VHA will rely on several widely accepted quantitative measures to assess improvement in physical, mental and social functioning of disabled veterans and special populations of veterans. These measures include the following:

• Survey of functional status for the enrolled population. VA will strive to improve the functional status of veterans annually in achieving positive health outcomes.

• Addiction Severity Index (ASI) for patients seen in specialized substance abuse treatment settings.

• Global Assessment of Functioning (GAF) score for patients suffering from mental illness.

• Provide optimal levels of care in skilled community nursing facilities, when clinically indicated.

• Special attention to independent living and employment including homeless veterans treated in VA domiciliary care and in contracted residential care programs.

• Discharges to non-institutional care for inpatient spinal cord injury (SCI) and traumatic brain injury (TBI) patients.

Interspersed throughout VHA's objectives are key strategies and performance goals designed to meet the health care needs of special populations of veterans. VHA is committed to maintaining the existing capacity of these programs and services and has adopted a set of performance goals to ensure this promise is kept. Public Law 104-262, the Veterans' Health Care Eligibility Reform Act of 1996, mandates that VA will report progress annually on performance goals for the following six disability programs: spinal cord injury, blindness, seriously mentally ill, traumatic brain disorder, amputation, and post-traumatic stress disorder. The performance goals established for these programs in the FY 2001 Performance Plan are as follows:

• Spinal Cord Injury: Maintain the proportion of discharges from SCI center bed sections to non-institutional settings.

• Spinal Cord Injury: Increase the percent of SCI respondents to the National Performance Data Resource Center Survey who rate their care as very good or excellent.

• Blind Rehabilitation: Increase the percentage of patients who are "satisfied" or "completely satisfied" when queried on the national Blind Rehabilitation Customer Satisfaction Survey.

• Traumatic Brain Injury: Increase the percentage of TBI patients able to live independently for first admissions patients who are discharged from TBI Network, medical rehabilitation beds to the community (home, board and care, transitional living, and assisted living residences), based on Uniform Data System for Medical Rehabilitation criteria.

• Mentally Ill: Increase the percentage of unique mental health patients seen during a single quarter as either inpatients or outpatients who received at least one GAF score during that quarter. Baseline to be established in FY 2000.

• Mentally Ill: Increase the percentage of homeless patients with mental illness (including substance abuse) who receive a follow-up mental health outpatient visit, admission to a Compensated Work Therapy Transitional Residence (CWT/TR) or admission to a Psychiatric Residential Treatment Program (PRRTP) within 30 days of discharge from from a domiciliary care for homeless veterans (DCHV) or health care for homeless veterans (HCHV) contract care.

• Mentally Ill: Increase the percentage of veterans who acquired independent living arrangements at discharge DCHV Program or a community-based contract residential care program.

• Preservation Amputation Care and Treatment: Increase the percentage of diabetic patients at risk for foot amputations who are referred to a foot care specialist (PACT Coordinator, podiatrist, orthopedic, or vascular surgeon, diabetic educator, etc.).

• Preservation Amputation Care and Treatment: Increase the percentage of patients satisfied with the use of VA issued lower extremity prosthetic limbs.

• Post Traumatic Stress Disorder (PTSD): Increase the percentage of specialized intensive PTSD programs (those currently enrolled in the National PTSD Outcomes Monitoring System) that meet the Special Emphasis Program goal of 50 percent follow-up at four months after discharge.

• Post Traumatic Stress Disorder: Increase the number of months in which the veteran received VA mental health services during the six months after the first PTSD visit.

• Addictive Disorders: Increase the percentage of patients seen in specialized substance abuse treatment settings who have an initial ASI and six-month follow-up ASI.

VR&E has created a pilot program of Employment Specialists (ES) who provide consultative assistance to other VR&E staff on employment services and may provide direct services to job-ready veterans. Through aggressive marketing and educational efforts, the ES promotes a positive image and assists the employment community to hire from a trained applicant pool. The ES monitors the veteran's program to analyze and identify operational difficulties encountered; determines what will reduce or eliminate difficulties; persuades officials to take corrective action; and follows up to assure that required changes have been made and successful outcomes are being achieved.

Employment services training for our supervisory staff and ESs, which includes job-hunting strategies, networking, and employment resources, helps reduce the amount of time needed for veterans to move into suitable employment. In FY 2001, this joint VA/DOL training will improve the skills for our rehabilitation counselors, employment specialists, and other front-line staff. This cross-agency training builds networking links that can speed the employment process.

A job is gained or lost based on the personal employment interview. Effective interview techniques, while very important, are not generally taught as part of educational or training programs. To assist our veterans in developing this skill, we will provide videotaping resources in some of our locations.

