the question?
Mr. Bump. It has come up. I serve on both the VBA Midterm
Bargaining Committee as well as our National Labor Management
Forum, and these are topics that are discussed there, so
certainly. The answer is always some form of we want the system
to work the way we designed it to work, instead of taking into
account changes that affect how that works and the projected
increase in the backlog.
If we are going to expect this increase and we are going to
do things the same way we have been doing them for the last 10
years, I do not think we are going to get a different result.
Mr. Crane. Thank you. I yield back.
Mr. Luttrell. Thank you, sir. Mr. Ciscomani, you
recognized, sir.
Mr. Ciscomani. Thank you, Chair. Just a quick question to
piggyback off the last part of our conversation on the
investments and how that is going to be improving in regards to
these changes. I have a question about how this is going to
benefit older veterans as well. My district has over 70,000
veterans, which is one of the highest concentration of veterans
in the country in any congressional district. Out of the over
70,000 veterans, many of them served in the Vietnam War with
service records and medical records that date back decades.
I am pleased to see the VA using optical character
recognition software to help find key words in the claims
paperwork. I have also learned that the accuracy still needs a
lot of improvement on that. We have seen live examples of that
happening. Mr. Tellez, how are you planning on improving the
optical character recognition so the automation can accurately
scan all these old service and treatment records that my
Vietnam veterans have now?
Mr. Tellez. Thank you, Congressman, for your question.
Because we are using professional services, they are bringing
the latest automation technology tools to bear. Part of it is a
learning process, natural learning processing. It takes time to
learn and do that. We see that accuracy improving and
improving. It does get harder when you start getting into those
older medical records with our handwriting. That is an industry
challenge wide for handwriting. Again, we are using our vendor
to implement that automation and to learn and improve the
accuracy of that. Then I will turn it to Mr. Orifici here.
Mr. Orifici. If I may add, we are also implementing the
Smart Search capability within VBMS. This is a service offering
from Amazon as part of their Cloud services. It has Optical
Character Recognition (OCR) and it maps it to where in the
document occurs. It also does recognition across images. If it
is not just type text or computer-generated text. It also has a
high rate of recognizing handwriting. This is one of the
improvements that we are rolling out this summer. A veteran
claims processor can search across the e-folder and it has that
ability to search both images and handwriting for increased
accuracy.
Mr. Ciscomani. Is this part of the same outsourced service
that Mr. Tellez was talking about or is this internal?
Mr. Orifici. This is internal to VBMS and this will be
fully exposed to other providers to utilize this data. It is
not just going to be isolated to VBMS for its use. It will be
available broadly to any service within the VA that wants to
use it.
Mr. Ciscomani. Regarding the service that we are hiring
from the outside, Mr. Tellez, and we are I guess contracting
the highest technology available, as you are describing, and
learning process on that, again, I am all about the efficiency
on this. In order to have efficiency, we got to have
expectations and timelines. In your mind, again, you know, no
system will ever be perfect. I understand that, but if there is
improvement to make, how much improvement have we made? Are we
instructing the service and company that is giving us these
services, what we need from this and the challenges we are
having with the older records as well?
Mr. Tellez. We do have a measurement for that. I will have
to get you back where we are improving on that, sir.
Mr. Ciscomani. Yes, please do. I want to see how much we
have improved and what do we still have to go in terms of the
metrics and the goals that you would set out on that and what
kind of progress we are making toward that.
Mr. Tellez. Yes, sir.
Mr. Ciscomani. Thank you. I yield back, Mr. Chair.
Mr. Luttrell. Thank you, sir. Mr. Rosendale?
Mr. Rosendale. Thank you, Mr. Chair. Mr. Bump, I really
like your comments about keeping the follow-on location. Let us
just say for a moment, let us just say that everyone was
trained exactly the same. Do you still think it would be easier
to talk to the person that is sitting next to you that has that
file if it was transferred over, than trying to reach across
the country to talk to someone?
Mr. Bump. Definitely. It is not only easier to talk to your
fellow coworkers in your office just because you are more
familiar with them, but it is also, I mean, frankly, if you are
in the office on the same day, you can actually just go and
physically speak with them and have everything at the ready to
do that.
Mr. Rosendale. Does not the actual act of transferring that
file to another location take a certain amount of time?
Mr. BUMP. The work that the National Work Queue does to
draw things back up into the Cloud and then disperse it, that
takes a certain amount of time. I am not sure how often that
is, but all of the information, so all of the ''paperwork''
that goes with the claim that is readily available to everybody
at the same time. That said, you are not supposed to access a
veteran's records unless you have a need to do so.
Mr. Rosendale. Exactly. Mr. Tellez, is there any part of
that that you disagree with, do you not feel that it is a lot
easier to talk to someone sitting next to you with the
documents right there in front of you than trying to go across
the country to bring them up to speed on all of the work that
you have just completed?
Mr. Tellez. I think meaningful engagements with employees
is always a positive outreach, for sure. I think we have built
an environment where we can have the flexibility to move the
claims around where we have capacity. I think that is one of
the benefits of the NWQ is to allow us to do it. As I said, I
think the intent is to keep the claim at the local regional
office to work it but there may be times when we can disburse
it.
Mr. Rosendale. Mr. Tellez, the intent of legislation many
times that I have seen go through does not get implemented in
that fashion once it gets translated by the bureaucrats that
are working on it. I have got a question. Mr. Tellez, Mr.
Orifici, there is a misconception that the VA's ability to
access medical evidence and existing health records has
anything to do with the replacing of the EHR. In reality, you
are already using information from Vista, from the Department
of Defense, and from private physicians to a limited extent.
What is necessary to improve and expand that?
