The Brookings Institution

Elaine [Kamarck, Founding Director, Center for Effective Public Management; Senior Fellow, Governance Studies, Brookings], thanks for that kind introduction, and for the opportunity to have this conversation. Thanks also to Ambassador Eisen for participating.

I want to start by answering the question asked today: “Can the Department of Veterans Affairs be modernized?”

The answer is—ABSOLUTELY YES.

Not only “can” it be modernized—it’s already being modernized, and we’re already seeing the results. Based on what Veterans are telling us, we’re already seeing improvements in the care they’re receiving from VA.

Last Fiscal Year, we completed nearly 5 million more appointments than in the previous fiscal year—almost 57 million appointments inside VA and over 21 million in the community.

This past March, we set a new record for completed appointments—5.3 million inside VA—730,000 more appointments than in March 2014.

We issued 370,000 authorizations for care in the community in March—twice as many as in March 2014. These authorizations will result in more than 2 million appointments in the months ahead.

Clinical workload is up 11 percent in the past two years—nearly 9 percent inside VA and 27 percent with VA community care. In a system the size of VA, that means over 7 million additional hours of care for Veterans.

The results: 97 percent of appointments are now completed within 30 days of the Veteran’s preferred date; 86 percent are within seven days; 22 percent are same-day appointments. Average wait time last month? Five days for primary care, six days for specialty care, and two days for mental health.

But none of those numbers tell the whole story. They’re important, but what really matters is whether Veterans are satisfied with their experience of VA. So we’re asking Veterans what they think, using automated kiosks at our facilities. More than half a million have responded in recent weeks.

One of the questions we ask is, “How satisfied are you that you got today’s appointment when you wanted it?” Nearly 90 percent say they are “Satisfied or Completely Satisfied.” Less than 3 percent say they are “Dissatisfied or Completely Dissatisfied.” I don’t know how patients in the private sector would answer that question, but I expect our results would compare favorably.

But guess what? As we improve access to care, more and more Veterans are choosing VA care—for the quality, for the convenience, or for the cost-savings. You’ve heard, “If you build it, they will come.” Well, we’re building a better VA, and Veterans know that and are coming to us for more of their care. So even though we’re providing more appointments than ever, some Veterans are still waiting longer than they should have to wait.

But that’s not a measure of our failure, that’s a measure of our success: We’re providing more care, Veterans are waiting less time for care, so they’re coming to us for more of their care, and they’re telling us they’re “satisfied or completely satisfied” with the timeliness of their care.

How does that not spell success?

But until all Veterans are satisfied with their care, I won’t be satisfied with VA. Nobody at VA will be satisfied with VA.

But I am satisfied that we’re on the right track and making great progress, and that progress is undeniable—though, of course, some people are determined to ignore it.

I’ve had some experience running very large organizations, and I know you can’t accomplish a major overhaul of a corporation’s culture and operations over night. I also know that VA has several areas of excellence it can fairly brag about.

• The American Customer Satisfaction Index has rated our National Cemetery Administration No. 1 in customer service five times running.
• J.D. Power has rated our mail-order pharmacy best in the country in customer satisfaction six years running.
• We’re a leader in many fields of research—PTSD, TBI, SCI, prosthetics, genetics.
• We’re also a leader in medical innovation: The first implantable cardiac pacemaker, the first successful liver transplant, the first nicotine patch, 3 Nobel prizes, 7 Lasker awards.
• And look at what we’ve done with the backlog of claims: Not long ago, we had a backlog of over 600,000 claims more than 125 days old. That was all you heard about VA in those days. What did we do? We added staff, adjusted some policies, and designed and implemented an automated claims processing system. And today the backlog is just a fraction of what it was. It’s down almost 90 percent.

So the idea that VA can’t be fixed, or that we’re not fixing it, is just nonsense. We are fixing it. We’re just not finished yet.

Our vision—the goal we’ve set for VA and are now working towards—is to be the No. 1 customer-service agency in the Federal government. We’re building a high performing organization—an integrated, customer-centric enterprise leveraging VA’s vast scope and scale on behalf of every Veteran we serve.

To achieve that goal, we’re applying the best practices and standards of customer-service businesses. Twelve of our top 17 executives are new since I became Secretary, and all 12 have top-level leadership experience in business, health care, and/or government.

