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Office of Public and Intergovernmental Affairs

Remarks by Former Deputy Secretary W. Scott Gould

ACT-IAC Executive Leadership Conference
Colonial Williamsburg, VA
October 26, 2009

I’m delighted to be here today and share this venue with so many talented people committed to building relationships between government and industry. A new era of innovation is not possible without it.

It’s an honor to be part of the President’s leadership team at Veterans Affairs. When Secretary Shinseki asked me to help him transform the Department, I saw a real opportunity to make a difference, and to support his tremendous drive for change and progress on behalf of our Nation’s Veterans. Nine months in, we are well on our way.

President Obama’s management agenda is clear—build a “high-performing government.”

At VA, this means transforming our agency into a 21st century organization, and ensuring that we provide high-quality care and timely delivery of benefits to Veterans over their lifetime, from the day they take the oath of allegiance until the day they are laid to rest.

VA is facing some important challenges:

  • Combating homelessness … with an eye toward vulnerable Veterans.
  • Extending health care to a half million Veterans who lost that entitlement in 2003.
  • Enhancing outreach/services for mental health care and cognitive injuries … with a focus on rural locations.
  • Providing greater benefits for Veterans medically retired from military service.
  • Providing comprehensive education benefits under the new, post-9/11 GI Bill.
  • Improving technology—not just for the sake of technology, but to improve access, transparency, and outcomes across the board.

The President’s remarkable 2010 budget—the largest increase in 30 years—demonstrates his personal commitment to Veterans and their families even during times of tremendous budget pressure. Building on Congress’s own enhancements to VA budgets for 2008 and 2009, the President’s 2010 budget will provide VA an extraordinary opportunity to begin reversing years of accumulated neglect and preparing VA to care for Veterans well into the 21st century, with new priorities and new capabilities, new challenges and new opportunities.

Let me tell you some things you may not know about VA.

VA is the second largest agency in the Federal Government, with nearly 300,000 employees and a budget for 2010 of $113 billion. If we were a private corporation, we would rank in the Fortune 15. We are organized in three main operating units: Health (called VHA), Benefits (called VBA), and Cemeteries (or NCA).

The health organization is the largest unified health care system in the world, maintaining 153 major medical centers, 765 community-based outpatient clinics, and 50 mobile health clinics. Just under 8 million are enrolled in VA health care programs. We treat 5.5 million Veterans per year in our hospitals and clinics. We run over 200 million lab tests annually. VHA conducts about a billion dollars in research each year that has lead to inventions like the CT scan, advanced prosthetics, and breakthroughs in treatments of Veterans with spinal cord injuries, diabetes, and Parkinson’s disease.

The benefits organization contains the eighth largest insurance company in America, overseeing more than seven million life insurance policies with a face amount of $1.3 trillion. Three-million Veterans receive VA disability and compensation checks every year. VBA guarantees nearly 1.3 million home loans, with an unpaid balance of $175 billion. It is second only to the Pell Grant Program in providing education benefits totaling $8 billion annually.

The National Cemetery Administration is responsible for maintaining America’s 130 National Cemeteries. Nearly three million Veterans are interred or inurned in our National Cemeteries. Last year we conducted more than 103,000 interments—a number we expect to rise as our population of World War II Veterans declines at about 900 a day. NCA recently earned the highest score ever in the American Customer Satisfaction Index (ACSI) performed by the University of Michigan Business School. The NCA score of (95) beat out such well-known leaders in customer satisfaction as Lexus (89), Google (86), and Apple Computers (84).

VA’s mission is inextricably linked to DoD’s mission. We are not an independent operator. We administer the Servicemen’s Group Life Insurance program covering the 2.25 million men and women of our Armed Forces. Our budget requirements are largely determined by DoD’s operational missions. For example, our health care providers work closely with DoD’s health care providers to care for wounded warriors returning home from Iraq and Afghanistan.

Together, VA and DoD work to keep the obligation our country makes to each Soldier, Sailor, Marine, Airman, and Coast Guardsman: to care for him who has borne the battle. This is an enduring moral obligation. It must be fulfilled in good times and in bad.

VA has had its share of problems:

  • Backlogs for claims
  • Data security
  • Performance issues like cleaning of endoscopes and recent false ALS notices
  • And fundamental problems with our management infrastructure in the areas of IT and acquisition.

The long-term solution to many of our problems and challenges is internal business process redesign and sensible integration of proven information technology—one of reasons I was hired as COO.  

VA’s IT issues are significant. Many projects are challenged by the inability to meet cost and schedule performance measures. So, we recently instituted a Performance Management and Accountability System (PMAS) to strengthen our IT oversight and performance. In June, we placed 47 IT projects under the PMAS; in July, we paused 45 of them. Many were over a year behind schedule. Some are too important not to get done.

Over the last 60 days, 17 projects were committed to meeting near-term milestones, and 15 met their milestones. We have re-planned and restarted 13 projects, and we have halted or cut funding for 15 or one-third of the original 45 projects.

To move ahead on the remaining projects, we need to add staff. We are currently working to fill vacancies at all levels, from senior program managers to fingers-on the-keyboard programmers. We will also need to upgrade the skills of our present IT workforce, and so we have instituted a new training requirement for programs over $5 million that puts our government and commercial partners in the same room for training and review of requirements, governance, and expectations. Commercial partners will participate on a billable basis. The goal is a better outcome for both parties.

We mean business on program management; and we will hold ourselves and our private sector partners accountable for cost, schedule and technical performance. Our near-term challenges are also demanding. Since enactment, the new Post-9/11 GI Bill has been our top priority for successful implementation by August 3, 2009. These completely new benefits required massive IT planning efforts on short timelines. Because of the terrific response to the program—lots of our post-9/11 Veterans are following their parents and grandparents back to school—Secretary Shinseki has authorized “advanced payments” to qualified Veterans while their applications work through our temporary system. We employed a Web 2.0 solution to get Veterans their money quickly and conveniently. The approach will remain in effect while we complete development of our full capability IT platform to ensure timely delivery of benefit checks in the future.

