PegaWorld iNspire 2024: Department of Veterans Affairs keynote - Caring for More than our Veterans: Modernizing the VA Family Member Program

Thank you for being here today. Thanks for having me. And thank you to your family for their service. We appreciate it. Absolutely. And thank you for the care. So speaking of the Veteran Family Member program, can you tell us what that is? Yeah. So the Veteran Family Member Program is a conglomerate of five federally mandated programs that provide services to the families of veterans.

It includes CHAMPVA, CWVV, Camp LeJeune, Spina Bifida, and FMP. That's a lot of acronyms. Can you break those down a little bit? Absolutely. I'll help you with all that alphabet soup. So CHAMPVA is our civilian health and medical program. CWVV is the children of women Vietnam veterans. We have Camp LeJeune, Spina Bifida, and FMP is our federal foreign medical program. A lot of impact.

That's amazing. What is your role? My role within the VA is I work for our program management office for VFMP, and it is my job to help manage our data analytics, dashboards. I also do project coordination, helping the business partner with IT to make successful projects. And I also do outreach, which is why I get to be here today with everyone. So huge scope of programs and huge scope of role. How did you get to where you are today? So true story. In college I wanted to be a park ranger more than anything, and I was a student contractor with the park service.

But it's really hard to get in with the Park service. And so my supervisor at the time said, now that you're graduated, I had to leave my contracting position. She said, get into the federal government anywhere. Just get in and then you can come back over. It'll be a little bit easier. So I was like, okay, cool. So I applied everywhere and the VA took me in. But when I got here, it was just such a powerful mission and it's such a cool thing to do. Every day we come in and we impact people's lives.

We make people's lives better. And so they just got me. They got their hooks in me. I joined as a voucher examiner. I was a lead. I was a supervisor. I went into program analytics. I worked for our eligibility and claims processing department, and now I'm in the program management office and I just love it. I can see why you love it.

You've got a huge impact. But I also know that you deal with a lot of complexities, not only due to the programs, but with all of the technology that you have to deal with. Yeah, definitely. I think a lot of people can relate to the struggle of having old technology. A lot of what we still do is snail mail. It's physical paper. It's insane. We also have a ton of fax issues. We receive faxes, and we still have to print them, rather than maintaining that digital platform.

It's crazy. And so everything's really manual. It's hands on. And so we create this black box where we receive something, but then nobody kind of hears back from us until the end of our process. And so they come in and then they're just waiting and waiting and waiting and waiting. And then they finally hear something. And that can be really frustrating. Absolutely. And I know you're not the only one here today that's dealing with old technologies.

So how are you using Pega for modernization? One of the first places we looked to leverage the technology and we were trying to modernize is our eligibility department, because that's step one. We got to get people in the doors before we can get them any kind of care. And so with our eligibility department, as I said, we're dealing with a lot of paper that's coming in. It's still manual. Somebody has to sort it and go through it. And one of our biggest hurdles, one of our greatest frustrations, was that documentation that comes in for eligibility. One of those documents is called an OHI cert, which is another health insurance certification. And it lets us know if there's another payer involved.

And that helps us with claims adjudication. Normally when you're trying to get in the door for eligibility, you're not interested in the claims payment part yet. You're just trying to get those benefits for your family. And so a lot of times people aren't thinking about that complexity. But we are, because the sooner we have that information in our system, the sooner we can start getting payments out to the families. And so it was a really painful manual process to get that OHI cert once we were done with eligibility, across the wall over to our claims department, where the OHI team could be able to do their role, and we couldn't send out the notification to the team until that was done, right. And there was no correct, like direct connection. It was insane. There was just this process where we have a report that runs, and then the OHI team would have to go on this kind of hunt and destroy to try and find who's the new bene, and where is their OHI cert, and get it in the system so that we could then send out that welcome packet.

And so we started leveraging the tools to get us to the point where we could make those two teams connected. They could get to each other quickly. And so now when our eligibility department finishes up an application packet and they set Complete on that document, it goes directly to my OHI team and they can get right to work, which means we're getting that packet out in days rather than weeks. So it really benefits the employees as well as the end recipients. Exactly. It helps everyone. Yeah, but that's just one one workflow. I imagine you have a lot more. So how are you approaching reuse in like a backbone?

Yeah, exactly. So it's not just eligibility, it's claims processing. It's records management. It's also the appeals department. We have duty to assess. So there's all these different teams that are trying to be effective, trying to communicate, trying to get information. So we're using that same process that we developed for eligibility and OHI to connect everybody. But we're also able to connect all these other pieces into the puzzle. So we have digital upload, which allows our teams to upload documents directly to each other.

