craigconnects: Connecting the World for the Common Good
contact

Craig's Blog

Veterans Disability Claims Backlog, setting the record straight

There's a lot of confusion and misinformation regarding the disability claims backlog at the Department of Veterans Affairs (VA).  Setting the record straight requires some honest brokering with many years experience in both customer service and writing computer software for moving from paper-based customer service to workflow systems.

It takes a customer service rep (eighteen years) and it takes a nerd (sixty years).

That makes it personal for me, particularly as I work with lots of veterans and military families groups.  I take this personally, since I figure if someone's stepping up to protect me, I need to reciprocate. That's particularly true when a fellow citizen goes overseas and risks taking a bullet for me.

One advantage of a deep dive like this means that I can include some recommendations for moving ahead faster.

Here's the deal, using the best metaphor I can figure.

The VA disability claims process has been like a car with the "check engine light" on for a decade or longer.  Wasn't much of a problem until maybe around 2005, when the car filled up, and more people needed that ride. Vets needed a much bigger car back then, but that costs money, and no one in Washington stood up for that.

Here's what the VA's VBMS screens look like. Similar to Gmail. Web based. Searchable. Fast.

This got worse in following years, since Washington did stand up for Vietnam era vets, particularly when it came to the Agent Orange situation. As troops returned from Iraq and Afghanistan, that's like the car getting more riders, who needed a longer ride.

Sure, I'm understating the case, the case load of Veterans Affairs got a lot worse, with the Camp Lejeune situation only beginning to heat up. The deal is that people knew about this maybe eight years ago or longer, when that engine light went on.  The new car didn't start to get made until 2009, when Washington stood up to support Vietnam vets as well as the vets returning from Iraq and Afghanistan.

Problem is that normally, in Washington, big software projects frequently fail, they don't get the job done, and projects are abandoned after spending maybe a billion or more.  In plain terms, the software specs are frequently written by big shots who long ago got out of touch with their customers.

Maybe twenty years ago, private industry figured a better way to build software for real people was basically:

1. Listen to customers, get an idea what the majority want and need.

2. Write some code, ask customers about it.

3. Repeat, forever.

That's the approach Veterans Affairs took in 2009, which really was swimming upriver. This was really a big deal challenge:

  • The old systems needed to be kept running while the new stuff was built.
  • The new systems needed VA customer service reps to work with VA software people, which is the opposite of the big shot way of doing things. That's big deal culture change and that's always painful.

All this was happening as the VA got way more claims, and the claims got way more complicated. That's to say that they built a new car while driving the old car, and the wheels are falling off the old car, and they have a lot more riders coming.

Meanwhile, explaining this is really hard, and in the Washington way of talking, there's no way to win.  People don't generally know that VA is getting through huge, unprecedented numbers of claims, over a million per year for the last three years. Last year they paid around $54 billion. Around half of vets in the backlog, mostly Vietnam vets, already receive cash from a prior claim.

Also, the VA gives Congress the reports they ask for.  You can get more info, just ask.  The downside of this is that it can look like VA is withholding vital info, if you don't know the way they talk.

This all only makes sense to me since I'm a customer service rep and a software developer, and I know something about charts, numbers, and statistics.  I can tell that VA has the worst of all worlds:

1. Gotta keep the old stuff working.

2. Gotta build the new stuff.

3. Gotta focus on finding and preventing the slow parts/bottlenecks.

4. Gotta move customers from old to new systems.

That means a new paperless system, the Veterans Benefits Management Systems, which has means of expediting claims. It moves toward replacing huge piles of paper with online workflow.  That means it's much easier to move case files from one worker to another, and it means no one loses track of paper.

Part of this involves means by which vets can fill out their own claims, via online eBenefits, which is kind of like TurboTax or similar. It's good for straightforward cases like when you don't need a CPA to do taxes.

If a vet needs help filing, that's much like getting a CPA to help with taxes.

Veteran Service Organizations can use the VA stuff via the Stakeholder Enterprise Portal, online.

VSOs sometimes use claims management systems, like VetPro. VA is testing a "digits to digits" interface for those systems. The deal there is to eliminate more paper, and to generally accelerate the process, since the outside systems talk directly with VA systems.  Security and privacy have already been addressed.

Making this happen means engaging in serious conversation with all VSOs, from the ground up, which is totally contrary to the usual Washington way of doing things. That is, talking with national leadership needs to be complemented with direct engagement with disability claim line workers, everywhere.

This means serious and ongoing real engagement with all customers, which is really hard to do. You need to listen to the majority of customers, who are largely quiet, not so much listening to noisy special interests.

That means engagement with line workers as well as the big shots, and in practice it means customer service reps talking with other Customer Service Representatives (CSRs).

