Chairman Hall and Mr. Lamborn, let me applaud you for holding these hearings on substantially improving the claims processing systems and greatly improving how we care for our Nation’s veterans.  Today’s hearing, “The Use of Artificial Intelligence to Improve the VA’s Claims Processing System” is very important in its own right but more so in how it supports the overall effort toward a truly caring, timely and effective processing of our veterans’ disability claims.

In my testimony today, I will be speaking both to the true meaning and obligation of “the duty to assist” and to the strong enabling role that artificial intelligence and other decision support tools can and should play.  I will point th the fact that, in the military where our veterans served, great honor is given to those who deliver “on time and on target”. 

Why do I believe this is so important?  I saw the sacrifice of our service members and the incurred debt by our Nation when I had the honor of serving as the Principal Deputy Assistant Secretary of Defense for Health Affairs.  I saw and helped achieve the great potential that the Military Health System has for truly caring for our service members, our retirees and their families. 

Subsequently, I saw the plight of many of our veterans and the great obligation of our Nation when I had the honor of serving as the Veterans Health Administration Chief Information Officer and Senior Advisor to the Under Secretary for Health.  I saw and helped achieve the great potential that the Veterans Health System has for truly caring for our veterans.  In this latter role, I also had the opportunity to work with the Veterans Benefits Administration as they explored the potential for a much better claims processing system.

Most importantly, I had the great privilege of getting to know both service members and veterans as people providing a great service to our Nation.  I had the opportunity to work closely with organizations supporting active service members, the Guard, the Reserve, retirees, veterans and their families. 

All this taught me that what the Department of Veterans Affairs can and should be doing is about the veteran and that everything VA does should be centered around the veteran.  VA should be a truly veteran-centric system, including its claims processing system.  This is not about claims per se, it is about a veteran who needs the support of the Nation that he or she served.

This is about strong leadership.  This is about effective management end-to-end.  This is about deploying effective technology.  Most importantly, this is about a new process that honorably discharges more of our obligation and delivers benefits on time and on target to our veterans.

A New Claims Processing System. 

Let me start with the claims processing system.  If we believe that veterans are hurting, that we have “the duty to assist”, and that we should meet the expectation of being “on time and on target”, then we need a new process now.  My suggestions for one such proposal and its rationale are detailed in the footnote below. [1]

Several years ago, I had the opportunity to help advise the veterans benefits system in its thinking about a new system.  I asked them how many hour of work it takes to process a claim.  They said about eight hours on average.  Sadly, this means it takes six months to a year or more to complete eight hours actual work.  That makes no sense.

What does make sense is a new system operating in real time like we do with the health care system.  When a veteran is hurting and needs health care, the veterans’ health system assists the veteran and provides care quickly.  When a veteran is hurting and needs financial benefits, the veterans’ benefits system does little to assist, forces the veteran to navigate a large bureaucracy and massive paperwork, and provides financial benefits only after months or years.

VA staff should come out and welcome the veteran.  They should actively assist the veteran to get everything processed quickly and correctly.  They should be working with the veteran on an ongoing basis as case managers.

But we also need the continuing support and assistance of the Veterans Service Organizations.  They have played an invaluable role over the years in trying to support the veteran in a broken system.

Changing the process means giving a veteran the financial benefit at least as soon as the veteran files a claim with basic evidence supporting that claim.  Real time would mean that VA would receive the claim and supporting evidence and make the decision on the same day.  That is achievable if we really want to make it happen. 

Let’s change the assumptions.   Let’s have VA presume that a veteran filing a claim with basic evidence supporting that claim is entitled to the associated benefit a) for the period of one year or b) until VA completes the processing of that claim [no more than one year], whichever is shorter.  Further, let’s have VA begin payments to a veteran within 30 days of that veteran filing a claim with the supporting evidence. 

But let’s also have the VA claims processing system function better.  Within six months, let’s have VA institute a new claims processing system that proactively assists a veteran with his/her claim.  Let’s have them produce a temporary or permanent decision (preferred) within two weeks of a veteran filing a claim with basic evidence supporting that claim.  And, let’s begin payments to a veteran within 30 days of that veteran filing a claim with the supporting evidence.  Further, preferably within six months, let’s have VA deliver the permanent decision within two weeks. 

This can be done.  It should be done.

Enabling Technology.

In my colleagues’ testimony, we have heard that the technology exists today to greatly improve the speed and accuracy of benefits decisions.  Using artificial intelligence or electronic decision support tools is nothing new.  Both government and the private sector use them every day. 

For those who argue benefit claims processing is a much more complicated and difficult process, I counter that it is not.  If you want to go to the most complicated and difficult process that exists today, it is arguably health care.  Yet, somehow health care has figured out how to provide care in real time without technology and even better with technology.

One doesn’t even have to go outside the VA system to find real time systems.  The veterans’ health care system is just that.  Much praise has been given to the veterans’ health system for its responsiveness, quality and effective use of technology.  Today, the veterans’ health care system can access any electronic information in any VA health care site in real time.  With due diligence, this will be even better in the future.  One of my honors was to have both rescued the VistA health information system and to have set it on the path to an even brighter future.

To help improve the claims processing system, we even went one step further.  We made the veterans health care information available to the claims processing system electronically and in real time.  Unfortunately, it doesn’t seemed to have sped up claims processing.