Together, we’ve conceived and organized a transformation initiative called MyVA, because that’s exactly how we want Veterans to see us—a VA they’re proud of.

We’re committed to five long-term strategies:

1. Improving the Veteran experience,
2. Improving the employee experience,
3. Achieving support services excellence,
4. Establishing a culture of continuous performance improvement, and
5. Enhancing strategic partnerships.

For the near-term, we’re focused on quick wins for Veterans—12 Breakthrough Priorities for 2016 that support our long-term MyVA strategies. Eight of the 12 are about directly improving service to Veterans.

1. Improve the Veteran Experience,
2. Increase Access to Health Care,
3. Improve Community Care,
4. Deliver a Unified Veteran Experience,
5. Modernize Contact Centers,
6. Improve the Compensation & Pension Examination
7. Develop a Simplified Appeals Process, and
8. Continue to Reduce Veteran Homelessness.

Four of the 12 priorities are critical enablers designed to improve the employee experience, staff critical positions that are vacant, transform our Office of Information & Technology, and transform our supply chain to increase responsiveness and reduce operating costs.

Those four critical enablers are about reforming internal system, giving employees the tools and resources they need to provide great service, and consistently delivering an exceptional Veteran experience.

For employees serving Veterans, growing a high-performing organization means intellectually equipping more and more teams to dramatically improve care and service delivery to Veterans.

That’s what our Leaders Developing Leaders program, LDL, is doing. LDL is an example of continuous, enterprise-wide growth, spreading best practices across VA. We launched LDL last November and have already trained over 19,000 employees.

We’re also training employees on advanced business techniques like Lean Six Sigma and Human Centered Design, and we’re tying executive performance ratings and bonuses to Veteran outcomes, employee surveys, and 360 Degree Feedback.

Growing a high-performing organization also takes world-class collaboration and strategic partnerships, vast networks working together to serve Veterans.

That’s why we’ve enabled a national network of 57 Community Veterans Engagement Boards. These boards are designed to leverage community assets, not just VA assets, to meet local Veteran needs. Our goal is 100 by the end of the year.

That’s why we’re capitalizing on strategic partnerships with external organizations to leverage the goodwill, resources, and expertise of partners such as IBM, Johnson & Johnson, Amazon, Bristol-Myers Squibb, the University of Michigan Health System, and many more.

That’s why we’re working collaboratively with world-class institutions like USAA, Cleveland Clinic, Wegmans, Starbucks, Kaiser Permanente, Hospital Corporation of America, among others.

And it’s why we’ve brought together the diverse group of business leaders, medical professionals, government executives, and Veteran advocates who serve on our MyVA Advisory Committee.

Growing a high-performing organization takes a clear purpose, strong values, and enduring principles supporting sound strategies. We already have a clear purpose: Our mission, caring for Veterans and their families. We have strong, admirable values: They’re our I-CARE Values of Integrity, Commitment, Advocacy, Respect, and Excellence—foundational to everything we’re doing.

Growing a high-performing organization takes strong, passionate leadership, and we have that—a growing team of talent making innovative changes and creating opportunities for even greater progress.

And it takes the kind of responsive systems and processes we’re building—Veteran-centric by design.

We believe that Veterans should have same-day access to primary care, and that new patients should receive a same-day mental health assessment and immediate care, if needed. This could mean a same-day appointment with a primary care doctor, or a call from a nurse with medical advice, or a telehealth or mental-telehealth encounter, or a secure message, a prescription refill, or a walk-in to a clinic or emergency facility.

We’ve put in place a system to identify best practices in VHA and implement them throughout the VHA system. We’re already doing that. It’s based on the “Shark Tank” model: We invite employees to submit ideas, take a couple dozen of the best ideas, and then have the employees themselves present their ideas to a panel of “sharks.”

The ideas that survive are then assigned a team to oversee implementation throughout VHA. It’s an ongoing effort aimed at continuous improvement in operations directly affecting the Veteran experience. And nobody else in the health-care community is doing it: VA is leading the way, as it often does.

We are improving access to healthcare in many other ways as well:

• We’re making it easier for Veterans on the road—away from their regular VA hospital—to receive care or refill a prescription at another VA facility.
• We’re making it possible for Veterans to enroll for health care online or over the phone, beginning July 5th.
• We’re already calling every new enrollee to welcome them to VA, offer to schedule an appointment, and tell them about other VA benefits and services.