Mr. Orifici. Yes, sir, thank you for that question. We
actually do have efforts underway to expand that right now. We
have work that is going on with Health Data Repository (HDR) on
the health side, which is pulling information directly into the
claims to eliminate steps that claims processors have to do to
pull health data from Capri into VBMS. There is continued work
with our partners in DoD to bring over older service treatment
records into our systems and have it right there in one tool
without having to have the request that Mr. Bump has been
referencing that are manual steps that need to be taken right
now. There is always more work to do as we work with our
partners in VHA to pull that data from either VHA or the
community care aspects to have that data readily available to
VBMS and the claims processors.
Mr. Rosendale. Mr. Tellez and Mr. Orifici, you mentioned
that you are attempting to expand the automation to 103
diagnostic codes representing 103 medical conditions. When will
you be able to speed up and automate most claims for these
conditions, not just a token number of simple claims?
Mr. Tellez. Thank you, Congressman, for your question. Our
intention to automate or make eligible those diagnostic codes
about 90 percent of what we call all rated claims issues. That
is about 250 diagnostic codes. That is where the real bang for
our buck is. We are expecting about an 18 to 24-month period to
accomplish that, get that information, get that capability in
the hands of users.
Beyond that, it is probably going to have to take a little
bit of look at to see whether or not those are automation
eligible, if we can automate that process, or do we have enough
claims to invest the dollars to automate. I think there is a
little bit of opportunity for us to look at those diagnostic
codes beyond the 250 to determine whether or not it is feasible
to do that.
Mr. Rosendale. Mr. Bump, how do you feel that your folks
that you work with are going to be able to integrate these
systems he is talking about?
Mr. Bump. Thank you, Congressman. We are really in the
infancy of all of this. I hope that at some point we get to the
point where we have more of this information already there, the
automated piece of it. As I mentioned in my opening statement,
I hope that we are never at the point where we are relying
solely on technology to process a claim that at least at some
point or points, that an actual human has to touch it because
there are things automation can not do, so.
Mr. Rosendale. I agree. I agree. Thank you so much, Mr.
Chair, I yield back.
Mr. Luttrell. Thank you, sir. That concludes our second
round of questioning. I recognize the Ranking Member Pappas for
his closing remarks.
Mr. Pappas. Well, thank you, Mr. Chairman. Thank you to our
panel for your comments today and for the work that you do for
our veterans. Given the implementation of PACT Act and the
impact that it is going to have on VBA claims, it is really
crucial that IT systems support the work of the claims
processors to ensure that veterans are going to receive their
benefits in a timely manner.
Modernizing these systems must be a partnership between
VBA, OIT, and end users. These folks have a wealth of knowledge
and that was borne out by this hearing today about what is
working and what is not working. With hundreds of thousands of
claims awaiting adjudication and more coming in every day, I do
not think we can ignore the voices of those who do this work
each and every day. I hope that that can be front and center as
we move toward greater modernization and find greater
efficiency for our veterans. Thank you all for your
contributions and your comments today and I yield back my time.
Mr. Luttrell. Thank you, Ranking Member Pappas. Thank you
all again for coming before us today. I look forward to
continuing to work with the Department and all our partners as
we track the VBA's implementation of its Five-Year
Modernization Plan. I believe the tools the VA is developing
are critical for reducing the backlog, improving employee
morale, and restoring veterans trust in VA.
Do know this, gentleman, we are very unified on this
committee and our primary concern is our veterans. I think you
saw that today. We are watching. With that, I ask unanimous
consent that all members have 5 legislative days to revise and
extend their remarks and include extraneous material. Without
objection, so ordered. This hearing is adjourned.
[Whereupon, at 11:46 a.m., the subcommittees were
adjourned.]
?
=======================================================================
A P P E N D I X
=======================================================================
Prepared Statement of Witnesses
----------
Prepared Statement of Raymond Tellez
Chairman Luttrell, Chairman Rosendale, Ranking Member Pappas,
Ranking Member Cherfilus-McCormick, and Members of both Subcommittees,
thank you for the opportunity to appear before you today to discuss the
Department of Veterans Affairs (VA or Department) report entitled,
``The Plan for Modernization of Veterans Benefits Administration
Information Technology (IT) Systems,'' as required by P. L. 117-168,
Sec. 701(b) (known as the PACT Act). For decades, our dedicated team
at the Veterans Benefits Administration (VBA) and the Office of
Information Technology (OIT) has worked tirelessly to support those who
have served our Nation with honor and courage. We have witnessed the
evolving needs of Veterans and recognized the pressing need to
modernize our systems and processes to better serve them.
Background
Before 2012, VA regional offices were buckling under the weight of
paper claims folders, and multiple systems were used to process
disability compensation claims. VA staff physically boxed and shipped
Veterans' claims folders from office to office across the Nation,
depending on available processing capacity. This archaic approach
resulted in significant delays to Veterans receiving their earned
benefits in a timely manner, as well as information security risks
related to tracking and shipping errors. During 2012, VA underwent a
historic transformation of the benefits claims process, moving from a
completely paper-based system to one predicated on electronic claims
processing.
The introduction of the Veterans Benefits Management System (VBMS),
VA's claims processing system, along with the integration of the
Veterans Claims Intake effort (where millions of paper claims folders
were digitized for ingestion into VBMS), was foundational to moving VA
from a paper-based process to an electronic processing environment.
Over the years, VBMS has undergone multiple enhancements and
optimizations to improve system resiliency, increase claims processors'
productivity and modernize system components. Recently, VBMS was
expanded to allow processing and control of VBA's fiduciary program,
improved Draft Rating Approval eliminating the need to manually process
second signature decision reviews, and in June 2023, VBA will deploy
Smart Search technology, which allows claims processors to conduct
intelligent searches of the entire Veteran's eFolder of documents,
which was formerly a tedious manual process of searching multiple
individual documents. While VA still receives paper claims, more
Veterans are filing claims online through an online portal at VA.gov.
Today, more than 1.1 million Veterans are active users of our digital
benefits products on VA.gov, with user adoption continuing to increase,
and over 50,000 claims being filed online each month.
