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Mrs. Maureen EllenbergerExecutive Director, Veterans Relationship Management Program Management OfficeVeterans Benefits Administration
FY 14-15: Agency Priority Goal
Improve Veteran Virtual Access to VA Benefits and Services
Priority Goal
Goal Overview
VA’s focus in Fiscal Year (FY) 2015 is to deliver seamless and integrated services while increasing the efficiency and effectiveness of virtual access. To achieve the best possible outcomes for Veterans, Servicemembers, and eligible beneficiaries, VA will improve access to, and encourage the use of, its virtual benefits and services. VA and Department of Defense (DoD) have established a jointly supported portal known as eBenefits, which allows Veterans, Servicemembers, and other eligible beneficiaries to access and submit information when, where, and how they want.
The development and proliferation of virtual access to care supports an organizational approach that is personalized, proactive, and patient-driven. VA virtual health services use technology and health informatics to provide Veterans with better access and more effective care management. Advances in virtual care expand where health care services can be accessed, reduce the need for travel to medical facilities, and transform VA’s delivery of health care and its effect on patients’ health outcomes.
Strategies
Self-service technology-enabled interactions provide access to information and the ability to execute transactions when, where, and how the client desires. eBenefits is an important virtual point of entry for clients to access their benefits and services. VA will seek to increase the number of eBenefits users, which will directly improve Veterans’ access to their benefit information. Improving the capabilities for managing benefit processes electronically will facilitate Veterans improving their access and timeliness of transactions.
VA experience shows that electronic transactions are more complete, accurate and help expedite VA processing of benefit claims and information inquiries. VA will encourage Veterans to utilize electronic transactions as part of our transformation from a paper based claims system to an electronic environment. In cases where Veterans do not have virtual access, VA will encourage them to work in partnership with a Veterans advocate, such as a Veterans Service Organization, who does have electronic access via the Stakeholder Enterprise Portal (SEP). As part of this overall strategy, VA will seek to increase the number of Veterans advocates who are registered users of the SEP.
Improving Veteran and Veteran advocate utilization of electronic transactions will also support VA’s initiative to increase the number of fully developed claims submitted, which will improve processing time and facilitate reduction in the disability claims backlog.
VA is introducing business process improvements, coupled with the latest technologies, to improve Veterans’ access to benefits and services.
Over the next two fiscal years, focus will be placed on increasing the percent of disability compensation claims received electronically through aggressive marketing, converting more applications into electronic format, and deploying Digit-to-Digit (D2D) functionality which will allow VSOs, County VSOs (CVSO) and State Veteran Affairs agencies with their own claims management system to directly submit electronic compensation claims into Veterans Benefits Management System (VBMS). This machine-to-machine interaction will benefit the Veteran by accelerating the speed in which claims are filed and, benefit VSOs, CVSOs and State agencies by allowing them to leverage their current investment in claims management systems and reduce the need to print and mail information to VA.
eBenefits will aim at increasing its registered user base by introducing additional functionality which will increase access to benefits and personal information; expanding awareness of services and benefits available through the online transition assistance training and health benefits eligibility tools; and implementing secure messaging and prototype mobile applications that will enable user access to benefits information and responses from healthcare providers.
SEP will focus on reaching out to Veterans to partner with an advocate who has access through SEP to file claims electronically for expedited processing; continued training for VSOs, CVSOs and State Veteran Affairs agencies; and conducting additional requirement sessions with our VSO partners to continually enhance the user experience. While SEP is currently limited to VSOs who hold Power of Attorney (POA) authorization for specific Veterans, plans include extending user capabilities to attorneys and agents who represent veterans.
Virtual health care services in VA help ensure patients receive effective care in the right place at the right time whenever possible and appropriate. VA is enhancing the quality, accuracy, efficiency, and timeliness of information exchanges and care delivery to facilitate virtual access to information and services. Expansion of virtual health care services will greatly improve access for Veterans located in rural and remote areas and those who have limited ability to travel to a VA medical facility. Virtual care options include:
Home Telehealth – allows for remote monitoring of vital signs of patients with chronic conditions (hypertension, diabetes, etc.), which can help them to remain at home and live independently.
- Secure Messaging – allows secure online communications between patients and their health care provider.
- E-consults – provides specialty care consultation through review of a patient’s electronic medical record, which can eliminate the need for a face-to-face appointment or better prepare a Veteran/provider for a face-to face visit with a specialist.
- Clinical Video Telehealth – allows a patient at a remote site (Community Based Outpatient Clinic) to access specialty care/consultation from a VA hospital or medical center via video teleconference.
Initiatives supporting increasing the percent of patients who use VA virtual care include:
- Enabling Veterans to communicate with their health care provider using video connections rather than traveling to meet in person.