There's talk of a Presidential commission to make this happen, but I'm not a patient guy, and I've already chatted with fellow nerds and CSRs in Washington who want to make stuff happen.  Here's the beginning of recommendations, which need a bit more reality testing, and then approval by the big guys.

(I'd like to present recommendations in priority order, but they're pretty intertwined, so in no particular order…)

1. Continuous engagement with VA workers, VSOs, vets, in social media.

  • Keep everyone in the loop, and most of all, that means two way communications with the customer service people in Veterans Affairs, and also with Veteran Service Officers, who help vets with the process.
  • Specifically, we need private discussion groups where CSRs, internal and external, talk to Veterans Benefits Administration (VBA) management and get answers where that makes sense.

My commitments:

  • Continuing engagement with engagement as illustrated by the thing you're reading right now, assuming that I'm not pissing off the people I need to talk to.
  • Participation in discussion, mostly to help articulate suggestions in the form that my fellow nerds might need to code.

2. Permanent employee innovation.

  • That means, perhaps as part of discussion groups, asking employees and VSOs what might make the system work better. Several years ago, I helped in a very minor way with an employee innovation effort which resulted in real results, one of which is the Disability Benefit Questionnaire (DBQ) thing below. This needs to be part of VA culture.  (It needs to be part of the culture of any organization, but that's a separate article.)

3. Identify bottlenecks, like records transfer from DoD, Guard and Reserve. VA Center for Innovation people and VBA developers, have an idea what they are.

  • Some can be solved with software improvements, but the most difficult involve getting treatment records and related info from other Federal agencies, which leads to …

4. Get the tech people in different agencies to start talking with each other, now, and get management approvals ready for the flow of data.  Some of this is already in process, but not enough. They can blame me.

5. Create workarounds in situations where getting service treatment records or related data will take too long.  That kind of thing's a big judgment call, and I'm happy to trust VBA workers with that.

  • For example, the employee innovation effort cited earlier involved a suggestion from VA in Pittsburgh.  If a private physician verifies a medical condition, no point in having a VA doctor do the same.  That involves private doctors filling out the Disability Benefit Questionnaire. However, DBQs need significant usability improvements, which VA folks and I have already discussed.  (VACI folks, I'm still on board for a challenge.gov thing.)
  • Very specifically, if a vet can show a medical condition, and getting records showing a service connection are too slow, give the VBA worker the okay to approve. I trust the line workers with such decisions. Blame me if it doesn't work.

6. Improve the user experience for all Veterans Benefits Management System (VBMS) UIs so that experienced people can submit claims with minimal additional help.  That is, if you know how claims work now, and you're Internet-literate, there should be no need to wait for, and maybe travel to, classes.

  • In the interim, maybe we need a quick VMBS for Dummies? I'd qualify the the latter part of that.

7. Get everyone on board to help vets build Fully Developed Claims(FDCs). FDCs are pretty much like filling out one of those forms CPAs give you, where you fill in lots of information, and provide the documentation needed to submit your taxes.

  • That needs the communications efforts described above, plus… this should be part of the Transition Assistance Program that active service troops do when leaving service.  That's in process, needs to be accelerated.

Turns out that VA has 56 regional offices, each running the old paper-based system, that's like 56 cars that are breaking down, some badly. The challenge is to replace each old car with new ones, while gracefully transferring riders to the new cars.  In practice, that means getting a lot of paper scanned into the new systems, a lot of work. Key to that is getting everyone on board, something assisted by the recommendations above.

Okay, that's the gist of things, and I'll add one more personal commitment:

I'll run these suggestions by VA people and others in Washington, and VSOs, and will update. If it means more time in Washington, even in August, well, I'll do what it takes.  After all, a nerd's gotta do, what… well, you know the rest.

Tweet Chat with VA Careers

Almost a year ago, Veterans Affairs Secretary Eric K. Shinseki announced that the U.S. Department of Veterans Affairs (VA) was hiring. As he put it at the time, “As more veterans return home, we must ensure that all veterans have access to quality mental health care.”

VA has answered that call by reaching out to as many platforms as possible. Now VA is taking this hiring initiative to a live Twitter chat via @vacareers. This Thursday, we will be honored to welcome Craig Newmark,  of craigconnects and craigslist, to share the e-space with others concerned about the vital need to take care of those who have taken care of us—the men and women who have served in America’s armed services.

I’m Darren Sherrard, of the Veterans Health Administration, and I oversee VA’s recruitment marketing efforts for healthcare providers—particularly psychiatrists and eligible psychologists—who can come work at VA. As associate director for health care recruitment and marketing in the office of workforce management and consulting, I’m trying to get the word out on behalf of VHA: A gratifying career awaits those who are ready to turn their time and attention to helping veterans.