We will increase veterans' access to employment information through development and electronic linkages to America's Job Bank; the proposed Veterans and Servicemembers Internet Site; and the Verification of Military and Training.

VHA provides eligible veterans at risk for psychological trauma from active military duty in a combat theater of operations and/or from military-related sexual assault access to clinically effective readjustment counseling that is culturally sensitive and results in positive consumer feedback. The Readjustment Counseling Service systematically surveys veterans for their satisfaction with Vet Center services.

Increasing the MGIB usage rate requires coordination between VA and organizations currently performing, or planning to perform, outreach activities. In addition to this partnering, a coordinated effort with DoD is underway to identify eligible service personnel and to build upon existing base counseling and outreach activities at military bases. State approving agencies and other stakeholders will provide a presence in remote locations. VA intends to establish a network for effective education outreach by supporting various activities in place and creating other activities to improve beneficiary access to benefits and services.

An independent evaluation of VA administered educational assistance programs, to be completed during FY 2000, will provide an opportunity to examine the extent to which these benefit programs serve their purposes and satisfy the needs of their intended beneficiaries. VA will analyze the findings from this evaluation and develop specific strategies for better meeting the needs of veterans and other beneficiaries.

The President signed the "Veterans Millennium Health Care and Benefits Act" (PL 106-117) on November 30, 1999. This comprehensive legislation improves a broad array of health services for our Nation’s veterans. It firmly established a high priority for nursing home care to the most severely disabled veterans and those needing nursing home care for a service-connected disability, enhances VA’s home and community-bsed extended care programs, and requires VA to maintain these programs at the FY 1998 level. The Act authorizes VA to set co-payments for higher income non-service-connected veterans who use VA extended care services and allows VA to update co-pay charges for pharmaceutical and outpatient services. The Act also allows VA and DoD to enter into an agreement expanding DoD reimbursement to VA for care of certain dually eligible TRICARE beneficiaries. The legislation authorizes VA to reimburse certain veterans as payor of last resort for emergency care, expands programs for homeless veterans and sexual trauma counseling, expands enhanced-use leasing authority, and enhances other VA medical programs.

VA needs to increase access by developing additional national cemeteries in unserved areas; expanding existing national cemeteries to continue to provide service to meet projected demand, including the development of columbaria and the acquisition of additional land; and developing alternative burial options consistent with veterans’ expectations. Three new national cemeteries will be opened in FY 2000 near Chicago, Illinois; Dallas/Ft. Worth, Texas; and Cleveland, Ohio. In addition, new national cemeteries will be developed to serve veterans in four areas identified in the 1994 report to Congress.

In addition to building new cemeteries, VA will expand existing national cemeteries by completing phased development projects in order to make additional gravesites and/or columbaria available for interments. Phased development in ten-year increments is a part of the routine operation of an open national cemetery. It is the practice of the National Cemetery Administration to lay out and subdivide a cemetery by sections or areas so that it may be developed sequentially as the need approaches. National cemeteries that will close due to depletion of grave space are identified to determine the feasibility of extending the service period of a cemetery by the acquisition of adjacent or contiguous land, or by the construction of columbaria.

To complement VA’s system of national cemeteries, NCA administers the State Cemetery Grants Program (SCGP), which provides grants to states of up to 100 percent of the cost of establishing, expanding, or improving state veterans cemeteries including the acquisition of initial operating equipment. These cemeteries may be located by the states in areas where there are no plans for NCA to operate and maintain national cemeteries.

VA provides headstones and markers for the graves of eligible persons in national, state, other public and private cemeteries. Delivery of this benefit is not dependent on interment in a national cemetery. In addition, NCA will continue to ensure Presidential Memorial Certificates are delivered accurately and timely. A Presidential Memorial Certificate conveys to the family of the veteran the gratitude of the Nation for the veteran’s service.

We will improve accuracy and operational processes, reducing the number of inaccurate or damaged headstones and markers delivered to cemeteries. Headstones and markers must be replaced when either the government or the contractor makes errors in the inscription, or if the headstone or marker is damaged during delivery or installation. When headstones and markers must be replaced, it further delays the final portion of the interment process, the placing of the headstone or marker at the gravesite.

VA will use, to the maximum extent possible, modern information technology to automate our operational processes. On-line ordering using NCA’s Automated Monument Application System – Redesign (AMAS-R) and electronic transmission of headstone and marker orders to contractors are improvements that increase the efficiency of the headstone and marker ordering process. NCA will increase its efficiency by encouraging other federal and state veterans cemeteries to place their orders for headstones and markers directly into the AMAS-R system.