- Providing additional health care services, including mental health services, via home telehealth and mobile technologies.
- VA will continue development of additional virtual capabilities and applications that expand the range of services Veterans can receive via electronic means. Other capabilities that will improve access include:
- Implementing patient-facing applications to support disease management.
- Establishing applications that give patients the ability to develop a pre-visit agenda and post-visit follow-up plan.
- Developing personal health profiles and personal health plans online for use by patients and providers.
- Establishing the capability to apply for an education certificate of eligibility electronically.
- Obtaining life insurance benefits and updating beneficiaries electronically.
- Improving electronic access to Federal employment search and application services.
- Providing access to comprehensive electronic information about VA and Department of Defense (DoD) facilities.
- Offering an online “preliminary evaluation” of burial needs by verifying electronically military service and eligibility prior to the time of need.
Progress Update
Electronic Claims Filing: As of September 30, 2015, the percentage of disability compensation claims received electronically by VA grew to 12.5 percent; an increase of 1.3 percentage points over the third quarter of FY 2015. While the cumulative percentage for the fiscal year is below target, progress is being made, as demonstrated by a peak of 16.2 percent in the month of August 2015. During the fourth quarter FY 2015, 40,867 compensation claims and 42,789 dependency claims were submitted electronically.
eBenefits: As of September 30, 2015, the eBenefits portal has 5,160,568 registered users. Since June 30, 2015, 247,969 new individuals obtained access to eBenefits. This represents a 5-percent increase. eBenefits met and exceeded the target for this quarter.
SEP: SEP has 3,299 Veterans Service Organization (VSO) representatives registered as of September 30, 2015, representing 90 unique organizations.
Since June 30, 2015, 600 new individuals obtained access to SEP. This represents a 22.2 percent increase over the previous quarter. VSOs, attorneys, and claim agents are actively submitting claims electronically on behalf of claimants via SEP. The SEP electronic claim receipts target is 2.2 percent of the overall 20-percent goal for FY 2015 electronic claim receipts. During this reporting period, electronic claim receipts via SEP grew to 3 percent, exceeding the goal of 2.2 percent.
Virtual Care Measure (VCM): As of September 30, 2015, the Veterans Health Administration (VHA) had a combined total of 2,297,473 individuals accessing care using a virtual format. This is a 3.44 percent increase over third quarter FY 2015 and exceeds the 35 percent target for fourth quarter FY 2015. VHA exceeded the FY 2015 overall goal of 35 percent by 4.63 percent. VCM covers a number of tools, such as: Home Telehealth, Secure Messaging, and electronic consults (e-consult). Secure messaging makes up the greatest portion of VCM users, giving Veterans instant access to their health care team. Telehealth is the next most frequent VCM used within VA, providing convenient care to Veterans directly in their homes and communities.
Specialty Care Services (SCS) currently provides consultation on one component in VCM. Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) is an initiative for ongoing education and training for primary care providers (PCP), as well as a means to provide virtual, clinical consultation without the patient present. PCPs present cases to a team of specialty care clinicians. These case presentations are usually submitted as a consult; this component of SCAN-ECHO is counted in the VCM. However, the overarching goal of this program is to increase the knowledge and skills of PCPs and their teams to provide increased care in community-based outpatient clinics (CBOCs), particularly those in rural areas where specialty input would require travel or follow up with non-VA clinicians, which could decrease continuity and care coordination. Over time, PCPs will increase their capacity to care for patients with complex medical conditions in local CBOCs. This aspect of SCAN-ECHO is not a component of the VCM. This initiative now exists in 34 medical and surgical specialty areas and is coordinated between SCS, Rural Health, and other VHA partners to provide education, consultation, and clinical support to PCPs and their teams through video-teleconferencing (v-tel). While neither e-consult nor SCAN-ECHO has a specific FY 2015 goal, both programs contribute to the overall VCM.
In FY 2015, SCAN ECHO held 417 clinics, involving 834 total presentations. E-consults have transitioned to field and clinical operations sustainment. Management of e-consults is completely field based and impacted by consult policy developed through the Access and Clinic Administration Program. In FY 2015, e-consults averaged 17.60 percent of all similar consult request responses in the same locations and services. In FY 2015, 577 new e-consults clinics were initiated in 56 different specialties and 431 were infacilities receiving support. In total, 504,881 e-consults were completed in FY 2015.
Secure Messaging (SM): As of September 30, 2015, My HealtheVet has 3,359,494 registrants marking a 12 percent increase to the fiscal year baseline and exceeding the end of fiscal year target of 10 percent. As of September 30, 2015, My HealtheVet has 1,643,769 patients who opted in for SM, marking a 50 percent increase to the FY 2015 baseline and exceeding the end of fiscal year target of 35 percent.
