Office of Public and Intergovernmental Affairs
Remarks by Deputy Secretary Sloan Gibson
US Conference of Mayors’ Veterans Affairs Task Force
January 20, 2016
Imagine transforming your entire city government: organizations, business processes, and comprehensive cultural change.
Now imagine having to do all that for a Federal department the size of VA.
We have 535 board members—Congress—and two thirds of our workforce is unionized. Hiring’s hard, firing’s harder. We have onerous budget and acquisition processes and operate in an entrenched bureaucracy. And whatever we do is subject to intense scrutiny by powerful and often competing interests.
I can’t think of any organization in America facing greater leadership and management challenges than VA.
But in every challenge, there’s an opportunity.
Last summer I met Dr. Harvey Fineberg. He’d just stepped down after 12 years as the president of the Institute of Medicine. I told him that because of the healthcare crisis, VA could accomplish more in two-to-three years than we could otherwise have done in two-to-three decades. Dr. Fineberg immediately corrected me. “No!” he said. “VA can accomplish things now it never could have accomplished!”
Harvey was right. VA has an extraordinary opportunity and we must seize it!
VA is the second largest agency in the Federal government with 360,000 employees—a third of them Veterans—and a $169 billion budget. Eleven million of the 22 million Veterans living today are enrolled for health care or use at least one VA benefit or service. Among our nine lines of business . . .
- Last year, we provided $75.4 billion in compensation benefits to nearly 5 million Veterans and their survivors.
- We supported 100,000 disabled Veterans with $1.2 billion in vocational rehabilitation and employment benefits.
- Since 2009, we’ve paid $59 billion in Post 9/11 GI Bill education benefits to more than 1.5 million Veterans and family members.
- In 2015, we guaranteed a record number of home loans—631,000 valued at $153 billion, for a total of 2.4 million home loans on our books, with one of the lowest foreclosure rates in the industry.
- Not many realize VA is the Nation’s 11th largest insurance enterprise with nearly $1.2 trillion in coverage for 6.5 million policies for Veterans, Servicemembers, and families.
- And we operate 134 National Cemeteries, maintain 3.4 million gravesites, and perform over 130,000 interments each year.
If VA were in the private sector, we’d be a Fortune 10 company—and I’m just getting to healthcare, our ninth line of business.We’re the largest integrated healthcare system in America, with nine million enrolled Veterans. We have 25,000 doctors and our 90,000 nurses make VA the largest employers of nurses in the country.
Last year, we completed over 56 million appointments for 6.2 million patients.
Authorizations for care outside of VA generate millions of additional appointments in the community.
We’re affiliated with 1,800 academic institutions. Clinicians from many of the most prestigious medical schools in the country deliver care, teach, and conduct research at VA. At the UC San Francisco medical school, the entire faculty is credentialed to practice in VA, and all our medical center physicians there are members of the University’s staff.
Today, we train 64,000 residents and medical students, 27,000 nursing students, and 29,000 students in other health fields, annually. About 70% of all U.S. physicians have received at least some of their training at VA hospitals.
We spend $1.8 billion annually on research. VA researchers have pioneered electronic medical records and bar-code software to safely administer medicines; developed the implantable cardiac pacemaker; proved an aspirin a day reduces risk in heart patients; conducted the first successful liver transplants; created the nicotine patch; and demonstrated that patients with total paralysis can use their minds to control robotic arms.
VA researchers have received three Nobel Prizes and six Lasker awards. Just last year, two VA researchers at the Bronx VA received the Samuel J. Heyman “Service to America” Medal for groundbreaking work on spinal cord injuries. So by any measure, VA innovation has contributed significantly to American healthcare—indeed, healthcare around the world.
A few years ago, VA set its sights on three main priorities—increasing access, eliminating the claims backlog, and ending Veterans homelessness—and we’ve made great progress on each.
Our immediate priority has been improving access to care. We’ve done that. We expanded capacity by focusing on staffing, space, productivity, and VA Community Care. VHA staffing is up more than 14,100 net—over 1,400 more physicians and 4,100 more nurses. We activated over 1.7 million square feet last year, and we’re more productive—clinical output has increased 8 percent. One-and-a-half million Veterans were authorized care in the community in the last year—a 36 percent increase.
The results: 97% of appointments are now completed within 30 days of the Veteran’s preferred date; 87% are within 7 days; 22% are same-day appointments.
Average wait times? 4 days for primary care, 5 days for specialty care, and 3 days for mental health.
What do Veterans think?
We’re asking that question constantly. We’re using automated kiosks at our facilities to let them provide us immediate feedback. Hundreds of thousands have responded just in recent weeks. The question we ask: “How satisfied are you that you got today’s appointment when you wanted it?” 89.0% tell us that they are “Completely Satisfied or Satisfied.” Just 3.0% say they “Dissatisfied or Completely Dissatisfied.” Not sure what this would look like in the private sector, but I’ve got a hunch this compares favorably.