At 1pm EDT (10 am PDT) today, I will host a Twitter chat via @vacareers to guide leaders like Craig, VA recruiters, and job searchers in an exchange of thoughts, ideas, and questions about mental health careers at VA. It’s a chance for the public to talk with veterans, supporters of veterans, and members of the mental health community in real time. We hope the lively exchange will let people know more about the life-changing work at VA in store for psychiatrists and other mental health professionals.

Craig is committed to helping veterans and their families, and there is no denying that giving this community access to the care they deserve means VA needs to hire extraordinarily talented, passionate mental health professionals. I invite you all to add your thoughts, experiences, and questions to the conversation by tweeting with the hashtag #WorkatVA. We’ll start the chat at 1 p.m. EDT on March 21, and I hope to see you there.

Guest blog post by Darren Sherrard,
Associate Director for Recruitment Marketing,
VHA Healthcare Recruitment & Marketing,
Office of Workforce Management & Consulting

Important voting messaging

Folks, there are some orgs out there who are doing real good work, like the Advancement Project, the Brennan Center for Justice, and SKDKnickerbocker, they really have their boots on the ground when it comes to talking about Voting.

Their key messages really are spot on, and highlight the importance of voting, and why you should vote. Here's the list, I figure we should post something, now and then…

  • Strengthen Our Community: Voting brings us together as Americans, and you should join your family and friends to help strengthen our community.
  • Equality: Voting is the one time we are all equal — whether you’re young or old, rich or poor. When we vote, we all have the same say.
  • Civic Duty: As American citizens, it is our responsibility and civic duty to vote and it’s something we do to show our country and children that we are proud to be American.
  • Free, Fair and Accessible: As the leading democracy of the world, the U.S. should work to keep our voting system free, fair, and accessible to all Americans.
  • Have Your Voice Heard: In order to participate in our great democracy and have your voice heard, every voter needs to understand the rules in their state, register on time, and show up at the correct polling place.
  • Empowerment: Voting is empowering and provides us with some control over what happens to our families and our community.
  • Your Vote Counts: Your vote makes a difference, and together Americans’ voices count. If you don’t vote, you can’t complain.

And folks – don't forget to check out all of the organizations doing good work on this issue.

Comments Off

craigconnects Celebrates a 2nd Anniversary

Hey there, folks -

It's craigconnects' 2nd anniversary already, and we've worked with some real good people in the last year to get stuff done. This year I'm also focusing a lot on vets and military families, and I've teamed up with Crowdrise to do a big campaign to raise money for these organizations, which will launch in a few months. I'd like to encourage any organizations working with vets and military families to get in touch with Crowdrise on how they can participate.

A few highlights of the good orgs and folks we've worked with for social good:

  • I went to a really good conference and hackathon addressing Truthiness in Digital Media last year. While I'm not going to tell anyone how to do their job, I feel the country needs the news media to restore trust in their reporting, in large part, by doing lots of factchecking again.
  • I worked with some good folks focusing on Voter Suppression issues to create an Infographic about Voter's rights, Think You Have the Right to Vote? Not so much! There are some bad actors that are trying to pass legislation that will keep eligible people from voting.
  • Re: voting, I supported the good folks at Election Protection, Lawyers' Committee, NOI, and Ushahidi who developed and launched Our Vote Live to help people out if they encountered problems while trying to vote.
  • And in this past year, I discovered that it's a new era of squirrel-based activism with the #Squirrels4Good campaign we did with the National Wildlife Federation, who really have their boots on the ground. I gave $1 for each use of the hashtag #Squirrels4Good, and donated $10K to NWF. Those squirrels really are urban survivors.
  • Folks often email me asking for support with their campaigns. I tell 'em to email me the links to their posts, and maybe they should do ask their supporters to do the same. Here's a little post about how to easily share your posts for the most visibility.
  • I've been quietly working with the Consumer Financial Protection Bureau including Liz Warren and Holly Petraeus, on stuff like customer service tech. They're for real, getting stuff done. The CFPB does stuff like protecting regular people from predatory financial institutions.
  • We created a few memes to talk about current affairs:

What I think happens with memes is that they get into someone's brain as code, executes in one's brain, and then spreads the idea of the meme using the person as a host where it is spreads to other people (hopefully in an epidemic manner). Again, I'm speaking literally, which shows I read too much science fiction. But it's not all science fiction.