VA Telehealth Programs: VA Telehealth Programs continue to expand and are a priority in the Department's commitment to increasing access to care for Veterans, especially in rural and remote locations.
In FY 2015, 6,300 Veterans accessed VA care directly from their homes via Clinical Video Telehealth (CVT). This represents a growth of more than 2,000 Veterans or 50 percent over that which was achieved in FY 2014. During FY 2015, Telemental Health CVT provided 20,500 encounters into the home to more than 3,400 Veterans; this represents an 84 percent growth of encounters provided to 77 percent more Veterans compared to FY 2014. As they did last year, Veterans can continue to use this service to access their VA healthcare team through webcams, personal computers, laptop computers, and iPad tablets. Additionally, Telehealth Services continues to distribute CVT Tablets (please see CVT Tablets section below) with peripheral clinical devices (e.g., stethoscope, pulse oximeter, blood pressure cuff, thermometer) to Veterans who need these technologies at home to connect to their VA care team via CVT.
- Mental Health via CVT expanded access to an additional 13,900 Veterans (13 percent increase) in FY 2015. A total of 122,700 Veterans were able to access Mental Health via CVT during FY 2015.
- The National TeleMental Health Center had 651 uniques with 2,912 encounters, compared to 698 uniques and 3,615 encounters for all of FY 2014.
- CVT Transplant evaluations have increased from 180 uniques with 317 encounters in all of FY 2014 to EOFY 2015 of 337, uniques with 382 encounters at the end of FY 2015.
- Genomic medicine encounters have increased to 2,084 uniques with 2,133 encounters compared to 1,825 uniques and 1,871 encounters in FY 2014.
Telehealth Services and the Office of Rural Health responded to Section 204, the “Mobile Medical Center” portion of the Veterans Choice legislation to ensure that telemedicine capacity is available on all mobile medical units (and mobile Vet Centers). The Telemedicine Assessment subgroup, which became an Integrated Process Team (IPT), completed the survey and summary report in response to the legislation during the fourth quarter. The report defines procedures for activation, management, and operation of mobile medical units. Upon submission of the summary report, the IPT transitioned the project to the Deputy Under Secretary for Operations and Management for maintenance and concluded its activity.
During FY 2015, VHA and the Offices of Information Technology (OIT) provided five Veterans Integrated Service Networks (VISN) 15 Medical Centers with the capability for live CVT interactive consults with ICU specialists in VISN 23, as well as seven VISN 7 Medical Centers and one VISN 4 Medical Center linked to the VISN 10 Tele-ICU support center. VISN 23 now supports 172 beds at 14 facilities and VISN 10 supports beds 123 and 12 facilities, for a national total of 295 Tele-ICU beds for VHA. The Joint Initiative Funding (JIF) collaboration with Department of Defense includes the installation of five DOD sites and two VISN 15 sites linked to the VISN 23 Tele-ICU support center in the next 24 months.
Telehealth Services has a collaborative agreement and completed the official charter with Special Care Services. The subject matter expert groups have started work on operations manuals, guidance documents, and training for TeleEndocrinology; TeleHematology/Oncology; and TeleInfectious Disease. TelePain and TeleEndorinology are pending charters and identification of SMEs.
Since June 2014, the web-enabled application that permits Veterans to access Home Telehealth (HT) care and case management services from their VA clinical care coordinator using the Veterans own PCs, laptops, and smartphones was released nationally. At the end of FY 2015, there were 3,216 Veterans enrolled across all VISNs.
The Low Intensity/Low Acuity (L2) pilot uses web-enabled technologies for health promotion and disease prevention for stable patients. Enrollment of L2 Veterans began September 1, 2015, with over 123 Veterans enrolled within the first month. In addition, seven new L2 Disease Management Protocols (DMPs) have been developed, and reviewed with the subject matter expert. Two of these, Weight Management and Tobacco Cessation, have been programmed and implemented by the vendor. The remaining five DMPs should be released by end October 2015. Five separate workgroups have completed their projects resulting in the completion of the DMPs, new L2 Documentation Templates were written, installed and in use, new training guidance, a comprehensive outreach marketing toolbox was developed, and a draft L2 Handbook has been composed. Three new work groups have formed to complete the enrollment targets and project timeline, outcome measures, and the pilot evaluation tool. Each site continues to meet with their local L2 Integrated Project in collaboration with Patient Aligned Care Team. The project goal for end FY 2016 is to have at least two Care Coordinators at each site at a panel size of 400 per Care Coordinator for a total of 2,000 patients across the five sites, and a completion of any revisions to the DMPs, templates, and operations manual, as well as a pilot evaluation summary.