Strategies of managed care have transformed VHA’s health care delivery system by facilitating patient treatment in the most appropriate setting. The primary care provider/team as the coordinator of health services plays a key role in assuring high quality, cost effective care. This shift to primary care enables veterans to receive services from clinicians who are accountable for addressing and coordinating their health care needs.

VA has developed plans and maintains readiness as required by Public Law 97-174. A Memorandum of Understanding between VA and DoD has been implemented which requires joint plans and procedures for using the VA medical system as the primary backup to DoD during war and other national emergencies. The National Disaster Management System (NDMS) Federal Coordinating Center Guide coordinates planning and conducts local NDMS area exercises as a Federal Coordinating Center responsibility. The four partners in NDMS are VA, DoD, the Public Health Service, and the Federal Emergency Management Agency (FEMA). The mission is to maintain these partnerships to address the varied needs of veterans, active duty military personnel, and victims of catastrophic disasters.

VA has realigned its priority research areas to more appropriately target research projects that address the special needs of veteran patients and to balance research resources among basic and applied research. This approach will ensure a complementary role between the discovery of new knowledge and the application of these discoveries to medical practice.

Scientific peer review will be augmented with an administrative review for relevance to VA's health care mission. Projects with VA health care relevance will be selected purposefully for funding before projects with no demonstrable relevance. VA will maximize its research potential and capabilities by focusing on collaborative opportunities where VA is uniquely positioned. VA has identified Designated Research Areas that represent areas of particular importance to our veteran patient population. The areas on which projected obligations for FY 2001 will be the highest are research projects on chronic disease, aging, trauma related illness, health systems, and military occupations and environmental exposures. An effective and efficient career development process will be implemented for VA investigators.

As the veteran population ages, the management of health care for the elderly becomes increasingly important to VA. New multi-site clinical trials are being planned with the National Institute on Aging to address health care delivery issues in the aged. The results of these studies should contribute to better, more cost efficient, care for elderly veteran patients. Prostate disease is also of great importance to both VA and Congress. New clinical trials are being planned to address the treatment of prostate disease and should be ready to start in FY 2000.

Projects with VA health care relevance will be selected purposefully for funding before projects with no demonstrable relevance. Scientific peers on the Federally chartered review boards determine the scientific merit of the projects seeking funding from VA's Research Program and institutions of higher learning. In addition, attention is paid toward ethnic, racial, gender, and geographical balance on these review boards.

VA will reduce its subspecialty medical resident positions and increase positions in primary care training. Based on the recommendations of the Residency Realignment Review Committee, VA will make a shift of 1,000 specialty resident positions by FY 2001. Some 750 positions will be filled as primary care positions and 250 positions will be eliminated. The latter is in keeping with the larger national goal of training fewer physicians. Further, VA will provide an educational and training experience for medical residents and other trainees comparable to, or superior to, their other academic training opportunities. VHA is working to ensure medical residents and other students rotating through its clinical programs are part of a modern health care system where not only the students but also the permanent staff learn as a result of the excellent patient care being provided. Therefore, VA will identify key drivers of medical resident motivation and satisfaction through surveys, and develop and implement appropriate improvements.

VA will maintain the appearance of national cemeteries as national shrines, so bereaved family members are comforted when they come to the cemetery for the interment or later to visit the grave(s) of their loved one(s). In order to achieve this objective, NCA must maintain occupied graves and developed acres in a manner befitting national shrines. Extensive renovation of grounds, gravesites and grave-markers will be undertaken at cemeteries where the greatest needs exist. NCA will begin renovation of historic structures at 59 national cemeteries that were developed during the Civil War era.

NCA will continue its partnerships with various VA and civic organizations that provide volunteers and other participants to assist in maintaining the appearance of national cemeteries.

NCA conducts surveys of the families of individuals who are interred in national cemeteries and of other visitors to measure how the public perceives the appearance of the cemeteries. Information obtained from these surveys is analyzed to ensure NCA addresses those issues most important to veterans, their survivors, other cemetery visitors.

All national cemeteries are important locations for patriotic and commemorative events. VA will continue to host ceremonies and memorial services at national cemeteries to honor those who made the supreme sacrifice. To preserve our Nation’s history, NCA will continue to conduct educational tours and programs for schools and civic groups.

VHA will continually strive to meet or exceed the expectations of veterans and their families by delivering accurate, timely, and courteous service. VHA obtains continual feedback from the general veteran population on their satisfaction with service through surveys, focus groups, complaint handling, direct inquiry and comment cards. This feedback includes information on the following:

• The percent of customers rating VA health care service as very good or excellent.

• The proportion of patients who rate the quality of VA health care as equivalent to or better than what they would receive from any other health care provider.

• The share of patients reporting coordination of care problems in the outpatient customer feedback survey.

