Inside the Dept. of Veteran Affairs Top Business Transformation Priorities

The Department of Veteran Affairs is entering the third year of an ambitious modernization plan that will transform the administration into a more efficient and patient-centered organization. As of 2018, the most recent year of available data, the VA is responsible for the care of 19.6 million veterans across the US, with 9.17 million actively enrolled in the VA healthcare system. The face value of the insurance policies supervised and administered by the VA totals a staggering $1.22 trillion.

As you can see, the VA is a massive entity that’s responsible for the care of our nation’s bravest heroes. In order to provide the highest level of care possible, the department is making huge investments to modernize its operations.

A few years ago, VA Secretary Robert Wilkie outlined the key focal points of a plan that would be the guiding force behind the department’s transformation. His 2018-2024 Strategic Plan specifies several areas where the VA will focus its efforts over the next four years. In a letter last year, Wilkie specified the administration’s top-four priorities for the years ahead.

Customer Service

First and foremost, the VA wants to improve customer service from all angles. Wilkie is dedicated to transitioning to a customer-centric mindset, and it’s the guiding principle behind most of the department’s transformation efforts.

MISSION Act Implementation

In 2019, congress passed the MISSION Act. This law allows veterans to receive health care treatment at community hospitals that are outside of the VA healthcare network. This landmark treatment should help improve treatment standards by fostering competition between the VA and the private sector. However, the administration must now reassess its operations to account for the possible implications of the new legislation. The goal is to ensure that VA resources are deployed in the most efficient manner possible, so it can meet or surpass the level of care provided by the private sector.

Upgrading Electronic Health Record Systems

The VA is developing a new EHR that will be fully integrated with the entire healthcare network. The new system will connect with the Department of Defense, private health care providers, and pharmacies. This upgrade will better protect patient’s sensitive data, promote more efficient coordination with providers, and ensure timely payment of benefits.

Business Systems Transformation

Perhaps the most ambitious of the VA’s priorities, this initiative aims to modernize the VA’s entire approach to operations. Wilkie wants to bring the VA into the 21st century by implementing a full-scale transformation into digital services. The new operational approach will help the VA become a more efficient, less wasteful organization that can provide veterans with world-class customer service and better overall care.

VA Strategic Goals

The aforementioned priorities are only one part of the big picture. Since 2018, the VA has been undergoing a dramatic overhaul. The administration’s modernization efforts are focused on four key areas, and these objectives will continue to guide the VA over the next four years. As the department continues to execute on its strategic goals, there will be significant opportunities for back-office solution providers.

#1 -Easy Access, Greater Choices, and Clear Information to Make Informed Decisions

Veterans are the VA’s first and only priority, and they want to ensure that these heroes have access to all the benefits at their disposal. The VA wants to improve its relationships with veterans and help guide them throughout the course of their service. In order to achieve this goal, the VA is working to create better one-on-one communication channels with patients so they can better understand individual needs. The department also wants to ensure that veterans are fully aware of the benefits, care, and services that are available to them through both the VA and other providers. Lastly, the VA is prioritizing delivering these services, care, and benefits in a timely manner.

Progress
The MISSION act is motivating a new focus on improving patient access and care at the VA, and the administration is determined to rise to the challenge. So far, the VA has risen to the challenge. Appointment totals increased significantly in 2018, surpassing the previous years’ total by 623,000. During this time, the department’s overall satisfaction rating also increased to 87.7%.

Opportunities

• Electronic Health Records. The VA is creating an integrated online portal that will allow veterans to easily understand their available benefits, and there could be opportunities for software solutions providers who can improve this system. In 2020, the VA requested $1.6 billion to modernize its medical records system, and it plans to spend $4.9 billion to maintain its EHR systems over the next decade.

#2 - Integrated Care & Support, and Excellent Customer Service

The ultimate goal of this strategic initiative is to ensure that veterans have the highest possible quality of life. In order to achieve this very important objective, the VA will fully integrate operations to ensure seamless delivery of benefits, care, and services. The administration plans to offer individually tailored treatment plans that will take into account every individual economic and health needs. This transformation strategy aims to improve the overall well being of veterans, their families, survivors, and care providers by giving them a clear path to economic security and well-being

This strategy also includes a plan to incorporate more technology into VA delivery systems. The administration also wants to drive the rapid expansion of their mobile capabilities so veterans everywhere can access services regardless of where they are located. Ultimately, the VA is looking at any technology that can offer a more efficient delivery of benefits, care, and services.

Progress
The VA has taken significant steps towards this goal in recent years. The most notable example is the passing of the Forever GI Bill, a ground-breaking piece of legislation that overhauled some of the VA’s treatment policies. Most of the changes expand education benefits for veterans, service members, families and survivors.

Opportunities

• Customer Service. The VA’s fiscal 2020 budget includes roughly $220 billion in overall spending. This year’s budget includes significant investments in new care facilities, improving patient access, and more; including $410 million for a new VA hospital in Louisville, Kentucky. In addition, the VA will invest $8.1 million to improve customer services.

#3 - Build Trust; Be Accountable & Transparent

Building trust is no easy task, but the VA is committed to improving its relationships with veterans and other beneficiaries. With the recent implementation of the MISSION act, it’s absolutely necessary for the administration’s long-term survival. The VA needs to build lifelong, trustworthy relationships with the veterans it serves, or veterans will abandon the VA for the private sector. Specifically, the VA will focus its efforts on enhancing accountability, transparency, and value for veterans everywhere.