Collaboration between Women’s Health and Telehealth has continued and the two services agreed upon the following position. Considering both medical appropriateness, and sensitivity to our patients, CVT may not be optimal if a visit requires a pelvic exam and has the potential need for immediate intervention. It is generally recommended that pelvic exams and colposcopy procedures be completed via an in-person visit with a provider. In a situation where there is a need to perform these exams using telehealth technology, the telepresenter should be a provider proficient in these aspects of the physical exam. In circumstances in which pelvic exams and colposcopy are necessary using telehealth technology, an interim packet with all required documents, including travel distances for in person examination and explanation why this particular location is unable to provide these examinations through a faceto- face visit with a provider must be submitted to Telehealth and Women’s Health Services. No examinations can be performed until interim packets are reviewed and Telehealth and Women’s Health Services provide the authorization for initiation of these services.
The OIT project team completed their review of the technology with regard to expanded use across the VA enterprise and issued a final project analysis paper. Although the summary indicates that OIT infrastructure currently exists to facilitate expanded use, the information technology management system will require improvements and a formal New Project Request will be needed to continue expansion. Also, due to recent funding limitations VA is unable to acquire new tablets for distribution to patients. VHA Telehealth Service has initiated a request to the Denver Acquisition and Logistics Center to form an integrated process team to advance an effort to develop a new competitive solicitation with the intent of engaging additional vendors and ensuring that market forces provide the best cost for the technology.
A memo from the Deputy Under Secretary for Health for Operations and Management was issued in July 2015, and later revised in October, that required all VISNs not yet in active deployment status to complete the Telehealth Scheduling System (TSS) deployment by November 30, 2015. Currently, the total number of systems users has expanded to 13,736. To date, 17,363 telehealth service activities have been scheduled in the system. The two primary tasks currently being addressed are: an upgrade to Microsoft CRM 2015 to address 508 compliance, and integration with VistA, which is dependent on the VA Medical Appointment Scheduling System deployment timeline.
Next Steps
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Performance Indicators
Percent of disability compensation claims received virtually/electronically
Number of accredited Veterans advocates who are registered users on the Stakeholder Enterprise Portal
Number of Registered eBenefits Users
Percent of patients who access VA health care using a virtual format
Contributing Programs & Other Factors
External contributing partners outside the agency: Department of Defense, Social Security Administration, Department of Housing and Urban Development, Department of Labor, Department of Health and Human Services and private sector healthcare providers.
Internal contributing programs within the agency: Veterans Relationship Management Program, Benefits Assistance Service, Compensation Service, Office of Performance Analysis & Integrity, Clinical Operations, Patient Care Services, Informatics and Analytics.
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Strategic Goals
Strategic Goal:
Empower Veterans to Improve Their Well-being
Statement:
Empower Veterans to Improve Their Well-being
Strategic Objectives
Statement:
Improve Veteran Wellness and Economic Security
Description:
Summary:
Numerous programs provide a broad spectrum of benefits and support services that assist Veterans and eligible beneficiaries. To enable Veterans and eligible beneficiaries to choose the best benefits and services for their needs, VA will improve coordination between our programs, leverage supportive interactions between programs, and reduce overlap across programs. Success will be measured by the differences made in the lives of the Veterans we serve, including decreasing Veteran unemployment, decreasing home foreclosures, decreasing homelessness, reducing processing times for disability compensation claims, increasing preventive care and healthy lifestyle changes, and increasing access to and utilization of virtual care modalities.
Strategies:
VA will eliminate Veteran homelessness by the end of FY 2015. VA, in collaboration with its Federal partners, will continue to provide rehabilitation services for homeless and at-risk Veterans, including employment assistance, access to permanent and transitional housing, and other supportive services. As the number of homeless Veterans continues to decline, the focus will shift from rescue to prevention.
VA will improve Veteran career readiness to reduce Veteran unemployment. We will synchronize and align Veteran employment programs managed by VA, and improve coordination across the various Federal Veteran employment initiatives. We will increase support to our Veterans with disabilities and those who are GI Bill eligible through programs offering educational and vocational counseling. VA will increase support to Veteran entrepreneurs through public-private partnerships to provide capacity building and by providing access to Federal contracting opportunities.
VA will provide Veterans and eligible beneficiaries with personalized, proactive, patient-driven health care to optimize health and well-being, while providing state-of-the-art disease management. VA’s Patient Aligned Care Teams (PACT) will ensure patient engagement in self-care, preventive services, primary care, and mental health services. PACT is a partnership between the Veteran and the health care team with an emphasis on prevention, health promotion, and self-management. PACTs use a team-based approach, with various members of the team stepping in at different points in time to provide needed care. We will expand and refine, in coordination with DoD, research into the long-term consequences of TBI and PTSD. VA will increasingly seek to understand underlying health, injury and disorder mechanisms to create evidence-based diagnosis, treatment, and rehabilitation methods for Veterans and eligible beneficiaries with support from their families.