Artificial intelligence and human intelligence together can make a difference.  Using health care as an example, we have some of the most highly trained people in the world providing health care.  More and more we are using less highly trained people as well.  More and more, these talented people rely upon many kinds of decision support tools to help them be effective.  They have real time access to virtually everything there is to know about a person that can help improve health.  More and more, they have real time access to the most current knowledge on any particular condition and on caring for the whole person.  They are supported by guidelines and advice on what best will help a person get healthier. 

Sometimes they treat even without full information if that is what it takes to reduce the misery now.  Sometimes they have to gather information from other physicians across town or across the country.  Sometimes, more often now than in the past, they have all the information they need to treat within their own health information system.  VA’s VistA and the future HealtheVet VistA do just that.  Many public and private sector health care providers’ health information systems do just that.

These health care providers have the decision support necessary to care for a person in real time.  They don’t have to wait months or years to make decisions on how to treat the person in misery today.  The person doesn’t have to wait months or years to get help with their misery.

But, keep in mind that health care did not wait for technology; it just got better with technology as an enabler.  Technology can greatly enable the claims processing system, but it is only an enabler.  For better claims processing, we don’t have to wait for the technology.  We can start reducing the misery today and then do it even better when the technology arrives.

Leadership and Management.

However, getting to a new, veteran-centric, effective claims processing system with the necessary enabling technology will only happen if VA leadership is fully committed.  This is not going to be easy, but it is doable. 

VA leadership will have to adopt the vision of a system that gets needed and appropriate support to the veteran in real time, meaning days and not months or years.  They need to lead a claims processing system that welcomes the veteran at the door (preferably reaches out to them earlier) and treats the veteran as one who has earned that welcome.  They need to lead a system where the intent is to have the veteran file a claim and get approval (if appropriate) on the same day.  They need to lead the current staff on how to better use their skills to help the veteran.  They need to demonstrate leadership and work in partnership with the VSOs on how to make the systems better and on how the VSOs can continue to assist the veteran during claims processing and afterward.

But leadership will not succeed without effective management to make and continue to make all this happen.  Not just VA but most of the Federal government does not have the management strength.  It clearly doesn’t have enough to deal with the level of change we are suggesting here.  For VA, there is good management talent in the veterans benefits area.  VA will need to develop that talent as well as bolster that talent with strong managers from outside the veterans’ benefits system as well.

Duty to Assist; Expectation to Be on Time and on Target

As I conclude, I am sure that some will argue it is unaffordable or undoable.  Let me suggest not.  First, it could well be built into the $100 to 150 billion economic stimulus package moving at this very moment.  Second, let me remind you that when we send our service members to war we seem to handle the budget.  We can and should do no less when they come home and need our help. That is part of the real cost of preventing or conducting war.

Today, there is a failure to understand and appreciate the veteran’s plight.  Today’s claims processing behavior is more like a castle under siege rather than a home providing compassion, warmth, help, and sustenance.  Contrast that with the veterans’ health system where care is provided in real time with most administrative details sorted out later.  Feel what it is like for a veteran to live in uncertainty and without support for six months or a year or more.  What if we did that for health care?  It would be unacceptable.  Protests would ring in and outside of every care facility.  Why do we tolerate it for benefits determination?

For a better future, the bottom line is this.  Change the assumptions.  Change the process. Use the best technology.  Care for the veteran. Meet our obligation – the duty to assist.  Deliver on time and on target.  “The duty to assist” is an obligation that VA, with regard to benefits, has yet to honorably discharge.  “On time and on target is what we expected of our veterans and what we should expect of VA.

[1] Economic Stimulus and Duty to Assist Our Veterans

What economic stimulus?

Effective upon enactment, the Department of Veterans Affairs shall:

• Proactively assist a veteran with his/her claim,

• Presume that a veteran filing a claim with basic evidence supporting that claim is entitled to the associated benefit a) for the period of one year or b) until VA completes the processing of that claim [no more than one year], whichever is shorter, and

• Begin payments to a veteran within 30 days of that veteran filing a claim with the supporting evidence. 

Within six months after enactment, the Department of Veterans Affairs shall institute a new claims processing system that:

• Proactively assist a veteran with his/her claim,

• Produces a temporary or permanent decision (preferred) within two weeks of a veteran filing a claim with basic evidence supporting that claim, and

• Begins payments to a veteran within 30 days of that veteran filing a claim with the supporting evidence. 

Why this economic stimulus?

• Stimulus is temporary (budget impact), timely and on target.

• Dollars paid to veterans will go directly and quickly into the economy to cover basic living expense.

• Housing foreclosures will be reduced as veterans are able to stay current on their mortgages.

• The misery of our veterans with disabilities and awaiting a benefits decision will be substantially reduced as the backlog is essentially eliminated.

• The Department of Veterans Affairs will be incentivized to move as soon as possible to a “real time” claims processing system.

• An important symbolic and real step would be taken to address the needs of veterans with current and future disabilities returning from Iraq and other wars.

• An important symbolic and real step would be taken to keep the promise to care for our service members when their service results in disabling conditions.  This also has a positive impact on recruitment and retention.

• The Nation would finally be really moving toward meeting the obligation of “Duty to Assist”.

• Bipartisan support is highly likely.