• The average number of problems reported per patient on courtesy questions in the annual outpatient customer feedback survey.

VA also obtains feedback from special populations of veterans to assess their satisfaction with the service they receive. These include the following:

• The percentage of spinal cord injury patients who rate their care as very good or excellent.

• The percentage of patients queried on the National Blind Rehabilitation Customer Satisfaction Survey who are satisfied or completely satisfied with their care.

The Department is beginning to reengineer processes and benchmark with world class organizations to optimize process cycle times and access to services. The focus of these efforts is on goals to improve access by decreasing waiting times for primary care appointments to 30 days, waiting times for specialty appointments to 30 days, and waiting times to see a provider to 20 minutes.

Additional strategies to improve service and access include providing 24 hours-a-day, 7 days-a-week access to nurse advice lines, implementing technological requirements to make patient clinical information available across sites of care for providers, and ensuring VISNs will have improved timely access to patient information needed for patient care and decision-making.

Providing 24 hours-a-day, 7 days-a-week access to nurse advice lines is a commonly provided service, if not a community standard, for most health plans today. In addition to improving the ability to provide timely and proximate care to patients, telephone care can improve the quality of care by reducing unnecessary emergency room visits, physician appointments, and walk-in-visits. All patients can potentially benefit from access to telephone care 24 hours-a-day, 7 days-a-week.

Strategies to accomplish this goal include: providing after-hours access to phone care through five regional call centers; upgrading phone systems in sites where regional call centers may be placed to allow for automatic intelligent call switching and call forwarding; developing and improving read only access to VISTA databases across sites of care; providing recurring funding to support call center staff in regional call centers; and providing the capability and connectivity for web-based interactive access to patients.

Patients increasingly seek and receive VA care at multiple sites. They may receive primary care at community-based outpatient clinics (CBOC) and specialty or inpatient care at one or more medical centers. Timely access to clinical information by VA staff from multiple sites of care is paramount to ensure prompt service, continuity, and quality care. In addition, providers need a more efficient means to document care.

The bulk of the necessary resources required to achieve improved patient clinical information will be for purchases of equipment and contract services. Examples of equipment to be purchased include: servers; personal computers and peripherals; wireless equipment; imaging equipment and high-resolution video equipment. Contract services would include: technical support; repository development; and telecommunication infrastructure installation. A small percentage of support staff would implement and manage the information technology.

VISN network directors understand the significance of having timely access to patient information for patient care and decisionmaking. Additionally, VHA intends to increase the number of VISNs using remote telemedicine capabilities to enhance access to care for clinical services.

Strategies developed to improve timely access to patient information include:

• supporting infrastructure and solutions to make clinical information available across sites of care;
• providing efficient means of documenting care including easy access to computers and training in the use of the electronic medical record, handheld/wireless devices, and speech recognition tools;
• expanding and enhancing VISTA Imaging and Picture Archiving computer Systems (PACS);
• improving the clinical lexicon (clinical vocabulary) which is essential to all long-term solutions for clinical information exchange and sharing;
• adding domains (laboratory, pharmacy and radiology) to expedite development of the Government Computer-Based Patient Records (G-CPR); and
• purchasing interface engines that will enable the exchange of information between VISTA and commercial off-the-shelf components.

VHA intends to develop a baseline for telemedicine activities in order to enhance access to care for an array of clinical services needed by the populations served. VHA will initiate telemedicine projects, including a national back pain referral center, a psychiatric consultation service for diagnosis and management of depression in the elderly and for management of bipolar disorders and expand the SCI Home Care clinical telemedicine services to remaining SCI centers. Other telemedicine projects will be initiated within VISNs.

VHA has innovative education and training programs and practices that promote a department-wide, systematic approach to the education, training and development of VA employees in order to provide high quality, seamless service to veterans. The VA Learning University (VALU) mirrors the movement in the private sector toward creating corporate universities as a means for providing continuing education and training of employees. If VA is to keep pace with industry standards, greater attention must be placed on providing employees with the knowledge and skills necessary for high performance in an integrated benefits and health care delivery system.

VHA senior level managers have determined that service and access are keys to success and are of direct benefit to veterans and their families. VHA’s overall service and access goal is to provide personalized care when it is needed and where it is needed in ways that are creative, innovative, and cost effective. Personalized care means continuity of care is provided across the continuum by a team that knows the veteran and his or her needs. Timeliness of services ensures care is received when it is needed. Providing care in the manner most convenient to the veteran enables us to provide care where it is needed and wanted.

Reducing costs and improving the revenue stream for the health care system will remain a strategy to responding to the pressures of shifting from a basic system of hospital-centered care to the delivery of managed, patient-centered, primary care and maintaining the necessary core of specialty care. VA will continue to increase the number of patients enrolled in the health care system, pursue sustained program growth, and provide greater access to veterans.