Statement:
Increase Customer Satisfaction through Improvements in Benefits and Services Delivery Policies, Procedures, and Interfaces
Description:
Summary:
VA is a customer service organization. Complicated application processes, long processing timelines or difficulties getting information and appointments all impact the client’s experience and satisfaction. Veterans and eligible beneficiaries deserve a support system that is responsive to their needs. VA must keep pace with Veterans’ expectations and transform its customer services – soliciting regular customer feedback, streamlining processes, and delivering consistent service across customer-preferred channels.
We live in a connected world. The rapid pace of technological advancement is reshaping Veterans’ expectations regarding how services, benefits, and support should be delivered. Today’s client expects instant access to information and self-service options via the Internet, and increasingly through mobile devices like tablets and smartphones (and the next generation “smart” devices that are yet to be deployed).
To provide a personalized experience, we must listen, learn, and understand the needs and expectations of those we serve. We must have the knowledge, information and insight to understand why some choose not to fully engage with VA.
Strategies:
VA will provide timely, accurate decisions on Veterans’ disability claims and eliminate the claims backlog. We will then implement a robust plan, and revisit procedures to ensure claims are addressed in no more than 125 days with at least 98 percent accuracy. The plan includes redesigning policies and procedures, continuing to enhance training for claims processors, and utilizing the most advanced IT. We will also increase the use of video teleconference hearings to address claims appeals.
VA will continue to expand implementation of PACT to improve partnerships with Veterans and eligible beneficiaries, increase team-based care coordination and management, and expand access to care. VA will improve patient-facing and clinician-facing e-health systems by expanding the development and use of health-related virtual modalities. These modalities include telehealth[1], E-Consult[2], secure messaging, MyHealtheVet, and mobile applications.
VA will enhance client satisfaction by capturing client data once, sharing it enterprise-wide, and using this client data for a lifetime, which will promote more efficient use of data across business lines. We will identify sources of consistent, reliable, and authoritative Veteran data. We will establish architecture, business rules, roles and responsibilities, and governance to enable VA lines of business to use the authoritative common client data to improve delivery of benefits and services to Veterans. VA will gain access to additional external data, knowledge, and experiences so we can broaden our understanding of our client’s needs and expectations. We will enable secure, privacy-protected electronic exchange of personal, health, and economic data on Veterans from induction oath through the final survivor benefit.
VA will rethink its operations as a Department, defining the fundamental crosscutting capabilities and interdependencies required to perform them. We will identify and address any internal organizational, policy, procedural, perceptual, and cultural boundaries that constrain our ability to coordinate, integrate, and deliver benefits and services.
VA will streamline its virtual presence (Web sites, portals and call centers), reducing duplication and enhancing personalization to enable clients to get the information they need, on their schedule.
VA will increase access to burial benefits in national cemeteries through its plans to construct five new national cemeteries and by recognizing and addressing the unique needs of Veterans and eligible beneficiaries who reside in densely populated urban areas as well as sparsely populated rural locations. We will ensure that the service and appearance of our national cemeteries meets the highest standards commensurate with these national shrines.
[1] Telehealth uses information and telecommunication technologies to provide health care services in situations in which the patient and practitioner are separated by geographical distance. Telehealth in VA increases access to high quality health care services using Clinical Video Telehealth (CVT), Home Telehealth (HT) and Store and Forward Telehealth (SFT).
[2] E-Consult is an approach to provide clinical support from provider to provider. Through a formal consult request, processed and documented in the Computerized Patient Record System, a provider requests a specialist to address a clinical problem or to answer a clinical question for a specific patient. Utilizing information provided in the consult request and/or review of the patient’s electronic medical record, the consultant provides a documented response that addresses the request without a face-to-face visit.
Agency Priority Goals
Statement:
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Improve client and stakeholder awareness of, and access to, Veterans benefits and health care services. By September 30, 2015, VA will increase the use of virtual service options by increasing the percent of claims received electronically, by increasing the number of accredited Veterans service officers registered on the Stakeholder Enterprise Portal, by increasing the number of registered eBenefits users, and by increasing the percent of patients who access VA health care using a virtual format such as video telehealth or online services.
Indicators:
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Description:
VA’s focus in Fiscal Year (FY) 2015 is to deliver seamless and integrated services while increasing the efficiency and effectiveness of virtual access. To achieve the best possible outcomes for Veterans, Servicemembers, and eligible beneficiaries, VA will improve access to, and encourage the use of, its virtual benefits and services. VA and Department of Defense (DoD) have established a jointly supported portal known as eBenefits, which allows Veterans, Servicemembers, and other eligible beneficiaries to access and submit information when, where, and how they want.
