Record claims spur demand for automation at VA

The Department of Veterans Affairs, which processed a record one million claims in 2010, is still seeing claims come in faster than it can process them and expe...

By Jared Serbu
DoD Reporter
Federal News Radio

The Department of Veterans Affairs is making progress on processing more claims more quickly, but expects to receive a record number of new claims in 2011. VA says applications for benefits still are coming in faster than the department’s staff and IT programs can move them through the system.

The department processed more than a million claims for the first time in 2010, said VA Secretary Eric Shinseki. But Shinseki said VA also saw 1.2 million new benefit applications come into the system at the same time. And Shinseki said they’re expecting even more this year—between 1.4 and 1.5 million.

“This growth is tied in part to the economic downturn, and merely hiring more claims processors won’t give us the added capability to dominate this kind of growth pattern,” he said. “We’ll get incrementally better, but it doesn’t allow us to handle the numbers coming in as well as take down the backlog. We must automate, and we must do that quickly.”

Shinseki, who spoke Tuesday to the American Legion’s Washington conference, said automation will let VA improve not just the speed of it claims, but its accuracy in processing them. The department’s claims process currently produces accurate results on 84 percent of claims. He said the goal by 2015 is not only to eliminate VA’s claims backlog and act on claims within 125 days, but improve its accuracy rate to 98 percent.

“We have terrific claims processors who’ve been doing this for 20 or 30 years. They’re very experienced and the quality of their decisions is extremely high,” he said. “Then we have youngsters who are still learning, but because of the sheer demand and numbers we have to put them on line, supervised by some of the more senior folks. What automation allows you to do is take the experience of that 30-year veteran and put it into a rules-based engine, so that the three-year experience person has the benefit of that kind of experience. When the data is provided, you push a button and get the decision that would have been provided by that 30-year employee.”

The President’s budget request for VA includes more than $3 billion in information technology spending and funding to hire more than 700 new claims processors. With those investments, VA thinks it will start to see some sharp, upward progress on the rate at which it can sift through and process backlogged claims by next year.

By then, Shinseki said several automation projects that are now in a pilot phase will begin to pay off. The ultimate goal is to fully automate the disability claims process.

“The budget provides $148 million to complete pilot testing and fielding of our paperless system, the Veterans Benefits Management System, VBMS,” he said. “That’s where we’re headed. We began piloting VBMS in Providence, Rhode Island in November 2010. It looks great. We hope to roll it out nationally in 2012.”

VA expects to see even more growth in claims in the coming five years. The department’s claims transformation plan tries to grapple with the fact that healthcare is getting more expensive, more benefits are being offered, more veterans are taking advantage of those benefits, and the veteran population is changing. Among the changes, Shinseki said, is a growing population of female veterans.

“These numbers are going to continue to grow,” he said. “We want to get out ahead of that growth and assure that we have both programs and facilities as well as research underway before their numbers become more significant.”

But new survey findings released by the American Legion Tuesday found that VA, from the perspective of female veterans themselves, is falling short of meeting their needs. The Legion’s survey of 3,000 women veterans found respondents felt female-specific VA health services were lacking, and that female veterans are often mistakenly identified by VA when they present for treatment as military wives, the military publication Stars and Stripes reported.

Only around 25 percent of eligible female veterans use VA services, according to the veterans advocacy group.

(Copyright 2011 by All Rights Reserved.)

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