A central goal for VA is to reduce the time it takes for a Veteran to have a claim fairly adjudicated. The total number of claims in our inventory today is around 400,000, and backlogged claims that have been in the system for longer than 125 days total roughly 149,000 cases. Regardless of how we parse the numbers, there is a backlog; it is too big, and Veterans are waiting too long for decisions.

Here, too, we’re making steady progress. Our CIO Roger Baker is working hand-in-glove with benefits Under Secretary Pat Dunne and attacking the problem on three fronts:

  • more trained Veteran service representatives
  • re-designing the process by which claims are adjudicated, and
  • professional, focused, and I think clever use of information technologies that promise to slash the backlog significantly.

Now, this problem didn’t appear overnight, and it isn’t going to disappear overnight. We intend to revolutionize our claims process—faster decisions, better decisions, no lost records, fewer errors. We have work to do here. But we understand what must be done. I’ve got a crack team on it, feeding me progress reports several times a week, and I think we’re finally going to break the back of this difficult and complicated problem.

In April President Obama charged VA Secretary Shinseki and Defense Secretary Gates with building a fully interoperable electronic records system. This new system will provide every member of our Armed Forces a Virtual Lifetime Electronic Record (VLER) to stay with them from the day they put on the uniform until the day they are laid to rest.

VA is a recognized leader in the development and use of electronic health records (EHRs). So is the Department of Defense. Once the VA and DoD systems are fully linked, the new VLER will ensure the seamless transition of service members from active duty to Veteran status. At present, when Veterans enroll in the VA system after leaving the military, it takes time to verify their eligibility and obtain their military health records. VLER will eliminate those delays.  

Built on existing point-to-point EHR infrastructure, VLER will leverage the standards-based, open-architecture framework of the Nationwide Health Information Network, the NHIN to enable seamless interoperability with other Federal agencies, and, crucially, private-sector partners. 

VLER will provide automated information access to Veterans, their families, care-givers, and their service providers. It will relieve them of the burden of keeping track of their paper records, because documentation will all be in one complete, secure, and “virtual” place.

DOD and VA spend about half of their combined health-care budget purchasing care in the private sector. When Veterans do come to VA for care, we need access—with their permission, of course—to the record of that outside care, to ensure that the care they are getting is seamless and safe. For the same reason, private-sector providers need secure, reliable, and Veteran-authorized access to our patient records as well. VLER will provide that access, and Veterans will receive better and safer care, sooner.  

Our work with DoD is already having an impact on the way we are able to provide quality health care to our Veterans. To date, VA has received from DoD 2.5 million deployment-related health assessments on more than one million individuals, and we are able to share between Departments critical health information on more than three million patients. Although our work is far from finished, our achievements here will go beyond Veterans and our service members to help the Nation as a whole, as have many of VA’s historic medical innovations.

As we move from proprietary architectures to standards-based systems, our commercial partners should expect that our future purchases of EHR IT systems will need to be fully compliant with interoperable platforms like the NHIN. The VA/DoD strategy leverages private-sector involvement in the software development in a new way. We believe that it will result in a more effective and cost efficient system.

In past efforts to improve access, VA has branched out from its 153 flagship medical centers to establish 765 Community-Based Outpatient Clinics and 50 mobile health clinics. Our next major leap will be to link our flagship medical centers to our outpatient clinics and mobile clinics via telehealth and telemedicine connections, which will put health care specialists in direct contact with distant patients. We are even connecting medical centers directly to the homes of chronically ill Veterans, so that health care professionals can monitor their patients’ conditions without trips to the hospital. Veterans won’t have to travel as much and will get better day-to-day care.

Critical to improving Veterans’ access to health care is our campaign to inform and educate them about how VA delivers care and benefits. Using social media Web sites like MyHealtheVet and Second Life, we are making contact with younger Veterans who might not respond to lectures, pamphlets, or telephone calls. We are also offering online, 24/7 access to VA crisis counselors through our Veterans Chat Web site. Veterans Chat collects no information except what Veterans volunteer, so they can seek help or get answers in complete privacy. Online chat doesn’t replace face-to-face or even telephone counseling, but it may provide the easiest and least intimidating way for younger Veterans to reach out to us when in need.

Finally, let me tell you about how we are using existing IT in ways it hasn’t been used before at VA. Our benefits administration recently used Web 2.-0 social networking tools to solicit suggestions from employees in our Benefits Administration on how to improve services to Veterans. In just a few weeks, we collected over 3,500 suggestions, from which the Regional Offices selected 70 with serious potential. The 57 Regional Offices were actually told to submit just one suggestion each, but several came back and asked if they could submit more—some suggestions were just too good not to send forward. We are now in the process of selecting the best 15 suggestions, and we expect to announce the winners in January with funding set aside in FY 2010 for their implementation.

Those are a few examples of how the new leadership team at VA is using robust, reliable, and convenient technology not only to assist in the management process, but also to improve care and services for Veterans. I am working with our Chief Technology Officer, and Chief Information Officer and we are working closely with the President’s Chief Performance Officer, CTO, and CIO to make sure that VA is benefiting from the great work at other agencies, and that they see what’s happening at ours.  

Transformation is a challenging task; shakes up the status quo; upsets traditions. As they say: “Hard work is hardly ever complete.” But it has been done and, together, we are doing it at VA.

Again, thank you for inviting me here today … you are doing important work for DoD, for the Federal Government, and for the American taxpayer.