The development and proliferation of virtual access to care supports an organizational approach that is personalized, proactive, and patient-driven. VA virtual health services use technology and health informatics to provide Veterans with better access and more effective care management. Advances in virtual care expand where health care services can be accessed, reduce the need for travel to medical facilities, and transform VA’s delivery of health care and its effect on patients’ health outcomes.
Statement:
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Improve accuracy and reduce the time it takes to complete disability compensation benefit claims. Eliminate the disability claims backlog and process all claims in 125 days in FY 2015.
Indicators:
* VA is in the midst of reviewing its claims processing accuracy metrics and goals to ensure VA continues to drive decisions of the highest quality. VA plans to engage its VSO partners and other stakeholders as more information becomes available. |
Description:
VA will provide timely, accurate decisions on Veterans’ disability compensation and eliminate the claims backlog in Fiscal Year (FY) 2015. Improving quality and reducing the length of time it takes to process disability claims are integral to VA's mission of providing benefits to eligible Veterans in a timely, accurate, and compassionate manner. In FY 2013, VBA began measuring the accuracy of individual issues for each claim (“issue-based accuracy”), as it provides a more detailed measure of workload proficiency. However, VBA will continue to monitor and report out on claim-based accuracy as a key indicator for this Agency Priority Goal. To improve benefits delivery, VA is transitioning to an electronic claims process that will reduce processing time and increase accuracy. As of the end of June 2015, over 94 percent of VBA’s inventory is in an electronic format and is being processed electronically by VBA employees using the Veterans Benefits Management System (VBMS). All claims are either received electronically or are converted to electronic format for processing.
Statement:
In partnership, the Department of Housing and Urban Development (HUD) and VA aim to reduce the number of Veterans living on the streets, experiencing homelessness to zero (as measured by the FY 2016 PIT Count).
Indicators:
- Reduction in homeless Veterans living on the streets, experiencing homelessness to zero (as measured by the FY 2016 PIT Count).
- The “Number of Homeless Veterans” on a single night is determined by the PIT Count, which is conducted annually the last week of January each year “The PIT Count reflects the results of the work performed and the fiscal obligation/budget made in the prior fiscal year.”
- Reduction in total homeless Veterans temporarily living in shelters or transitional housing to 12,500 (as measured by the FY 2016 PIT Count).
Description:
VA has taken decisive action toward its goal of ending homelessness among Veterans. The End Veteran Homelessness initiative is intended to prevent Veterans and their families from entering homelessness and to assist those who are homeless in exiting as safely and quickly as possible. VA’s “no wrong door” philosophy will ensure that homeless and at risk for homeless Veterans have timely access to appropriate housing and services. Any door a Veteran comes to - at a medical center, a regional office, or a community organization - will lead to the tools to offer Veteran assistance. Ending homelessness among Veterans will advance the mission of VA by ensuring that all Veterans and their families achieve housing stability.
On a single night in January 2014 during the Point in Time (PIT) Count [1], there were 49,933 homeless Veterans in the US. Effectively ending homelessness among Veterans requires rapid access to permanent housing, health care, employment, benefits, and other supportive services. VA works closely with community partners to meet current and new demands for any Veteran who is experiencing or is at imminent risk of homelessness. Housing First and Rapid Re-housing are two of the many evidence-based approaches VA uses to end homelessness. The Housing First model follows the philosophy of providing permanent housing as quickly as possible to Veterans/individuals experiencing homelessness and then wrapping health care and other supportive services as needed around the Veteran to sustain housing and improve their quality of life. Rapid Re-housing is a set of strategies to help families quickly move out of homelessness and into permanent housing. It typically involves: housing search and landlord mediation assistance, short-term or flexible rental assistance, and transitional case management services. Rapid Re-housing provides crisis intervention services to quickly place an individual or family who is currently homeless into a permanent, sustainable housing situation.
[1] The annual PIT estimates are a snapshot of homelessness. They are submitted to HUD each year by communities and account for homeless Veterans in emergency shelters or transitional housing on the night of the PIT count (i.e., sheltered) as well as homeless Veterans who are in places not meant for human habitation such as the streets, abandoned buildings, cars, or encampments (i.e., unsheltered). Communities typically conduct their PIT count during the last week in January when a large share of the homeless population is expected to seek shelter rather than stay outside. Because counting people in shelters is more precise than conducting street counts, the timing of the PIT count is intended to improve the accuracy of the estimates. (Source: Veteran Homelessness: A Supplemental Report to the FY 2010 Annual Homeless Assessment Report to Congress).
Strategic Objectives
Strategic Objective:
Statement:
Increase Customer Satisfaction through Improvements in Benefits and Services Delivery Policies, Procedures, and Interfaces
Description:
Summary:
VA is a customer service organization. Complicated application processes, long processing timelines or difficulties getting information and appointments all impact the client’s experience and satisfaction. Veterans and eligible beneficiaries deserve a support system that is responsive to their needs. VA must keep pace with Veterans’ expectations and transform its customer services – soliciting regular customer feedback, streamlining processes, and delivering consistent service across customer-preferred channels.