As a result of VA's continued investment in VBMS, the establishment
of the Evidence Intake Center (EIC) to digitize inbound paper mail for
ingestion into VBMS, and developing a paperless claims process, VA
maximized telework capabilities during the COVID-19 pandemic to
minimize employee health and safety impacts while still maintaining
service to Veterans. While VA successfully pivoted to remote work,
while still serving Veterans, the inability to conduct in-person
disability medical examinations and access paper Federal records led to
a temporary increase to the disability compensation claims backlog. VA
later reduced the claims backlog by approximately 100,000 in fiscal
year 2022, but the lessons from the pandemic processing period
highlighted the need for increased digitization of relevant paper
records and supporting medical evidence.
Passage of the PACT Act
On August 10, 2022, the enactment of the PACT Act expanded VA care
and benefits to millions of Veterans and their survivors. To
effectively deliver the additional care and benefits, VA must continue
modernizing and expanding its business processes and technology, as
well as continue improving communications with Veterans and other
claimants. While VA has and will continue to hire more people to
process claims, adding more personnel is only one facet of the
solution. VA must equip our new and existing employees with tools to
enhance productivity by increasing the accuracy and timeliness of the
delivery of benefits for Veterans, families and survivors.
The report required by Section 701(b) in the PACT Act created a
fresh opportunity to develop an enterprise-wide plan to deliver
technology products that enable a journey-driven, proactive engagement
with the Veteran and improve the way VA delivers benefits and services,
leading to increased customer service, higher utilization, and better-
quality outcomes for the Veteran. A key principle of 701(b) is
embracing automated decision support tools.
VBA and the Office of Information Technology (OIT) partnered to
create VA's Five-Year Modernization Plan of Benefits Delivery IT
Systems to improve efficiency of claims processing and create more
reliable and resilient systems. VA will evolve its approach to
leveraging data to anticipate needs and more efficiently and
proactively serve the Veteran. IT modernization is a continuous
investment that will continue beyond 5 years; however, the 701(b)-
modernization effort will realize benefits across five key pillars:
Improved Veteran Experience;
Increased Efficiency and Accuracy in Claims Processing;
Improved System Architecture and Resiliency;
Improved Data Infrastructure and Use of Data; and
Improved Employee Experience and Efficiency.
This modernization plan will allow VA to move toward a seamless and
personalized engagement model in support of Veterans and their
beneficiaries, while shifting the focus from the Veteran requesting
help to VA providing a service. This includes simplifying the process
of submitting claims and proactively notifying Veterans when they are
entitled to additional benefits and services. The impact of 701(b) IT
modernization will be life-changing to Veterans and transform claims
processing.
Enhancements to VBMS and other Claims Processing Systems
As anticipated, the passage of the PACT Act resulted in a surge of
claims and an increase in the number of employees using VA IT systems
to process these claims. Since the PACT Act was signed, Veterans and
their survivors have filed more than 1.7 million claims, an increase of
30.2 percent over the same period last year. VA has already received
more than 588,000 PACT Act-related claims since August 10, 2022. The
modernization of the VBA Corporate Data base and transition of IT
systems to the cloud directly supports VA's ability to respond to these
challenges. Additional capacity has been added to VBMS allowing the
system to handle the increased claims volume and additional users.
Efforts are underway to move the remaining VBMS modules to the cloud to
take advantage of these offerings.
In addition to VBMS, VA uses several other IT systems to facilitate
the delivery of benefits. Many of these older systems were designed to
solve different problems from those that VA faces today, for example,
when many of these systems were created, VA was relying on paper claims
folders and entering data into these antiquated systems. These legacy
systems are inefficient and fail to fully meet VA's current needs,
creating challenges for employees to deliver world-class customer
service to Veterans. Many aging systems date back to the 1990's and are
at end-of-life. Dependencies and integrations with these obsolete
systems make it complex to automate and modernize. However, OIT and VBA
continue to work together to move or modernize functionality from
legacy systems into more modern systems. This approach allows VA to
leverage modern interfaces and authoritative data sources to meet the
business requirement in the short term, streamline processes by
retiring these aging systems and avoid the long-term costs of
integrating with legacy systems. For example, VA just completed
migrating capabilities from VETSNET Award into VBMS. This allows the
claims processors to complete all compensation awards actions within
VBMS without switching back and forth between multiple systems.
Additional efforts completed through the VBA--OIT partnership to
modernize VBA's claims processing systems include:
Production Optimization Continuous Improvement Model
In addition to investing in large modernization efforts, VBA and
OIT commit resources to improve the VBMS system through the Production
Optimization Continuous Improvement Model, which implements feedback
and suggestions from claims processors. During fiscal year (FY) 2022,
VA implemented 67 enhancement requests, and in FY 2023 to date, VA has
implemented 38 enhancement requests. These requests range from VBMS
system defects found by claims processors to optimizations for
improving the employee experience. The system enhancements eliminate
time-consuming workarounds and improve the system accuracy for claims
processors. Overall, VBA and OIT have improved the response to
resolving system defects, with the majority being resolved in less than
30-days, minimizing delays for Veterans.
Draft Rating Approval
VA implemented Draft Rating Approval to support the average 700,000
rating decisions completed per year that require a second signature.
All rating decisions require the signatures of two decision makers
until the first signatory rating specialist has reached a level of
proficiency to complete decisions under a single-signature authority.
Additionally, specific types of rating issues, a few examples include
Traumatic Brain Injury, Special Monthly Compensation and Military
Sexual Trauma, always require a second signature due to the level of
complexity of the decision. This improved productivity and
accountability in the review process to ensure draft Rating Decisions
were completed within the VBMS platform eliminating the need to
download, manually sign, and reupload forms. This streamlined process
is expected to save more than 75,800 hours annually equivalent to 36
full-time employees.