Improvement in technical accuracy of claims adjudication remains the number one priority of the compensation and pension programs. This priority is reflected on the balanced scorecard with accuracy weighted the heaviest. Baseline technical accuracy levels were established during 1998 from special reviews of nationwide samples of cases. Baseline accuracy levels are 64 percent for core rating work, 70 percent for authorization work, and 51 percent for fiduciary work. We anticipate that improvements in the area of accuracy will help drive improvements in other scorecard areas and we would expect a cascading effect on the other strategic objectives.

In the reengineered environment, job certification will become the new formal, standardized process by which employees will demonstrate they have acquired job skills and knowledge. Career progression will be based on acquisition and demonstration of skills. A team of senior level VBA managers is currently addressing certification issues.

As part of VBA’s succession planning strategy to maintain an effective workforce during these times of high attrition losses, in FY 2000, the compensation and pension programs will require an additional 440 FTE. In FY 2001, additional FTE will be hired or redirected into the compensation and pension programs.

Cycle time analysis reveals that most education claims are held for days awaiting review by a decision-maker. By streamlining work processes and minimizing hold time, dramatic improvements in timeliness are achievable. An information technology solution that incorporates artificial intelligence into the claims resolution process by permitting data to arrive electronically, filtering through an "expert" or rules based application, and updating the data base for payment authorization will eliminate the waiting time for many claims not needing human intervention.

To ensure education beneficiaries and other stakeholders receive the best possible service, we will create pertinent training programs that give employees the skills and knowledge necessary to accomplish our mission. This takes on greater importance as VBA pursues workforce planning. As jobs are redesigned to meet the changing needs of our veteran population, effective and timely training becomes critical. We will leverage limited resources by working with VBA’s training staff to present training sessions in the most efficient manner possible. We will provide technical training to stakeholders who assist us in the process of helping eligible beneficiaries achieve the education or training goals.

Improving the veteran's access to vocational rehabilitation and employment (VR&E) staff and information will help VR&E achieve the goal of 60 days to make entitlement determinations by placing staff in military discharge centers and other locations where the veteran population indicates the need. Adjusting work schedules, as needed, will provide additional access to VR&E staff at times more convenient to veterans. We will place teleconferencing capabilities in VR&E locations and locations such as selected county veterans offices, military discharge centers, and state vocational rehabilitation offices which are proximate to veteran populations.

Improving the skills of our staff, through training, we will improve both the quality and timeliness of the entitlement determination process. In 2001, we will develop a needs assessment instrument which will assist us in evaluating the veteran's vocational rehabilitation requirements.

The accuracy of decisions will be improved through our ongoing communications improvements and by improving our access to information sources. Our information management systems, including WINRS and other electronic resources, will improve our ability to obtain important information quickly. We will focus on the accuracy of payments to veterans, institutions, contractors, and vendors, and the accuracy of determining the need to a specific expenditure and procurement of the best goods and services for the best available price.

Our strategies to improve communications, access, and staff skills will place us in a position to meet the needs of our veterans in an effective and efficient manner. Because the nature of VR&E services is direct personal intervention, we need to be accessible. VR&E staff are located in each VA regional office and have approximately 150 outbased or itinerant sites. We will relocate some of our staff to provide access in key population areas not currently well served and support VA’s presence at selected military discharge centers. We will use technology to augment our staff and provide tools to improve access and services.

VA has several methods for controlling costs of the VR&E program. Activity Based Costing will assure that charges for veteran services are properly accounted. Our National Acquisition Strategy will help us evaluate the need for external service providers, agree upon reasonable fees for service, reduce contract administration overhead, and even reduce the number of contract service providers needed to manage our workload. Our further implementation of the WINRS information management system, part of the VBA corporate database, will provide us with tools to collect and analyze program data, including costs, which will support decision-making.

The VR&E program, along with the Federal Aviation Administration, has been selected to participate in a unique organizational development program created at the Massachusetts Institute of Technology. This will allow VR&E to improve its ability for strategic planning, create a systems approach to management, and improve employee development. The program was implemented for VR&E Service staff in 1999 and will be carried to field staff in 2001, 2002, and 2003.

VBA continues to stress the Lender Appraisal Processing Program (LAPP). Under LAPP, certain lenders are authorized to establish property value in accordance with criteria established by VA. With more lenders opting for this procedure, VA staff resources are available to provide better service on those cases where VA makes the value determination. Management has placed strong emphasis on CRV timeliness by making it one of the two critical speed measures on the Loan Guaranty Balanced Scorecard.