We live in a connected world. The rapid pace of technological advancement is reshaping Veterans’ expectations regarding how services, benefits, and support should be delivered. Today’s client expects instant access to information and self-service options via the Internet, and increasingly through mobile devices like tablets and smartphones (and the next generation “smart” devices that are yet to be deployed).
To provide a personalized experience, we must listen, learn, and understand the needs and expectations of those we serve. We must have the knowledge, information and insight to understand why some choose not to fully engage with VA.
Strategies:
VA will provide timely, accurate decisions on Veterans’ disability claims and eliminate the claims backlog. We will then implement a robust plan, and revisit procedures to ensure claims are addressed in no more than 125 days with at least 98 percent accuracy. The plan includes redesigning policies and procedures, continuing to enhance training for claims processors, and utilizing the most advanced IT. We will also increase the use of video teleconference hearings to address claims appeals.
VA will continue to expand implementation of PACT to improve partnerships with Veterans and eligible beneficiaries, increase team-based care coordination and management, and expand access to care. VA will improve patient-facing and clinician-facing e-health systems by expanding the development and use of health-related virtual modalities. These modalities include telehealth[1], E-Consult[2], secure messaging, MyHealtheVet, and mobile applications.
VA will enhance client satisfaction by capturing client data once, sharing it enterprise-wide, and using this client data for a lifetime, which will promote more efficient use of data across business lines. We will identify sources of consistent, reliable, and authoritative Veteran data. We will establish architecture, business rules, roles and responsibilities, and governance to enable VA lines of business to use the authoritative common client data to improve delivery of benefits and services to Veterans. VA will gain access to additional external data, knowledge, and experiences so we can broaden our understanding of our client’s needs and expectations. We will enable secure, privacy-protected electronic exchange of personal, health, and economic data on Veterans from induction oath through the final survivor benefit.
VA will rethink its operations as a Department, defining the fundamental crosscutting capabilities and interdependencies required to perform them. We will identify and address any internal organizational, policy, procedural, perceptual, and cultural boundaries that constrain our ability to coordinate, integrate, and deliver benefits and services.
VA will streamline its virtual presence (Web sites, portals and call centers), reducing duplication and enhancing personalization to enable clients to get the information they need, on their schedule.
VA will increase access to burial benefits in national cemeteries through its plans to construct five new national cemeteries and by recognizing and addressing the unique needs of Veterans and eligible beneficiaries who reside in densely populated urban areas as well as sparsely populated rural locations. We will ensure that the service and appearance of our national cemeteries meets the highest standards commensurate with these national shrines.
[1] Telehealth uses information and telecommunication technologies to provide health care services in situations in which the patient and practitioner are separated by geographical distance. Telehealth in VA increases access to high quality health care services using Clinical Video Telehealth (CVT), Home Telehealth (HT) and Store and Forward Telehealth (SFT).
[2] E-Consult is an approach to provide clinical support from provider to provider. Through a formal consult request, processed and documented in the Computerized Patient Record System, a provider requests a specialist to address a clinical problem or to answer a clinical question for a specific patient. Utilizing information provided in the consult request and/or review of the patient’s electronic medical record, the consultant provides a documented response that addresses the request without a face-to-face visit.
Agency Priority Goals
Statement: Improve Veterans Experience with VA: Fulfilling our country’s commitment to Veterans, VA will deliver effective and easy customer experiences in which Veterans feel valued. By September 30, 2017, reach 90% agreement with the statement “I trust VA to fulfill our country’s commitment to Veterans.” Because this is a new measure, VA will establish the baseline in FY16 and add the measure to surveys covering all of VA’s primary services and product lines.
