VA urged to use advanced technology to cut backlog of benefit claims

Advanced technologies such as artificial intelligence could help the Veterans Affairs Department reduce a backlog of disability claims that has spiked past 1 million, according to computer experts and veterans advocates.

The Veterans Benefits Administration, which processes the claims, has a backlog of 650,000 pending claims and another 147,000 that are under appeal and working their way through a process that "is paper intensive, complex to understand, difficult to manage and takes years to learn," Rep. John Hall, D-N.Y., chairman of the Veterans Affairs Subcommittee on Disability and Memorial Affairs, said at a Jan. 29 hearing of the House Veterans Affairs Committee.

Training an employee to rate VBA claims can take two to three years and many leave within five years, Hall said. Experienced raters can adjudicate only about three claims a day, spending two to three hours on each claim. He said the VA should consider the use of artificial intelligence technologies, such as automated decision-support tools that can determine disability payments, which would speed up claims processing.

Computer experts who testified at the hearing said technology exists today that can automate the claims process and eliminate the backlog.

"If we can develop computer software such as TurboTax, which guides taxpayers as they fill out complex tax forms online, and which then provides them with instant, computer-based application of complex tax regulations to calculate to the penny the taxes they owe, then I see no reason why we cannot develop similar software to automate online filing of VA benefits claims and to automate a substantial fraction of the processing of these claims," said Tom Mitchell, chairman of the Machine Learning Department at the School of Computer Science at Carnegie Mellon University in Pittsburgh.

Mitchell said the VBA needs to emulate health insurers such as Highmark Inc., a Pittsburgh-based company that uses computers to process 90 percent of its claims. The computer system automatically determines payments, Mitchell said, "because it contains a large collection of rules, each one specifying the payment to be made in some very specific case, defined by the details of the patient's policy, treatment and history. The complex policy for determining what payment is due under which condition is encoded in these rules inside the computer."

While the type of claims processed by Highmark are not identical to the kinds of claims processed by the VBA, Mitchell said they are similar enough to "conclude online processing will be of considerable value to the VA."

Mitchell said other AI techniques that could work for VBA include case-based reasoning systems, which tap into a database of historical data to compare past cases with a current case, and machine learning and data-mining, which could discover patterns in a current claim that indicate more information is needed to process the claim.

The VBA could automate its processes by developing a document naming system for paper documents, which are then electronically scanned into a database to make it easier to retrieve, said Ronald Miller, professor of biomedical informatics at Vanderbilt University..

VBA repeatedly loses paper records submitted by claimants. Robin Cleveland, wife of retired Marine Gunnery Sgt. Tai Cleveland, told the hearing that since November 2005, she has submitted multiple copies of Tai's medical record and was told that the VBA could not find the records and she needed to resubmit them. She said her husband, a paraplegic after injuries incurred in August 2003 during a hand-to-hand training exercise in Kuwait, only started to receive benefit payments this month after Congress intervened.

Dr. Marjie Shahani, senior vice president of operations at QTC Medical Services, which conducts medical examinations on veterans and active duty personnel seeking VBA compensation, said her company has developed an application called the Evidence Organizer, which creates an electronic file for a claim, which can include multiple medical conditions and is accessible at the click of a mouse. Shahani said the organizer cuts the time to rate an individual claim from 3.5 hours to 2.2 hours. The time savings should allow a VBA ratings specialist to review 711 claims compared with the 533 a specialist processes today, he said.

The VBA already has begun to develop technologies to increase the number of claims that specialists can process, said Kim Graves, director of business process integration for the VBA. The agency has a comprehensive strategy to develop the Paperless Delivery of Veterans Benefits initiative, which will employ a variety of enhanced technologies to support end-to-end claims processing, Graves said. In addition to imaging and computable data, it will also incorporate enhanced electronic workflow capabilities, enterprise content and correspondence management services.

Graves said VBA also is considering the use of business-rules-engine software for workflow management, which could improve processors' decision-making.

Stephen Warren, principal deputy assistant secretary for the VA Office of Information and Technology, said the department is preparing a statement of work to engage the services of a lead systems integrator to develop strategy and business requirements for Paperless Delivery of Veterans Benefits, though he did not provide a timeline.

Gary Christopherson, who served as chief information officer for the Veterans Health Administration in 2000 and principal deputy assistant secretary for Health Affairs in the Defense Department, said "using artificial intelligence or electronic decision support tools is nothing new." Government and corporations routinely use those tools, and VBA claims processing is no more difficult than any other application of AI, he said.

Christopherson also called for a radical policy change in how VBA provides benefits. He said that it should presume that a veteran has a valid claim and is entitled to benefits for a period of a year until it completes the processing of that claim, with payment starting in 30 days of the date the claim is filed.

"Today, there is a failure to understand and appreciate the veteran's plight," Christopherson said. "Today's claims processing behavior is more like a castle under siege rather than a home providing compassion, warmth, help and sustenance. That attitude and approach needs to change to a pro-active system, which welcomes veterans seeking help based on 'the duty to assist.' "