Automated Data Ingestion
VA and our industry partners collaborated on Automated Data
Ingestion (ADI) functionality that automatically transcribes
information received from medical exam vendors uploading Disability
Benefits Questionnaires (DBQs) into the VBMS system used to calculate
ratings. This technology assists Rating Veteran Service Representatives
(RVSRs) by eliminating the need for manual data transcription. This
helps to promote the consistency and standardization of decision-
making. ADI is currently being operationalized at eight regional
offices with all 26 PACT Act medical condition DBQs scheduled for
release by the end of this fiscal year.
VBMS Demo Academy
In response to VBA's increased hiring of new employees, OIT
upgraded the VBMS Demo Academy capacity to support eight-times the
number of new hires and eliminated one week of preparation to reset
testing environments between training sessions. The VBA training
program supports Instructor-Led Web-Based Training (IWT), Virtual and
In-Person (VIP) training and Warrior Training Advancement Course
(WARTAC) training for newly hired claims processors. This training
environment and platform provides VBA with the ability to walk new
hires through a simulated and controlled environment for training in
every phase of the claims process. The training supports the 6 to 12
weeks of training required for all claims processors. These
improvements ensure VBA can train a continual stream of new employees
supporting PACT Act claims processing.
Of note, national quality remains high. The systematic technical
accuracy review (STAR) data for rating 12-month accuracy is currently
95.64 percent and has increased since Jan 2023.
The more current rating 3-month STAR accuracy is 97.33 percent.
This is the highest 3-month accuracy since Jan 2022. The STAR non-
rating 12-month accuracy has also remained steady and has been 92
percent or better since Sept 2022.
Individual compensation quality data for claims processors remains
high.
Veterans Service Representatives (VSRs) have a national
quality FY 2023 to date of 95.09 percent (FY22 VSR quality was 94.82
percent).
Rating Veterans Service Representatives (RVSRs) have a
quality FY 2023 to date of 95.98 percent (FY22 RVSR quality was 95.85
percent).
System Automation
Automation offers VBA the ability to process claims more quickly,
reduce the time claims processors spend on administrative tasks, and
provide more consistent claims decisions. To provide oversight of the
effectiveness of the automation process, VBA established the Deputy
Under Secretary for Automated Benefits Delivery (DUSABD) in 2021. As
part of VBA's People, Process, Technology framework, the Office of
Automated Benefits Delivery (ABD) focuses on VBA's digital
transformation strategy providing innovative solutions to leverage
automation and maximize efficiencies.
Mail Automation
ABD has executed improvements in mail automation efficiency, now
automating approximately 68 percent of initial claims intake processing
activities for inbound mail received at VBA's EIC. This enables VBA to
focus employee efforts on more complex decision-making tasks. Since May
6, 2020, mail automation has established over 2.7 million claims
representing over 7.6 million individual contentions.
Pension and Survivor Benefits Automation
VBA's Pension and Fiduciary Service aims to move toward an
automated electronic claims submission process for all pension
applications forms. These automated capabilities will streamline the
process to gather the evidence needed to grant both Veterans and
survivors pension, Dependency and Indemnity Compensation (DIC), burial
and accrued benefits.
This initiative builds on VBA's proven track record for leveraging
automation to provide survivor benefits. Currently, when VBA is
notified of a Veteran passing and specific criteria are met, the system
automatically pays the month of death benefit to the surviving spouse
for Veterans, who are in receipt of disability benefits. Additionally,
burial and DIC benefits may also be paid to the surviving spouse when
the spouse's information is available in VBA systems, and the spouse
meets the eligibility requirements. These payments are completed
without the need for an application and are based on the evidence
available at the time of the Veteran's death, as allowed by P. L. 114-
315. Since implementation in 2014, VBA has paid out over 206,000 month
of death and burial benefits claims automatically, without the need for
an application.
Proactive Scanning
In FY 2022, VBA partnered with the National Personal Records Center
(NPRC) to digitize all available Service member and Veteran records for
use in determining a claimant's eligibility for VA benefits. VA
digitized military records and claims folders for approximately 170,000
Veterans who may potentially file an initial claim for benefits under
the PACT Act. Once digitized, these records are available to claims
processors on the same day as the corresponding Veteran's claim is
received. This reduces the administrative burden of collecting records
and results in faster claims processing for Veterans, Service members,
their family members, and survivors.
Automated Decision Support Tools
VBA is undergoing business modernization efforts designed to
leverage technology by automating administrative tasks and workflows,
known as Automated Decision Support (ADS). The ADS tools support claims
processors to make faster and more equitable claims decisions by
indexing relevant medical evidence and automatically ordering exams in
certain situations. In December 2021, VBA established a prototype site
at the Boise Regional Office to evaluate the proof of concept for
automation. Based on the success of the process combined with the
positive feedback from claims processors at this site, the automation
capabilities were expanded to claims for increase for asthma (March
2022) and sleep apnea (April 2022). In September 2022, VA expanded the
prototype site to three additional regional offices and in December
2022, VA expanded to four additional prototype sites for a total of
eight (8) sites. In May 2023, VA added eight (8) pilot sites to
validate the automation logic in preparation for national deployment.
VBA planned to continue adding three additional diagnostic codes
per quarter; however, with the passage of the PACT Act, VBA shifted its
focus to the diagnostic codes associated with this enactment. Under the
direction of the DUSABD, 57 diagnostic codes are automation eligible,
including all 26 PACT Act presumptive conditions.
Today, claims processing tasks, supported by technology to enable
automation using artificial intelligence, Natural Language Processing,
and Optical Character Recognition, enable automation with data and
records extraction from Veterans' electronic health records,
verification of military service eligibility, expediting claims that
can be decided based on the evidence of record, ordering examinations
when required, and the intelligent indexing of the relevant
adjudicative information. Since December 2021, over 179,000 claims have
utilized automation.