We’ve called 200,000 Veterans so far this year, and the response has been great.

• We’ve created a mobile app that lets Veterans to schedule, reschedule, or cancel appointments on their smartphone. Thousands have already tried it and loved it in field tests, and we expect to make it fully available later this year.
• We’re creating a single phone number and a single website so Veterans have a one-stop source for information, rather than asking them to navigate our complicated internal structure.
• We’re also working to give Veterans more opportunities to provide immediate feedback on the quality of the service they receive. These channels will be in place later this year, and that feedback will help us to better meet the needs of Veterans.

We’re committed to doing everything we can for Veterans—advancing on all these lines, and many others.

But important priorities for transformational change require congressional action. The President’s FY2017 Budget Request is another tangible sign of his steadfast devotion to Veterans and his commitment to transform VA. The Senate Appropriations Committee approved a budget nearly equal to the President’s request. The House markup, however, proposes a $1.5 billion reduction.

Let’s be clear: That reduction will hurt Veterans, and it will impede some critical initiatives necessary to transform VA into the high-performing organization Veterans deserve. So we’re encouraging Congress to fully fund VA at the level requested.

More than 100 legislative proposals for VA are in the President’s 2017 Budget and 2018 Advance Appropriations requests. Over 40 are new this year. They require congressional action. Some are absolutely critical to maintaining our ability to purchase non-VA care.

In mid-March, I testified to Congress about the most important requirements to help us serve Veterans better. Deputy Secretary Gibson will be testifying before the House Veterans’ Affairs Committee again Thursday.

We need Congress’s help modernizing and clarifying VA’s purchased care authorities. Above all else, this needs to get done to ensure a strong foundation for Veterans’ access to Community Care.

We need Congress’s help streamlining VA’s Care in the Community systems and programs. Last October, we submitted our plan to consolidate and simplify the overwhelming number of different programs and improve access to VA Care in the Community.

We need Congress to enact legislation that will allow us to better compete with the private sector to get the best medical professionals to choose VA. That means flexibility on the 80-hour pay period limit for certain medical professionals and compensation reforms for network and hospital directors.

Likewise, we need to treat health-care career executives more like their private-sector counterparts. That means expanding the Title 38 hiring authority to VHA Senior-Executive-level Medical Center Directors, VISN Directors, and other health-care executive leadership positions.

Then, we could hire these employees more quickly with flexible, competitive salaries, and they’d operate under stronger accountability policies.

We have to be more responsive to Veterans’ emerging needs. So we’re asking for modest flexibility to overcome artificial funding restrictions on Veterans’ care and benefits.

And we’ve urged ambitious action on our disability claim appeals system. We simply cannot serve Veterans well unless we can come together and make big changes in the appeals process. It’s a heavy lift. But we’ve met with the VSOs and other Veteran advocates, and we’ve gotten their assistance in putting together a comprehensive appeals-modernization legislative proposal, which we submitted to Congress in April and updated earlier this month.

I believe Congress is responding. On the Senate side, Chairman Isakson in partnership with Ranking Member Blumenthal is working on the Veterans First Act—a large omnibus that includes many of the legislative solutions we’ve been urging. On the House side, Chairman Miller has been working with us closely as well.

But our window of opportunity is closing fast. We need Congress to act on the proposed legislation before they leave town in mid-July for their extended, election-year summer recess.

If Congress doesn’t act on these transformational changes, VA will not be able to complete its transformation, and Veterans will have to settle for a VA that is not as responsive to their needs. There’s no question of that.

If Congress acts, we’ll all look back on this year as the year we turned the corner for Veterans.

Those are a few points about our progress and challenges.

Now, some have argued that VA can best serve Veterans by shutting down VA health care altogether. They argue that closing VHA is the kind of “bold transformation” Veterans and their families need, want, and deserve. I suspect that proposal serves some parties somewhere pretty well.

But it’s not transformational. It’s more along the lines of dereliction. It doesn’t serve Veterans well, and it doesn’t sit well with me.

President Reagan gave Veterans “a seat at the table of our national affairs” nearly three decades ago. MyVA is about keeping Veterans at the table, in control of how, when, and where they wish to be served.

Thank you for sharing this time with me this morning. I look forward to your questions.