Description: VA offers a remarkable array of services and benefits to Veterans and eligible dependents. But the experience is disjointed and inconsistent. There are hundreds of phone numbers and thousands of websites, each operating independently under different standards. Similarly, there are a wide array of VA and non-VA resources at the Federal, state, local, corporate, non-profit and tribal level that are not coherently organized or coordinated into a single source or reference point for the Veteran. Veterans deserve better and so do VA staff, who care deeply about delivering the best possible outcome for Veterans. The Veterans Experience team is leading a powerful new effort to improve customer experiences across VA, nationwide. Our goal: Fostering the delivery of effective and easy customer experiences in which Veterans feel valued. We are achieving this goal the same way the world’s most successful companies do: by listening to our customers – Veterans, their families and supporters – when they describe how they want things to work. Equally important, we are listening to our employees about obstacles to excellence on-the-job. Employee empowerment is an essential part of the equation. This is user-centered design. It puts Veterans and the employees who serve them front and center. VA and the Veterans Experience team face a number of challenges and barriers: The APG will track our ability to overcome these barriers by implementing the strategies described in the next section. To build trust among our customers, VA must consistently deliver customer experiences marked by effectiveness, ease, and engagement.[1] To ensure comparability across VA’s disparate service and product lines, the same measures of Trust and Customer Experience will be applied. Trust VA earns trust among Veterans by knowing them and showing that we care; by understanding and anticipating their needs; by providing fair benefits and timely services; by being there when they need us; and by keeping our promises. With every interaction, VA has the opportunity to deepen a trusting relationship with Veterans, or to diminish that trust. Our Agency Priority Goal states: By September 30, 2017, VA will reach 90% agreement with the statement “I trust VA to fulfill our country’s commitment to Veterans.” Timeline: Q1 FY16: Trust and Experience measures incorporated into existing customer experience surveys Q2 FY16: Baseline data collection begins Q3 FY16: Baseline measurement established; quarterly targets specified Q4 FY 2016: Publish quarterly update Q1 FY 2017: 70 percent of VA customers surveyed ‘agree’ or ‘strongly agree’ with Trust statement Customer Experience Q2 FY 2017: 75 percent of VA customers surveyed ‘agree’ or ‘strongly agree’ with Trust statement Customer Experience Q3 FY 2017: 80 percent of VA customers surveyed ‘agree’ or ‘strongly agree’ with Trust statement Customer Experience Q4 FY17: 90% of VA customers surveyed ‘agree’ or ‘strongly agree’ with Trust statement Customer Experience Trust in VA is built one interaction at a time. The experience must be effective; it must be easy; and, ideally, it must be engaging and reflective of a valued, personal relationship with our customer. Trust is broken when VA does not consistently meet expectations in these three categories. VA will use customers’ ratings of their individual experiences as indicators of performance toward the overall Veterans Experience APG. The measures will include level of agreement with questions such as: These measures are also new, and will be implemented along the timeline for the Trust measure indicated above. They will be added to new and existing VA customer experience surveys where responses will be correlated with operational data to highlight performance improvement opportunities that will improve Veterans experiences. [1] Adopted from the Forrester Research customer experience framework.
Statement: Indicators:
Improve client and stakeholder awareness of, and access to, Veterans benefits and health care services. By September 30, 2015, VA will increase the use of virtual service options by increasing the percent of claims received electronically, by increasing the number of accredited Veterans service officers registered on the Stakeholder Enterprise Portal, by increasing the number of registered eBenefits users, and by increasing the percent of patients who access VA health care using a virtual format such as video telehealth or online services.
Description: VA’s focus in Fiscal Year (FY) 2015 is to deliver seamless and integrated services while increasing the efficiency and effectiveness of virtual access. To achieve the best possible outcomes for Veterans, Servicemembers, and eligible beneficiaries, VA will improve access to, and encourage the use of, its virtual benefits and services. VA and Department of Defense (DoD) have established a jointly supported portal known as eBenefits, which allows Veterans, Servicemembers, and other eligible beneficiaries to access and submit information when, where, and how they want. The development and proliferation of virtual access to care supports an organizational approach that is personalized, proactive, and patient-driven. VA virtual health services use technology and health informatics to provide Veterans with better access and more effective care management. Advances in virtual care expand where health care services can be accessed, reduce the need for travel to medical facilities, and transform VA’s delivery of health care and its effect on patients’ health outcomes.
Statement: Indicators: * VA is in the midst of reviewing its claims processing accuracy metrics and goals to ensure VA continues to drive decisions of the highest quality. VA plans to engage its VSO partners and other stakeholders as more information becomes available.
Improve accuracy and reduce the time it takes to complete disability compensation benefit claims. Eliminate the disability claims backlog and process all claims in 125 days in FY 2015.
Description: VA will provide timely, accurate decisions on Veterans’ disability compensation and eliminate the claims backlog in Fiscal Year (FY) 2015. Improving quality and reducing the length of time it takes to process disability claims are integral to VA's mission of providing benefits to eligible Veterans in a timely, accurate, and compassionate manner. In FY 2013, VBA began measuring the accuracy of individual issues for each claim (“issue-based accuracy”), as it provides a more detailed measure of workload proficiency. However, VBA will continue to monitor and report out on claim-based accuracy as a key indicator for this Agency Priority Goal. To improve benefits delivery, VA is transitioning to an electronic claims process that will reduce processing time and increase accuracy. As of the end of June 2015, over 94 percent of VBA’s inventory is in an electronic format and is being processed electronically by VBA employees using the Veterans Benefits Management System (VBMS). All claims are either received electronically or are converted to electronic format for processing.