Verification of Military Service Eligibility
In the third quarter of FY 2022, VA obtained authoritative military
service deployment data from the Defense Manpower Data Center (DMDC)
that enabled VBA to proactively determine PACT Act eligibility for more
than 3.5 million Veterans. This allows VBA to provide Veterans with
faster decisions on their PACT Act claims by reducing instances where
manual research is needed by claims processors to determine military
service eligibility.
Automated Issue Management
In December 2022, VBA and OIT released Automated Issue Management
(AIM) functionality, providing the ability to route claim types by
issue and automate specific issues without breaking up the overall
claim. This directly benefits Veterans as it lowers the barrier to
evidence collation on certain issues within the overall claim, rather
than waiting for all issues to be developed.
Smart Search Technology
In the third quarter of FY 2023, VBA and OIT will begin deploying
Smart Search technology, which allows claims processors to conduct
intelligent searches of the entire Veteran's eFolder of documents,
which was formerly a tedious manual process of searching multiple
individual documents, including images and handwritten documents. This
capability increases employee efficiency by accelerating the ability to
search for relevant information to expedite PACT Act claims processing.
Verify, Validate, Graduate (VVG) Plan
In 2022, VA recognized the need for a robust, repeatable process to
assess the effectiveness of automation outputs with the goal to make
data-driven decisions for nationwide deployment of automation
functionality. VA subsequently established the Verify, Validate,
Graduate (Prototype, Pilot, nationwide release) plan, ensuring all ADS
tools pass a consistent validation assessment before they are advanced
to nationwide release. In April 2023, VBA validated the automation
logic first diagnostic codes to move from Prototype to Pilot phase and
added eight new Pilot locations across the Nation. These Pilot Sites
will test the automation logic and ensure it meets strict criteria
before graduating to national release.
Early accomplishments include 57 diagnostic codes in production (54
are PACT Act specific) and compared to the traditional claims process
for single issue claims, ADS claims have a 27.5 percent examination
avoidance compared to 9.5 percent, reducing the burden on Veterans.
Future of Claims Processing
Throughout the remainder of calendar year 2023, VBA is on track to
expand automation to an additional 103 diagnostic codes related to some
of the most frequently claimed conditions, such as hearing loss, mental
health, peripheral nerves, and musculoskeletal conditions, that
represent over 700,000 annual claims. Over the next 18-24 months, VBA
will continue to apply automation to conditions most frequently claimed
by Veterans to enable continued execution of the vision to provide
Veterans faster, more accurate, consistent, and equitable claim
decisions than ever before.
Conclusion
VA's IT modernization vision is grounded in its unwavering
dedication to Veterans, their families, caregivers, and survivors. The
efforts outlined in VA's 5-Year Modernization Plan of Benefits Delivery
IT Systems sets the foundation for a future of continual modernization,
where systems are regularly improved with the most up-to-date
technology. Automation can enable and empower VA employees to deliver
world-class, proactive service to Veterans in ways that have never been
possible before. Further, automation only succeeds if the underlying
architecture and systems are modern, agile and resilient.
The outcomes envisioned in VA's IT modernization plan have the
potential to change Veterans' lives. With event-driven processes,
automated to deliver benefits with greater speed, VA can provide a
seamless and personalized experience for Veterans.
VA is confident that the modernization roadmap described in this
plan can be realized. The continued support and commitment of Congress
is key to VA achieving this goal. We look forward to continued
engagement with you as we implement this plan and strive to serve with
excellence those who have served the Nation. Thank you for the
opportunity to appear before the Committee today. I would be pleased to
answer any questions that you or members of the Committee may have.
______
Prepared Statement of David Bump
Chairman Luttrell, Chairman Rosendale, Ranking Member Pappas,
Ranking Member Cherfilus-McCormick and Members of the Disability
Assistance and Memorial Affairs and Technology Modernization
Subcommittees:
The American Federation of Government Employees, AFL-CIO (AFGE) and
its National Veterans Affairs Council (NVAC) appreciate the opportunity
to testify at today's subcommittee hearing titled ``From Months to
Hours: The Future of VA Benefits Claim Processing.'' My name is David
Bump, and I am a National Representative for the NVAC, and serve as the
Second Vice President for VBA for AFGE Local 2157, in Portland, Oregon.
I also serve as a member of the NVAC's Veterans Benefits Administration
(VBA) Legislative Committee and the VBA Midterm Bargaining team. I have
also had the privilege of serving veterans in the VBA for 21 years,
including 10 as a VSR, and 11 as an Authorization Quality Review
Specialist in the Milwaukee, Wisconsin, Regional Office, and now the
Portland, Oregon, Regional Office.
On behalf of the 291,000 Department of Veterans Affairs (VA)
employees AFGE represents, including thousands who are frontline
workers at the VBA, over 50 percent of whom are veterans themselves, it
is a privilege to offer AFGE's views on the IT challenges facing VBA
today, and more importantly, offer suggestions that could improve the
use technology at VBA, and enable claims processors to better serve
veterans more efficiently and accurately.
VA's Five-Year Modernization Plan:
AFGE was proud to support the PACT Act which expanded eligibility
to VA healthcare for millions of veterans. Section 701(b) of the PACT
required the VA to submit to Congress ``a plan for the modernization of
the information technology systems of the Veterans Benefits
Administration.'' AFGE supports the use of technology to better enable
VBA's processors to perform their duties and best serve veterans.
However, we are concerned about the negative effect on veterans of
replacing human processors with technology. AFGE strongly supports the
work done by lawmakers to protect VBA employees, and to make sure that
all claims have to be reviewed at some point during the process by
human claims processors. It is important that our approach to the use
of technology emphasize that information technology supplement and not
supplant the VBA's workforce.
Veterans Benefits Management System
The Veteran Benefits Management System (VBMS) is the core platform
VBA Veteran Service Representatives (VSRs) and Rating Veteran Service
Representatives (RVSRs) use to process veterans' claims. While VBMS
generally serves its purpose, there is certainly room for improvement
from the perspective of the end user.