To improve VA’s ability to effectively assist veterans who are delinquent on their mortgages, VA will implement an automated system to track the variety of actions taken by VA, lenders, and borrowers during the default period. This system will automate routine and redundant activities, improving efficiency and allowing employees to concentrate on supplemental loan servicing. It will also allow for an earlier analysis of the appropriateness of the different alternatives to foreclosure.

VA totally revised the measurement of the quality of loan guaranty field operations to improve fairness and accuracy, and to focus on essential work processes. The process requires a review of quality at the local level, and a second review away from the work site for validation purposes. The second level review for regional offices is performed at the Regional Loan Centers (RLC). loan guaranty service in VA Central Office reviews the work of the RLCs. After the first year of this process, refinements will be made as the results are analyzed. Staffing changes, training and other management actions will be directed toward areas/functions needing improvement.

The loan guaranty program is moving toward EDI (electronic data interchange) with our trading partners. Testing and implementation of the receipt of loan applications via EDI occurred in 1999. This will be followed in 2000 by development of the receipt of appraisal data by EDI. This will reduce the cost for VA and lenders for originating a guaranteed loan. It will reduce manual data entry and the filing and storage of paper records, freeing staff for more productive work. We plan to have all major communications with lenders on defaulted loans, including intent to foreclose, foreclosure completion, election to convey property and claims filed, submitted by EDI. This will allow staff to concentrate on delinquent loan servicing by reducing person hours associated with review and storage of paper records.

VA relies heavily on the lending industry to deliver the home loan benefit. Ultimately, the level of veteran satisfaction is directly dependent on how well VA can meet the expectations of lenders, builders, real estate brokers and appraisers. This means adapting the delivery of our services to industry practices and making timely changes as technology generates improvements in the loan origination process. Current plans call for major enhancements in the following areas: loan funding fee replacement, EDI, and automated determination of eligibility.

To give employees the training they need to perform their duties properly, Loan Guaranty Service has built a training program for both new hires and seasoned employees. This training has three components: classroom instruction; self-paced, computer-based, and web-based training; and interactive televised training over the Veterans Benefits Network. Because of our unique reliance on our private sector partners (e.g., banks, mortgage companies) to provide the benefit to veterans, we provide training to numerous program participants in the details and workings of the VA home loan program.

Two major actions are being undertaken to maintain the high level of veterans’ satisfaction: the paperless processing initiative and the self-service initiative. In addition, the survey instruments themselves are used as a basis for improving satisfaction. We revised S-DVI forms and pamphlets as a result of feedback that indicated these forms were confusing. We improved follow-up procedures through the use of a new software application after learning we failed to follow-up on some inquiries. We have also made adjustments to work processes based on responses to a survey question that asks, "What could we do better?" We anticipate reassessing our training needs based on survey results in order to improve the delivery of services and the satisfaction ratings.

Several factors impact the toll-free line’s performance. Workforce flexibility and an adequate number of trunk lines for the 800 line play important roles in reducing blockage and average hold time. The insurance program continues to expand the number of telephone agent positions to accommodate high telephone traffic periods during which most blockages occur.

We continue to expand the Interactive Voice Response (IVR) system and Internet access. Recently, the IVR system was expanded to allow the insured to select certain system-generated letters and forms for downloading. Further expansion of the IVR system will take place under the Insurance Self Service initiative.

Veterans with Internet capability can now access the VA Insurance website at www.vba.va.gov/vainsurance.htm. Through this website, policyholders and beneficiaries can download forms needed to request loans, change beneficiaries, and make a death claim. They can also submit questions about their policies or request policy changes either through the website or via e-mail at VAinsurance@vba.va.gov.

VA has undertaken various actions to improve the timeliness of insurance disbursements. Special post office boxes were set up so applications for disbursements would bypass the mailroom and decrease the time required for a veteran to receive a payment. We also improved the way we process returned mail. Incorrect addresses from returned mail are electronically sent on a daily basis to the Social Security Administration in order to obtain a better address. Another focus area is the elimination of data processing delays. Some disbursements require manual processing which is slower and more labor intensive than computerized processing. Programming changes have and will continue to eliminate some manual processing situations. In the future, primary improvements in this area will come from the Paperless Processing, Self Service, and Debt Collection Improvement Act (DCIA) initiatives.

VA has three hub cemeteries to provide weekend scheduling of an interment in a national cemetery for a specific time in the ensuing week. One hub cemetery is located in each of NCA’s three geographic, administrative areas to provide this weekend service to families and funeral directors.