So if I receive something like, a call center often gets emails, instead of having to print that email and carry it down to the mail room to get it sorted and scanned, they can just send it directly into Pega to who needs to have it to make that determination. And that's a huge impact for not just our beneficiaries, which is nice, but it's also a huge impact for our employees because our employees like me, my team's small, we're very small. We joke we're the mom-and-pop shop, and they care a lot. So having these tools that allows them to be more effective is really empowering for them. We also have been able to work towards getting our faxes to where they stay digital, instead of having to print them, and we can just load them directly to who needs to have them instead of having somebody else touch them. And we're looking forward to an opportunity where having all of these pieces connected gives us more transparency for the beneficiary. And one of the things that I took away as well is you're streamlining it, but not getting rid of all the inputs because you're dealing with a multi-generational base. So you can't just get rid of all that technology. No, some people love their faxes.

Yeah, not me, but that's fine. What wisdom do you have post-implementation? The key to the success that we've been having with this effort has been that our IT department is really now out of their silo and working with the business. We're really a collaborative partnership now, where the business is in the room talking to our development team. We're having a lot of back and forth. And so early on we're identifying places where maybe our developers had a different idea than my business team. And we can collaborate and look at it and build together. And so every step of the way they're tweaking it and getting us where we want to be, which is really nice, because historically, I've had the experience where IT was so siloed out from the business that we would go to them and say, I need a tool that does this. And then a couple months later, they'd be back and be like, here's your tool.

And I'd be like, that's really great, thank you. But I kind of need it to do this, and I need this over here. And they'd be like, well, we're kind of done, but we could make it pink. And so it's always been really frustrating, and we're really proud of the way we have changed that process within the VA. Yeah. So collaboration and in the end saving time and money. Absolutely. That's awesome okay. So what else have you achieved with the modernization efforts?

With that change, we've also really been able to see across the board that increased efficiency we've talked about. We've been reducing backlogs. We've been reducing the paperwork employees have to handle. I talked about, when we print a fax, an application packets like 5 to 15, maybe 20 pages, and each of those pages has to be identified. You have to print a barcode, you kind of have to stack it all together and then put it through the scanning. And so it's just a very intense process. And we're working towards a future where they don't have to get their hands on it. And we can streamline that process. And these are our first steps in that direction where things are digitized and it's so much better.

And so it's improving the experience for our employees, which is increasing that performance for our beneficiaries. And we have 700,000 beneficiaries within our program. And we're growing. We have a future where we see a lot more growth since the passing of the 2022 PACT Act, which made disability access larger for the veterans. And so we've got a lot to work towards. So it's extremely important that all of these back end processes and streamlining impacts who you serve. So how else are you seeing that happen? So one of our greatest pain points is our foreign medical program, because that process I talked about where we have to go through and sort all the documents and do all that, we get to do it like three times. Because we receive things and we receive emails, we receive faxes.

We have to print those, we have to sort them. And then when we scan them, we can only send them to the translator. So we just get one place and then the translator send it back, and we get to print all that again and go through that whole process again and then get it into our digital workflow. And so we end up having to touch the document two, sometimes three times. Because if it comes to the eligibility department, then we have to do it again to get it over claims. And so we can end up touching the same document three times. You have six different people involved before it actually gets to the person who gets to make the decision. And so it takes so long, just time consuming. And so it's really hard to get those payments out timely.

It's really hard to make those decisions timely. And so we have worked to build a process where a document can come in, it can stay electronic and go to our translators. It can come back to us, it can go to eligibility, and then it can go to claims without ever having to be in print once, which is really nice because I really care about the rainforest as a ranger. Yeah, let's save the rainforest, that will help. Awesome. So you've achieved a lot, but what's next? I'm really excited about what's next. And I'm really grateful for the opportunity to share it with everyone. We're really proud of the work we've been doing in the VA.

We are partnering with VA.gov to create an online portal where people can apply through the portal online. They can go directly there, they can upload all the documentation we need with that packet. And that's going to be up by the end of this calendar year. We're so excited. And then we also have online claims submission coming online and record management and appeals submissions. All of that will be managed through VA.gov. So that our partners, to your point about multi-generational experiences, some people really love to send us faxes. Some people are very comfortable with mail. Other people like me have young children, and we're a different generation and we want to have that access.

And so a lot of our beneficiaries want to be able to go online and just submit that documentation, and we're going to be bringing that capability to them very soon. And we are so excited. That's awesome. It's huge. We are so stoked.