Other things that happened over the last year:

  • A good friend of mine, Maria Teresa Kumar, Co-Founder and President of Voto Latino, and actress America Ferrera began a new media, grassroots campaign called America4America. The campaign's main message "Don't Let Anyone Scare You" is geared toward Latino Voters. The campaign is doing good stuff educating young folks about issues like voter ID laws and immigration.
  • Okay, I was chatting with Reshma Saujani from Girls Who Code last year, providing modest social media help, and blurted out that "code is power." And I still think that it's true. Girls Who Code is a nonprofit that teaches under-served girls how to computer program.
  • Speaking of women in tech, Allyson Kapin, craigconnects team member and founder of Women Who Tech, co-authored a book with Amy Sample Ward of NTEN called Social Change Anytime Everywhere. I wrote the book foreword and had a chance to talk nerdy about why nonprofits need to use social media and online channels to reach people.
  • Last summer I wanted to help out with the massive wildfires that were blazing across Colorado and the people (and animals) there that needed help dealing with the damage.  I committed a matching donation up to $5K to support the good folks at a local American Red Cross. They're doing the real hard work on the ground to help those in immediate need. Small gesture on my part, but it's something…
  •  I worked with the good folks at Electronic Frontier Foundation (EFF) to create an infographic explaining how CDA 230 really protects Internet speech.
  • I've been teching across the globe, funding tech labs around the globe. Ranging from San Francisco to Kenya, a Beduoin village in Israel, to Haiti and India, and the Palestinian West Bank; this is a really big deal. It's important that people have access to the voice that they may not have otherwise.
  • Hurricane Sandy was real serious. It caused a lot of damage across the East Coast including my hometown Morristown, New Jersey from downed power lines to major flooding. I did my small part with Crowdrise by matching $25K to relief organizations like the American Red Cross, Feeding America, AmeriCares, IAVA, and National Wildlife Federation, who have their boots on the ground and help people (and the little furry ones) out. We raised over $110K!
  • I spoke at the Poynter Journalism Ethics Symposium last October. I spoke only as a news consumer, I just want news I can trust. The press should be the immune system of democracy, and needs to fulfill that role again.
  • The Bob Woodruff Foundation’s Sixth Annual Stand Up for Heroes benefit was this past November. There were some real great folks there, and we raised some money for a good cause. My match of $25k was met during the event, and another donor matched $25k on Friday. A total of over $3 million was raised. The wounded warriors and their families have really stood up for us, now it’s time we stood up for them.
  • I teamed up with the good folks at National Wildlife Federation once again to raise money for the furry little critters. I asked folks on social media to #Hoot2Give. Each time someone used the hashtag on Facebook, Twitter, Pinterest, I gave $1 to NWF (up to $5k). In just a few days there were over 5k mentions and a lot of really cute photos of owls.
  • I asked folks, how does the Internet give you a voice?  I collected answers about how the Internet gives people a voice and shared them on Internet Freedom Day.

It was a really busy year. We're really looking forward to the years to come. I don't think of it as altruism, it just feels right and a nerd's gotta do what a nerd's gotta do.

 

Big IT development at Dept of Vets Affairs

(from the dept of giving-credit-where-it's-due)

Peter Levin and Roger Baker leave Dept Veterans Affairs

VistA is the Dept of Vets Affairs health record system, and it's been a huge success. VA has open sourced it, which is remarkable achievement for
Washington, a really big deal. It means that anyone can improve it or interface with it. Check out the Challenge.gov VA Medical Appointment Scheduling Contest.

What they're now saying is that the Dept of Defense is considering a health records system, and that VistA should be considered for that.

That sounds right to me, it gets the job done, has been working well for years, and is already available publicly for the public to better help veterans. That means people can find ways to add function to better help active service troops. Find out more here: http://fedscoop.com/va-responds-to-defense-iehr-rfi-with-open-source-recommendation/

But wait, there's more! Folks at VA have been doing some big stuff since 2009. They've announced the VA Center for Innovation. I'd say that the
following is a small part of VA innovation, I've seen it firsthand and it's real. Here's a little of what they have to say:

As you can see, the new VA Center for Innovation is more than a name change for us. And to make this all the more real, we get to announce a
few recent milestones along with the VACI rollout:

  • Launched a dozen new innovations covering telemedicine, prosthetic socket designs, kidney disease, mobile health/Blue Button, and robotics for sterilization of medical equipment
  • Launched the new VACI website at: www.innovation.va.gov
  • Published the 2010-2012 Stakeholder Report (available for download at www.innovation.va.gov)
  • Selected our first Senior Fellows (Dr. Adam Darkins and Dr. Peter Almenoff on telehealth and healthcare value, respectively)
  • Named serial entrepreneur and Air Force veteran Steve Blank as Senior Advisor to VACI
  • Appointed our first EiR in Doug Trauner, CEO of theCarrot.com and co-chair of the FCC's mHealth taskforce
  • Added our first participant in the Partnership program with the nation's largest health carrier, UnitedHealth Group
  • Added our second Partnership, this one with TEDMED

Tags: , , | Comments Off