Another means of providing quality service to cemetery visitors is to provide automated gravesite locator information through a user-operated kiosk. Kiosks provide an easy-to-use vehicle for locating gravesites both on weekdays and weekends, particularly outside normal business hours when cemetery staff are not available. Although these kiosks are used primarily for locating gravesites, they also provide other information regarding burial benefits such as eligibility requirements, headstone and marker ordering information, customer service standards, and floral regulations.

NCA works closely with components of the DoD and veterans service organizations to provide military honors at national cemeteries. While VA does not provide military honors, national cemeteries facilitate the provision of military honors and provide logistical support to military honors teams.

The capital investment process was created in June 1997 to foster a One VA approach to the use of capital funds and to ensure all major capital investment proposals are based upon sound economic principles and are fully linked to strategic planning, budget, and performance goals. The process does this by reviewing asset proposals that include high risk and/or mission critical projects. The Department demonstrates excellent progress implementing both the principles and practices of performance-based acquisition management. VA is the first civilian agency to develop an agency-wide capital planning process which allows for investment trade-offs both among and between categories of assets, i.e., medical and non-medical equipment, information technology, infrastructure, and leases. The VA Capital Investment Board (VACIB) makes recommendations to the VA Resources Board (VARB) on capital investments submitted by the major organizations of the Department, resulting in a unified comprehensive VA Capital Plan (VCP) consistent with agency mission, goals, objectives, priorities and strategies. The VACIB is made up of top management from across Department business lines.

Each proposal includes a description of the capital investment and how it supports the Department’s strategic goals. Proposals were first validated to ensure the application criteria were adequately addressed prior to scoring. Investment proposals were scored and submitted to the VACIB for review and approval. Proposals were evaluated based on the following criteria: customer service, return on taxpayer investment, high performing workforce, risk, alternatives analysis, threat mitigation, and special emphasis program. The first three criteria relate to the Department’s strategic goals, while risk and alternatives analysis address improved business practices. Threat mitigation addresses the issue of life safety in VA facilities especially related to seismic safety. The special emphasis program criterion addresses Congressional concern regarding the programs of spinal cord injury, seriously chronically mentally ill, traumatic brain injury, blind rehabilitation, post-traumatic stress disorder, and prosthetics. The acquisition and use of these capital assets will enhance the Department’s ability to attain its strategic goals and perform its mission.

The following projects have been approved for FY 2001:

Project Description: The Government Computer-based Patient Record (GCPR) Framework Project is a joint effort of the VA, DoD, and the Indian Health Service (IHS). It includes the design, development, and implementation of the standards, technical architecture, data architecture, hardware, and software architecture required to achieve an easily accessible, yet secure, life-long medical record for each veteran, military personnel and their dependents, and Native Americans and their descendents.

The primary goal of this readily accessible record is to enhance the health care provided to the patients of the VA and the GCPR partner agencies. Additional goals are to enhance medical research, reduce health care costs, ease transfer of military retirees into VA’s system and improve the efficiency of keeping medical records.

Total Cost: $19,100,000

Project Description: This project will provide for renovation and new construction to establish space for a joint venture Cardiovascular Institute (VA, Scott & White Hospital Affiliate and Texas A&M Medical School) in existing Building 162 and adjacent to Buildings 204 and 162 (Temple Division). This project includes up to 41,300 net square feet of building space, modifications to Center drives, an additional 63 parking spaces, a new chiller, and relocation of several existing functions to make way for the project

Total Cost: $11,500,000 – Funded in FY 2000 with reprogramming

Project Description: This project will lease office space within the central business district of Phoenix. The new leased facility will provide the regional office with the latest facility infrastructure that will provide additional space required because of new program and staff. The state-of-the-art facility will enable the regional office to provide optimal customer service in the form of improved business processes. The new facility will allow the regional office to implement all business process reengineering concepts without any undue hindrances, obstacles, or limitations that would be encountered in an older facility. As a result, implementation of business process reengineering initiatives will produce faster response times, fewer errors, better service to customers, and in the end, happier, more satisfied customers.

Total Cost: $5,773,555

Project Description: This project will implement a Virtual Information Center (VIC), to employ a virtual call center concept by deploying telephone technology that will allow all call servicing resources in a geographically defined region (Service Delivery Network) to participate in a common call queue regardless of their physical location. This strategy will allow regional office telephone managers to adjust the availability of staff without the need of relocating them to centralized locations. A pilot test of this concept is currently being developed for the Service Delivery Network Two (SDN 2) area of responsibility. The SDN 2 Virtual Information Center will use the network resources, the VBA N-ARS and a homogeneous customer-based telephone network to service the customer call demand for the entire SDN 2 servicing area. This initiative proposes implementing a Virtual Information Center at each of the nine Service Delivery Areas.