This strategy includes an added emphasis on organizational accountability. The VA is committed to using data analysis to improve its operational efficiency and process improvement. Part of that commitment includes a focus on proactively identifying and eliminating fraud, waste, and abuse. Individual accountability is also an important aspect of this initiative as well. Veterans Affairs wants to hire employees who embody their values and have a strong commitment to the VA’s mission.

Progress
In 2017, federal law mandated that the VA create a new fraud-prevention division, the Office of Accountability and Whistleblower Protection (OAWP). The OAWP’s stated goal is to investigate misconduct and protect whistleblowers from retaliation. This department faced some criticism in its first few years but the VA is committed to getting the program back on track. VA released a statement analyzing the departments short-falls over prior years and laid out a clear framework for addressing the issues. The newly revamped division should help the VA better eliminate waste and fraud, and it could create a more trustworthy public image.

Opportunities

• Fraud Prevention and Accountability. The VA’s 2020 budget included an 8% increase in the Office of Inspector General’s budget, raising this total to $207 million this year. The VA hopes these increased allocations will “strengthen accountability, promote transparency, and reduce waste, fraud, and abuse.” The administration also allocated $22 million to support the aforementioned Office of Accountability and Whistleblower Protection; a 25% increase from last year. These increases should help the administration build more trust with the public and veterans.

Modernize Systems and Efficiently Focus Resources

Perhaps the most exciting aspect of the VA’s transformation strategy is its commitment to modernizing its back-end systems. In particular, these efforts will focus on human resources and IT. The VA believes that these departments must be optimized rapidly in order for the modernization effort to be successful. However, this strategy also includes a major commitment to improving VA supply chains and logistical efficiency.

Effective supply chain management is integral to efficient operations and a high level of care. The VA’s goal is to build trimmed-down, highly-efficient supply chain that provides timely access to patient data and financial outcomes. However, the revamped supply-chain overhaul will also improve patient access to services and ensure timely delivery of veteran benefits, care, and services.

Last year, the VA entered into a strategic partnership with the Dept. of Defense’ Defense Logistics Agency (DLA) to collaborate on supply-chain modernization. The partnership allows the VA to utilize the DLA’s worldwide logistical network and acquisition system, which will give the administration better access to a broad range of vital supplies, including medical tools, construction materials, and other vital supplies. This year’s budget includes $36.8 million for supply chain modernization.

This unified healthcare logistical system will be much more streamlined and efficient than the previous supply chain, and it will help the agency meet its strategic transformation goals. A VA press release said the partnership will create a ‘centralized ordering system for VA, reducing risk, waste, fraud, and abuse in purchasing medical supplies.

Opportunities

• Financial Technology. Over the past few years, critics have focussed a lot of their attention on the VA’s operational inefficiencies, so it’s no surprise that the agency is putting a lot of money towards trimming the fat in this area. The VA’s aging financial infrastructure is one of the focal points for this controversy, and the agency allocated $184.9 million towards replacing its financial systems this year. Its current systems are over three years old and it’s already attempted to upgrade them twice without any success. The new system is closely linked with VA’s supply chain resources, and some experts predict it will cost about $2.5 billion before it’s ready to roll out.

• Cloud Applications / IaaS. The VA also needs to update its legacy IT systems, which are expensive to maintain and highly inefficient. Over 80% of VA’s IT spend goes towards operating and maintaining these systems, and the costs are still increasing. The VA requested an additional $240 million for its Office of Information and Technology in 2020, bringing the office’s total budget to nearly $4.1 billion next year. That doesn’t include an additional $1.1 billion that’s slated to fund the VA’s ongoing EHR modernization efforts. The VA’s legacy systems are old, wasterful, and susceptible to cyber attacks. In fact, many of the administration’s legacy systems aren’t even supported by the vendor anymore. Ther VA could turn to cloud-based services to solve its IT problems because cloud systems are scalable, efficient, and highly adaptable. There could be significant opportunities for cloud service providers, including IaaS, cybersecurity, and more.

Sources
VA Strategic Plan 2018-2014 (updated May 2019): https://www.va.gov/oei/docs/VA2018-2024strategicPlan.pdf

The MISSION Act: https://stateofreform.com/news/federal/2019/05/the-mission-act-seeks-to-provide-more-health-care-options-for-veterans/

Other budget figures:
https://www.affordablecollegesonline.org/college-resource-center/forever-gi-bill/

OAWP information
https://federalnewsnetwork.com/veterans-affairs/2019/10/vas-new-accountability-office-puts-whistleblowers-at-risk-ig-says/
https://www.va.gov/oig/pubs/VAOIG-18-04968-249.pdf
VA/DOL
Info: https://www.meritalk.com/articles/va-dod-enter-agreement-to-boost-va-supply-chain-management-modernization/
Press Release: https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5295

IT spending/legacy systems:
https://federalnewsnetwork.com/veterans-affairs/2019/04/vas-legacy-it-spend-is-going-up-even-as-growing-list-of-new-projects-call-for-tech-upgrades/

$4.9B EHR spending this decade:
https://www.fiercehealthcare.com/tech/va-dod-adopt-single-logistics-system-for-healthcare-supply-chain

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