Reliability
The most serious problem that claims processors raise about VBMS is
its unreliability. The system often crashes or requires rebooting,
delaying claims processors from doing their required work. Even when
the system does not crash, complaints of general sluggishness also
create unnecessary delays. While managers are supposed grant ``excluded
time'' when the system is down to account for less time for employees
to meet their performance metrics, this is not done universally or
consistently. Claims processors fear when the system goes down that
they may suffer negative consequences through no fault of their own.
Basic Functionality
When hearing from claims processors around country, two basic tools
appear to be missing within VBMS. First, it is not easy to know what
previous employees have looked at or worked on a claim; either a
special note must be entered, or an employee must click on the
information to see who worked on it. Giving employees using VBMS the
ability to quickly see who worked on something previously, and then use
VBMS to contact that employee with a simple question would save time,
and let claims move through the claims process more efficiently.
Additionally, the user does not have the ability to sort or filter
information to get a chronological view of a claim's history, other
than what VBMS automatically provides. This basic function could help
claims processors and save time.
Interoperability
Another common complaint about VBMS is its lack of interoperability
with other systems claims processors must use every day. A clear
example of this provided by the Houston, Texas, Regional Office is
related to form letters that claims processors send to veterans to
inform them of their decisions. Redesigned Automated Decision Letters
do not automatically populate information in VBMS for all the
withholdings that may affect a veteran's compensation, including
severance pay, separation pay, or drill pay withholdings. Other letters
that RVSRs send do not auto-populate within VBMS and must be completed
in the Personal Computer Generated Letters (PCGL) system. Other
employees raised the problems of integration for letters related to
Individual Unemployability (IU) claims within VBMS. These are all
examples where RVSRs have to manually update letters in VBMS and pull
information that is more up-to-date in other systems, that should
ideally be in VBMS. This takes extra time that can be better spent
performing work that require a claims processor's expertise and leads
to unnecessary errors that negatively affect an employee's performance
rating or a veteran's benefits.
The process for getting a veteran's Service Treatment Record (STR)
is also a clear example of problems with interoperability. The
Portland, Oregon Regional office cited that VBMS will automatically
pull up STRs from a veteran who served in a modern war from the Health
Artifact and Image Management Solution (HAIMS) system. However, for
veterans who served further in the past, VBMS makes a request for the
data from the older Personnel Information Exchange System (PIES) but
does not record its own request. This leads to the employee having to
make a manual request in VBMS on top of what they did, but may also
create duplicate requests in PIES, further wasting time.
The Cleveland, Ohio Regional Office cited problems with the Joint
Legacy Viewer (JLV) that were similar to problems experienced in
Portland, Oregon. When using the JLV to view a veteran's records, each
document must be opened separately, saved, and then uploaded into VBMS,
with each document taking several minutes to upload. Additionally, if a
claims process attempts to upload too many documents at once, the
system may not work, and the employee must start over, wasting valuable
time.
Unnecessary Repetition
Another key criticism of the system for RVSRs comes from the
Pittsburgh, PA, Regional Office. RVSRs in this facility identified that
VBMS-R (the portion of VBMS raters use) requires RVSRs to enter
multiple levels of SMC (special monthly compensation) on a veteran's
claim. To do this, RVSRs must instead use a workaround that enters the
first level of SMC, then delete the coded conclusion (the number
generated for payments), then enter the second SMC with the combined
numbers. VBMS will not create the narrative for both levels of SMC
unless employees use the system this way. This can lead to errors as
well in incorrectly entering the SMC levels and can create over/under
payments if done incorrectly. Also, if SMC is awarded temporarily,
RVSRs must manually end the SMC even though the RVSR initially entered
an end date, because if the RVSR does not go back in to ``zero out''
(coding to stop payment) then the veteran will never stop being paid.
VBMS would be more efficient if the system allowed employees to create
the narrative issue and the correct coding all in one entry instead of
multiple entries.
VBMS also does not work well when considering conditions that
cannot be evaluated separately, including several cardiac conditions,
digestive issues, gastroesophageal reflux disease, irritable bowel
syndrome, traumatic brain injury, post-traumatic stress disorder,
asthma, and sleep apnea. VBMS sometimes allows claims processors to
combine these symptoms at the end, but it does not always work,
especially if one condition was already service-connected and the
employee is attempting to add service connection to a new condition
that cannot be evaluated separately. This can create performance
errors, overpayments and extra work in correcting these errors.
To improve VBMS, it would be better if claims processors could rate
certain conditions at the same time and then be able to merge them
based on the higher evaluation rules. This would also save time by not
having to use external evaluation builders and copy and pasting
additional information within the system. There are specific diagnostic
codes that cannot be evaluated separately, but if there were the
functionality to add a co-morbid condition that must now be rated
individually, it would greatly improve employee efficiency and reduce
errors.
Fixing these examples within VBMS would greatly reduce time spent
on claims affected by these workarounds, reduce erroneous decisions,
and deliver a higher quality product to our nation's veterans.
The National Work Queue
Another critical component of the claims process that the
subcommittees must examine is the National Work Queue (NWQ). AFGE
agrees with the Inspector General's (IG) 2018 conclusion that VBA's
decision to eliminate specialization of claims processing has had
adetrimental impact on veterans whose claims are more complex and
sensitive in nature. As the IG report explains, prior to the
implementation of the NWQ:
The Segmented Lanes model required VSRs and RVSRs on Special
Operations teams to process all claims VBA designated as
requiring special handling, which included MST-related claims.
By implementing the NWQ, VBA no longer required Special
Operations teams to review MST-related claims. Under the NWQ,
VSRs and RVSRs are responsible for processing a wide variety of
claims, including MST-related claims. However, many VSRs and
RVSRs do not have the experience or expertise to process MST-
related claims.\1\
---------------------------------------------------------------------------
\1\ VA OIG 17-05248-241 Page iii August 21, 2018
Because of the level of difficulty in processing these claims, AFGE
strongly supports returning to a ``Special Operations'' model for as
many complex claims as the system will support. AFGE supports the
current use of these specialty lanes for Military Sexual Trauma (MST)
and Camp Lejeune Water Contamination Claims among others and encourages
their expanded use.
