Collaborating to Make a Difference

In May, the VA announced a partnership with two veterans service organizations --  the Disabled American Veterans and The American Legion -- to reduce the backlog of claims for veterans benefits by encouraging the filing of “fully developed claims.”  Such claims can be expedited in half the time it takes to process a regular claim.

The VA’s use of collaboration with veterans outreach organizations reflects a broader trend in government to partner with non-profits and others to navigate the complex requirements of various federal benefit programs, such as Medicaid, Social Security Disability, Supplemental Security Income, and the Supplemental Nutritional Assistance Program (SNAP, or food stamps).

In the case of the VA, a new report for the IBM Center by Drs. Lael Keiser and Susan Miller concludes that collaboration is seen as useful and it is growing, at the front lines in the VA’s regional benefit determination offices around the country.  They found that: “Effective collaboration between government agencies and outreach organizations can potentially: 

• Reduce the time that it takes to process applications
• Increase accuracy in eligibility decisions
• Improve customer service”

They note, however, that collaboration is not easy to achieve for a number of reasons, such as the inherent tension between outreach advocates for approval of benefits vs. the duty of a federal benefits examiner to accurately apply program eligibility criteria.

Drs. Keiser and Miller conducted several dozen interviews with VA managers, state government-run veterans agencies, and various veterans service organizations such as The American Legion and Veterans of Foreign Wars.  They offer insights on how collaboration in the field affected timeliness, accuracy, and customer service.

Impact on Timeliness.  Interviews with both veterans organizations and VA managers highlighted both the positive and negative effects of greater collaboration, on the timeliness of processing benefit applications.

On the positive side, veterans organizations (VOs) help reduce the workload of VA benefits examiners by ensuring the claims submitted are complete, so the VA can make a decision without extensive back-and-forth with a claimant: “Many regional office managers believe that the relationship the VOs have with veterans, as well as the amount of experience they have communicating with veterans, make VO representatives particularly effective in getting documents from veterans . . . veterans trust them.”

On the negative side, though, some VA managers believe that “because outreach organizations place such a high priority on providing the best service to their clients – which VA agrees is a good thing – this can sometimes lead to the filing of questionable claims that may not be supported by evidence.  This ultimately slows down the process and contributes to backlogs in the system.”

The authors found that, where VA regional offices did joint training with VOs on the process and where they co-located offices, these kinds of concerns were reduced through better informal communications.

Impact on Accuracy.  Interviews also found that cooperation between VA and VOs “can have an impact on the extent to which claims are processed accurately and consistently.”  Again, they observed both positive and negative effects from collaborative efforts.

On the positive side, the additional reviews of claims by both parties improved their accuracy.  One VO representative told Drs. Keiser and Miller: “we help each other not make mistakes.”  For example, one Connecticut veteran claimed an injury to his left knee, but the medical evidence showed that it was on the right knee . . . the VO confirmed and ensured the veteran corrected his claim.

On the negative side, some interviewees felt that inaccuracies would increase because VOs “might learn ways to make claims fit the eligibility criteria. . . . if non-agency personnel have access to the inner workings of government agencies they may ‘learn the key.’”

To mitigate this potential negative effect, interviewees agreed that VO representatives need to “develop a reputation as professional advocates.  This requires the VO personnel to work inside the rules and regulations.”  When advocates are honest brokers, they create trust among both their clients as well as the VA.

Impact on Customer Service.  “Customer service,” notes the authors, “involving helping veterans understand the program and the process while being treated with compassion and respect.”  Because many of the VO representatives are former veterans themselves, veterans trust the information they receive from them.

The authors say “The VOs field a tremendous number of calls from veterans, and this help to eliminate the burden on the VA.  The VA can thus focus more attention on processing claims quickly and accurately. . . VA employees recognize the importance of these functions.”

“VOs can also alert regional office managers when frontline workers are not providing good customer service,” notes the authors.  For example, “Sue Malley, director of the New York regional office, . . . describes an incident where the VOs alerted her to a problem with customer service.  Without the VOs, she would not have know about the issue.”

Insights and Strategies.  While key stakeholders found collaboration between VA and the VOs beneficial, Drs. Keiser and Miller found variations in the levels of collaboration between various VA regional offices and veterans service organizations.  They identified several best practices that could be applied more broadly, such as highlighting shared goals, co-locating offices, and ensuring the VOs were seen as “honest brokers” in the claims process by all parties.  This can be done by building trust “through expertise and joint training,” note the authors.