But guess what? As we improve access to care, more and more of them are choosing VA care—for the quality, for the convenience, or for the cost-savings. Even though we’re completing millions more appointments, the number of Veterans waiting for appointments has actually gone up. So we have more work to do.
What about the Veterans Benefits Administration?
The backlog of disability claims pending more than 125 days peaked in 2013 at 611,000 — It’s down around 80,000 this morning, down nearly 90%. Average days pending for all claims is now just 93 days, and we finished 2015 with the lowest claims inventory since 2008. Tell me of another major part of the federal government that has transformed more in the last three years than VBA.
What about Veterans homelessness?
I’ve been in government for less than two years now, and when I think of what the American public expects of government, I think the public expects governmental departments engaging each other rather than functioning as silos, federal agencies working with states and counties and cities in true inter-governmental collaboration, processes engaging NGOs and the private sector in meaningful public-private partnerships, programs tackling significant challenges and providing appropriate support to those among us in greatest need, goals, and objectives based on measurable outcomes for those served, and reporting that shows steady progress year-by-year. In my view, those are the characteristics of best-in-class governance, best-in-class collaboration.
A great example is the work being done to end Veteran homelessness. We have a strong, productive collaboration among the Department of Housing and Urban Development, the U.S. Interagency Council on Homelessness, Veterans Affairs, partners at state and local government, and both non-profit and for-profit organizations in the private sector. Since 2010 we’ve seen a 36 percent decline in the estimated number of homeless Veterans. There’s been a nearly 50 percent drop in the number of Veterans sleeping on the street.
But it’s only because of a concerted effort toward a best-in-class government ideal that we’ve gotten as far as have. We have a winning strategy. It’s called the “Housing First” approach: Get Veterans into permanent housing, then meet their clinical and other needs.
That’s what we’ve done: Since 2010, over 260,000 Veterans & family members have been permanently housed, rapidly rehoused, or prevented from falling into homelessness by our programs & HUD’s targeted housing vouchers.
Last year, thanks to those partners, more than 45,000 Veterans and family members were housed using HUD-VASH vouchers, more than 60,000 were saved from eviction thanks to VA’s Supportive Services for Veteran Families, and more than 45,000 Veterans found temporary housing through VA’s Grant & Per Diem program.
For the homeless Veterans we’ve housed: Emergency room visits are down 28 percent, and inpatient hospitalizations are down 30 percent. So we’re not just getting Veterans off the streets—we are healing minds and bodies and making better use of resources, so we can serve more Veterans.
We haven’t made this progress alone. We’ve made it by working closely with our public and private partners—4,000 of them nationwide. “Housing First” works best when we all work together—cities, counties, community groups, and local VA health facilities. That’s why we absolutely have to have local leadership—leaders on the ground in every city—to take charge, to marshal the available resources, and to forge the necessary connections among the many partners it takes to make the strategy work.
If you are already participating in the First Lady’s Mayors’ Challenge, thank you for your commitment. We’ll do all we can to help you succeed.
If you have not taken the pledge, it’s not too late. We are not committed to a date, but to the Veteran, and we should not rest until every Veteran has a safe and stable place to call home.
If your community has already met the challenge and announced the end of Veterans homelessness, we are still your partners in preventing homelessness when possible and housing and healing homeless Veterans when necessary.
That’s a summary of the things VA has accomplished in recent years. Here’s where we’re headed:
We have begun a major cultural and organizational transformation, to make VA the top-ranked customer service organization in the Federal Government. It’s called MyVA, and it’s focused on five objectives:
- First, improve Veterans’ experience—a seamless, integrated, responsive customer-service experience, every time.
- Second, improve employees’ experience —eliminate barriers to excellent customer service.
- Third, improve internal support services.
- Fourth, grow a culture of continuous improvement to identify and correct problems faster and replicate solutions nationwide.
- Fifth—and this one involves you—strengthening strategic partnerships. That is, building vital and innovative networks of collaborative relationships across federal, state, and local governments—and with both non-profit and for-profit organizations.
One way we’re doing that is by helping communities around the country form Community Veteran Engagement Boards, or CVEBs, to bring together local Veteran service providers and advocates to improve outcomes for Veterans and their families. These are community-driven networks, run not by VA but by local civic and business leaders. They give Veterans and their families a proactive forum to address issues and promote opportunities for collaboration. And they aim to resolve issues and help all of us better meet Veterans’ needs. 36 are already up and running, and 15 more are in development. If there’s one in your area already, get involved and see how you can contribute. If there’s not one in your area, you could take the lead in forming one. We can help you do that.
We still have a lot of work to do, but we’re making great progress. And with your support and continued great partnership, we will succeed.