AFGE also encourages the VA to modify the NWQ so that cases remain
within the same RO for VSR and RVSR review. Every RO, despite uniform
production standards, has its own way of conducting specific tasks, and
having VSRs and RVSRs who are more familiar with each RO's standard
procedures will help process cases efficiently. Additionally, by better
identifying which employee worked on a particular claim, better
collaboration between VSRs and RVSRs can be achieved.
Last, the NWQ should reprogrammed to allow VSRs and RVSRs to always
have access to all readily available claims. Despite the national
claims backlog that existed prior to the COVID-19 pandemic and has
grown with the passage of the PACT Act, it is a common refrain from
VSRs and RVSRs that they do not have enough work assigned to meet their
production standards and that they have to constantly request new work
from their coaches. Although the NWQ was designed in part to maximize
the VBA's claims processing capacity, it is counterproductive to deny
employees access to all available claims when the technology to do so
already exists. Workers should not have to request additional work to
meet their standards but should instead be constantly engaged in
efforts to reduce VBA's backlog.
Conclusion
I hope that my testimony today leads the subcommittees to conduct
further oversight of VBA's IT challenges. The VBA should survey its
employees as it modernizes IT systems and use employee feedback to
promote improvements that will help veterans. AFGE and the NVAC stand
ready to work with the House Veterans' Affairs Committee and VBA to
reach this goal. Thank you, and I look forward to answering your
questions.
Statement for the Record
----------
Prepared Statement of Foundation for American Innovation
Introduction
Mr. Chairman, Ranking members, and members of the Subcommittees,
thank you for the opportunity to submit this written statement in
support of this hearing. My name is Reynold Schweickhardt. I am a non-
resident senior fellow with the Foundation for American Innovation, a
nonprofit think tank focused on innovation, governance, and national
security. During my career, I have worked in the public and private
sectors on technology policy, management, and modernization. I
previously served as a senior technology advisor with the General
Services Administration. Before that, I was a strategic advisor with
the House Office of the Chief Administrative Officer and Director of
Technology Policy for the Committee on House Administration. Earlier in
my career, I worked as the chief technology officer and chief
information officer in the U.S. Government Publishing Office and as an
R&D project manager for Hewlett-Packard.
While I have extensive experience working on technology policy and
advising senior governmental leaders on technology modernization, I do
not have specific expertise on the Department of Veterans' Affairs's
technology systems or health care information technology systems.
Therefore, my comments are based on my review of the Department of
Veterans Affairs's five-year technology modernization plan and on
conversations with experts who have experience working on VA or similar
federal IT systems. Moreover, I share the subcommittee's commitment to
ensuring that the VA provides better service to the veterans who have
patriotically served our country.
Modernizing the Department of Veterans Affairs to Improve Disability
Services to Meet Growing Demand
The enactment of the PACT Act in 2022 will create a significant
increase in new veteran disability claims, as well as reviews of
previously declined claims by the VA. As a result, the Veterans Benefit
Administration (VBA) will face a significant workload increase.
Modernizing the VA's information technology systems--specifically, the
VBA--will likely determine if veterans receive these benefits in a
timely manner.
To do this, Congress and VA leaders should be asking several
questions:
To what extent will the VA's five-year plan improve
outcomes for veterans in the next several years, or will the
improvements manifest in later years after the surge in claims has been
submitted to the VBA?
What are the key projects, their dependencies, and
maturity to provide material benefit in the short-to-medium term?
What are the options to segment the anticipated workload,
identify claims with a simpler requirement set, and process those more
rapidly?
Short-Term Improvement
Identification of Cases with Required Information for Quick Resolutions
The Hypertension Automated Decision Support is the FY23
implementation that can affect claims processing speed, and the ongoing
metrics should be reported to the Committee. Other conditions should
also be added to this automation where the available data supports
simplified review--for example, specific cancers and service locations
creating a presumption of environmental exposure during military
service.
Value of Robotic Process Automation
Robotic Process Automation (RPA) is a strategy to bridge two
systems that have not been integrated. It is effectively an automated
cut-and-paste methodology to reduce staff's time performing lower-level
tasks. In the long term, the systems in question would be integrated to
automate the transfer of data. The anticipated benefits to VBA
processing time will require an analysis of time spent performing these
tasks manually.
An enterprise RPA platform, which is required for the scope and
complexity of VBA, is initially implemented as a pilot with an initial
transaction, and then rolled out enterprise-wide and expanded to
additional use cases. Several agencies within the federal government,
especially the General Services Administration, have a demonstrated
track record of using RPA to rapidly improve processing. The former CFO
of the General Services Administration set an aggressive goal of
implementing one transaction a week and achieved an average of 2-3 per
month. By January 2022, according to the Office of GSA's CFO, GSA had
implemented 104 automations at an annual cost of $2.5 million, creating
more than 350,000 hours of additional capacity annually. This approach
also included business process reengineering (BPR) to simplify and
align processes to avoid automated outdated processes.
Simpler, Faster Ways to Use Artificial Intelligence
The Social Security Administration is using AI to process complex
claims, including disability benefit applications, more effectively.
The AI tool sorts the claims into similar buckets, which are then
assigned to a group of claims processors that are responsible for
processing them. This allows staff to specialize in similar claims; by
learning the nuances of applicable case law and processes, they can
reduce both errors and time spent.\1\ The AI tool improved workload
management and did not automate decision making, nor did it predict the
outcome of cases. This approach is simpler than task 5D ``Limited
Predictive Use of Data to Enable Outcomes.'' This approach could be
implemented with minimal integration complexity, allowing for faster
results and improved processing times at the VA.