FY 2001 Cost: $11,683,000

Project Description: This information technology proposal examines alternatives to support continued operation of the BDN until a more modern and less fragile system can be developed. The BDN comprises those application systems, hardware, operating systems software, and network (WAN/LAN) apparatus VBA employs to pay non-medical benefits to the Nation’s veterans. These alternatives are examined in light of the larger issue of the Department’s implementation of data center consolidation (DCC) as mandated by OMB.

FY 2001 Cost: $4,781,000

Project Description: The purpose of this project is to develop burial areas in the remaining undeveloped land and to provide additional and improved facilities needed to support cemetery operations. The gravesite development portion of the project will create the following new burial areas to extend the life of the cemetery to 2020: 26,400 casket sites – including 13,200 pre-placed crypts; 7,000 in-ground cremains sites; and 10,000 columbarium niches. The site improvement portion of the project encompasses development of 66 acres as well as modifications to the existing cemetery to unite the whole cemetery site of 213 acres including: site clearing, demolition, grading, drainage, fencing, and planting; utility distribution systems and lawn irrigation; roadway system, walks and parking; pedestrian and vehicular access modifications. Building construction and renovation included in the project will improve operations and address space deficiencies such as renovation and conversion of the existing Administration Building to Information Center to serve funeral attendees and visitors; new Administration Building located near the existing maintenance complex; and renovation and improvements to three existing committal service shelters.

Total Cost: $19,400,000 - $3,300,000 in C&P

Project Description: This project will provide a multi-vectored approach to managing the risk to VA’s information assets from known threats and vulnerabilities. The eleven initiatives in this proposal represent the concurrent actions necessary to manage the areas of greatest information security risk, as defined by recent GAO and IG audits and the best judgment of the Department-level Information Security Work Group. These initiatives are: Enterprise Risk Assessment; Departmental Incident Response Capability; Standard Security Packages; Remote Network Access; Research Capacity; VA Information Security Awareness Program; VA Information Security Training Program; Information Security Policy Framework and Promulgation; Certification and Accreditation; VA Information Security Web Page; and Information Security Organization. In addition to these initiatives, this proposal requests funds for eight FTE for the Department’s Information Security Program office to support its oversight and coordination role. FTE levels indicated in each initiative are requirements for Office of Information and Technology information security staff only. FTE resources from the Administrations and Staff Offices will also be required to fund the eleven initiatives.

FY 2001 Cost: $17,500,000

Project Description: VA proposes to replace the existing core financial management system and selected other applications that collect and feed financial information to the core system with an integrated, Department-wide commercial off-the-shelf (COTS) based core financial and logistics system. The current systems, which form a collection of non-integrated legacy financial and mixed applications, exhibit a variety of functional limitations and operational deficiencies. The replacement of the core financial system will strengthen the flow of financial information, improve data integrity, increase standardization of procedures, enhance service to veterans and our other customers, and decrease costs.

FY 2001 Cost: $56,899,000

The information technology (IT) vision, One VA, is expressed as a set of functional capabilities needed to better serve veterans in an integrated manner. These capabilities can be thought of as the primary integrated set of customer service requirements that IT is expected to help satisfy. They are divided into four general categories: (1) customer service; (2) customer self-service; (3) internal data sharing and exchanges; and (4) external data sharing—federal and non-federal.

Realization of the IT vision will require that certain of VA’s information systems successfully integrate or exchange information in a manner that is transparent to VA customers regardless of where information originates, how it is being transmitted, or how it is managed.

The IT vision is intended to guide the operational, tactical, budget, and capital planning for all future information technology initiatives for the entire Department. Actual implementation of the concepts in the vision will be staged over the next three to five years. An IT Architecture Report and Integration Agenda was published during FY 1999. Other initiatives and activities that are underway or being developed by the Administrations are being reviewed for applicability and development as One VA IT vision projects.

VA has set the following environment goals in accordance with Executive Order 13101, "Greening the Government Through Waste Prevention, Recycling, and Federal Acquisition:"

• Waste prevention goals are 5 percent waste reduction by FY 2000; 20 percent waste reduction by FY 2005, and 40 percent waste reduction by FY 2010.

• Goals for recycling are 5 percent recycling increase by FY 2000, 20 percent recycling increase by FY 2005, and 40 percent recycling increase by FY 2010.

• Goals for purchase of EPA's designated CPG items are 100 percent for FY 2000, FY 2005, and FY 2010.

Under the direction of the Department’s Environmental Executive, we will set policy, issue guidance, and provide training and education to VA employees in our Administrations and staff offices. Plans include the establishment of a VA Environmental Council with key personnel from these organizations to provide the essential communication network and overcome resistance in obtaining buy-ins into the Department's Environmental Program.