---------------------------------------------------------------------------
\1\ ``SSA reported 12 percent reduction in case processing time and
7.5 percent reduction in returns from administrative appeal judges to
attorneys.'' Engstrom, David Freeman, Daniel E. Ho, Catherine Sharkey,
and Mariano-Florentino Cuellar. 2020. http://complaw.stanford.edu/
readings/government_by_algorithm.pdf; ``Government by Algorithm:
Artificial Intelligence in Federal Administrative Agencies.''
Administrative Conference of the United States.''https://
law.stanford.edu/wp-content/uploads/2020/02/ACUS-AI-Report.pdf.
---------------------------------------------------------------------------
Improved Search
Subcommittee staff shared an example of the current maturity of an
Automation Aid to identify cases ready for adjudication. The goal was
to identify notes with conditions that were presumptively grounds for
benefits and present them to raters who would evaluate the specific
claim. However, in the example, the search was extremely primitive,
selecting cases with ``rhinitis,'' for example, without evaluating
``does not have rhinitis.''
The plan has a task to address this deficiency, ``Smart Search
within Veterans eFolder [6-12 month].'' However, it includes more than
is necessary to improve the immediate user experience. Effectively
using a modern search engine would improve the accuracy of the results.
After initial implementation, the search engine could be tuned,
including with machine learning, to improve accuracy over time.
Implementing Longer-Term Improvements
The overall plan could be implemented more effectively if the
Veterans' Administration addressed these opportunities:
Define and prioritize the infrastructure for a modern
infrastructure. This reduces ongoing cost and complexity, improves
reliability, and implements modules in the end-State to eliminate
rework.
Examine areas of duplication to implement a ``build once,
use many'' strategy, which reduces implementation costs and increases
software quality by focusing on a single implementation for a given
task. This strategy is enabled by a modern infrastructure.
Effectively adopt an agile methodology, which is not
reflected in the plan today. An agile approach typically starts with a
Minimum Viable Product (MVP) that meets the user's core needs. Through
feedback and metrics, bug fixes and enhancements are created, tested,
and released in a six-to-eight-week cycle, which repeats until further
improvements are no longer a priority. Do not let the perfect be the
enemy of the good.
BIP Capability Key to Modernization of Systems
A critical design goal described in the plan is achieving a modular
architecture, in which different functions are maintained separately
and loosely coupled via Application Programing Interfaces (APIs). A
mature BIP is critical to this goal because it allows for such
capabilities as including, adding, or replacing individual modules
without rebuilding the entire system.
In a modern design, an updated module can be replaced while the
system is running. A module could be replaced and reverted to the older
version if necessary. In fact, BIP could allow for two modules that
perform the same task. The updated module would be installed and
initially given a small percentage of the workload (after having been
properly tested) and evaluated for compliance with requirements.
Gradually, it would replace the original version.
BIP also supports the principle of ``build once, use many.'' For
example, the plan appears to suggest there are different exam
scheduling functions in the Veterans Benefits Management System (VBMS).
A single module supporting the different requirements would be
implemented and interconnected appropriately using the BIP. Therefore,
the maturity and migration of functions to use the BIP should be
closely watched as an implementation and risk-reduction metric.
Data Centers, Testing Infrastructure, and the Cloud
Supporting geographically dispersed data centers is a key principle
of resiliency. A related challenge is testing new modules in the
context of a complete system, introducing them to production, and
reverting to the original versions if required. The complexity of
supporting identical hardware stacks in two locations depends on the
extent to which legacy hardware is still required. The desired end
State is to have 100 percent cloud hardware to simplify management of
identical hardware stacks. Cloud implementations also provide for rapid
scaling to add capacity when needed and remove it when no longer
needed.
The plan proposes two similar investments: two widely separated
data centers (East and West) for normal operations and resiliency, and
a separate Blue/Green testing/deployment infrastructure. According to
the Blue/Green concept, one color is the live version, and the other is
the test version, in which new functionality is introduced. The roles
of the two systems are switched, and the new functionality is put into
production. If there is an issue, the roles are reversed, and
functionality reverts to the prior state.
Software testing has multiple levels, and the most complex is
automated testing of the entire system from an end-user perspective.
However, modular architecture involving software modules with tightly
defined interfaces reduces the need for a separate system-wide testing
infrastructure. The dual module configuration discussed above would
allow for new modules to be put in the production environment and
initially released to a small group of users for evaluation.
One reason that a full-sized testing environment was used in the
past is that it could evaluate capacity and performance. In a cloud-
based world, performance and capacity are managed by increasing the
power or number of instances of a function that is constraining system
capacity. A smaller but identical test environment can be created as
needed in a cloud environment.
Being fully cloud-ready involves two aspects: First, all of the
system functionality, management, and security is running on cloud
instances of hardware. This transfers the responsibility for hardware
reliability and availability to the cloud provider. Second, VBMS and
related software has been decomposed into independent modules
interconnected by APIs over the BIM. The modules would allow for
multiple instances to run simultaneously, allowing for scaling up and
down for performance and capacity reasons.
Conclusion
The Veterans Administration has submitted a detailed and well-
thought-out plan. However, the challenge of rapidly implementing
significant improvements with increased processing accuracy to serve
veterans also requires cultural change.
When the system development process is long and subject to delays,
the tendency is to add everything possible into the plan because it is
the only opportunity for many years. Requirements can change or become
obsolete, or the business side can develop its own workarounds during a
multi-year development cycle, which reduces the value to the enterprise
of the new software. In the worst-case scenario, the new release is
obsolete upon arrival.
An agile development methodology also requires cultural change for
both the IT and business sides to implement a new way of working
together. It requires changes to the procurement process and
requirements for effective implementation. In the short term,
identifying specific areas where an agile approach can be implemented
to improve the veteran experience sooner rather than later is
essential. This will build human capacity and mature the Veterans
Administration's internal capacity in this area.
[all]