Timely disability benefits decisions: Strategic direction for improving wait times

Mission

Veterans Affairs Canada (VAC) will continue to improve its services to Veterans and their families by changing the way we work to make faster disability benefits decisions. This document outlines the measures we will take to achieve this mission.

We will increase staffing levels, empower our employees, increase integration, enhance innovation and leverage digital technology. We will find new ways of making our processes more efficient by using data and knowledge related to the military experience to guide decision-making.

As we drill down on these measures, each line of effort will include concrete plans for resource allocation, specific timelines and public-reporting of results. As part of our commitment to innovation, Veterans will be directly engaged in developing better practices and methods to improve their experience.

Current Situation

In 2015-16, VAC received 45,000 applications and processed 42,544. In 2019-20, VAC received 63,100 and processed 57,600. In the coming years, the increase in applications is forecasted to continue.

The increase in the volume of applications is the combination of several factors, including the heightened awareness about VAC’s services and benefits, the growing demand for mental health services and the increase in medically releasing Veterans.

VAC has significantly increased the number of applications it has processed through improved decision-making processes and the hiring and training of new employees. Budget 2018 provided funding to hire temporary employees which resulted in an increase in the processing of applications. In the latest fiscal update, the Government committed to more than $192 million over two years in additional funding (2020-2021 and 2021-2022) to put our plan into action. This additional funding will be used to extend disability adjudication resources provided in Budget 2018 to keep pace with incoming applications, innovate adjudication processes, hire new teams dedicated to reducing the backlog and to renew our case management approach.

The outbreak of coronavirus (COVID-19) has placed a strain on Canadians, including Veterans, Canadian Armed Forces (CAF) and Royal Canadian Mounted Police (RCMP) members and their families and VAC employees. Although it is a challenging period, we have adapted quickly, ensuring employees are getting benefits to Veterans in greatest need.

During this period, we have been reaching out to vulnerable Veterans to ensure they know we are here to support them during these extraordinary times. Almost all of our employees are now working remotely, where they are answering calls, responding to secure messages, making decisions on disability applications and issuing payments.

We have enabled decision-makers to work more efficiently, using available evidence to reach the fastest decision possible. The Department has made adjustments and modified processes during this critical period and will build on lessons learned as we move forward.

To date, since the outbreak began, we have paid out over $200 million in new benefits and made more than 10,000 disability benefit decisions for Canadian Veterans and their families.

Strategic Direction

We will achieve our mission of improving services by reducing wait times for Canadian Veterans and their families through four lines of effort: Public Service Capacity, Integration, Process Innovation and Digital solutions.

Public Service Capacity – Report on progress and next steps

Budget 2018 announced funding of $42.8 million over two years to increase service delivery capacity and to hire temporary employees which resulted in an increase in the processing of applications. If not for this funding, combined with the gains achieved through streamlining and process innovation, the number of applications waiting to be processed would be more than double its current size.

In the latest fiscal update, the Government committed to more than $192 million over two years in additional funding (2020-2021 and 2021-2022) to put this plan into action. As a result of this new service delivery capacity funding, we will retain and hire additional employees dedicated to making decisions and reducing wait times. At the same time, we will explore innovative measures to more efficiently process future applications. By 2022-23, we will be positioned with new processes and tools to work faster. As a result, we are also hiring additional employees dedicated to reviewing our processes, developing innovative solutions and changing the way we work.

Increasing Our Capacity (Implementation Stage): We are temporarily increasing the number of decision-making staff and those who support the process—like pay officers. We are retaining the staff we hired as a result of funding received in Budget 2018. This represents approximately 160 trained employees who are already making decisions for Veterans and their families. Their focus is on processing older, more complex applications and ensuring urgent applications are processed more efficiently.

With the new funding for 2020-2021 and 2021-2022, we intend to hire over 300 additional full-time staff for two years to primarily focus on the most common applications we receive which include hearing loss, tinnitus and musculoskeletal conditions. By having new employees focus on these applications, we will aim to minimize the time spent on training and maximize the time spent making decisions. We expect the first cohort of new hires to begin making decisions no later than January 2021. Like many other industries, the outbreak of COVID-19 has changed the way we approach our work. New health and safety requirements, most notably the need to work from home is being taken into consideration as we hire and train these new employees. Our timelines have been adjusted to reflect these new realities and we are developing increased online and virtual training to meet these new needs. By March 2022, our goal is that the combined efforts of the above teams will mean fewer Veterans waiting beyond the 16 week service standard. We will be monitoring their decision-making and publishing regular updates.

VAC is also hiring temporary employees in other areas of the Department, but they will have the same mission—reducing wait times for Veterans and their family members. With this staff, the Department will explore new innovative and digital solutions, improving the efficiency of all aspects of the disability benefits process.

Organized and Predictable Staff Training (Implementation Stage): We are developing roadmaps for key positions, e-Learning modules and an accessible online library of training materials, which will align to a new self-directed learning training structure. These actions will reduce training time for new employees and allow employees to individually progress to subsequent training steps after they have demonstrated the expected competencies, rather than waiting for group training sessions.

Integration - Report on progress and next steps

We are using a whole of VAC focus to reduce wait times. Within the Centralized Operations Division – the area that processes applications – we have implemented systems to support better integration within the decision-making teams.

Veteran Benefit Teams (VBTs) (Implemented): In June 2020, we established integrated teams to breakdown silos, eliminate inefficient file hand-offs and improve the quality of decision-making. We expect these integrated teams will increase the number of applications processed. The pilot of the VBTs had an approximate 11% increase in productivity. We expect similar results in six months from this new structure and we will be monitoring this progress.

Innovation Hub (Implemented): The Innovation Hub is a dedicated team and provides VAC with a venue to research, consult with users and test process changes and digital solutions. The Hub allows us to collaborate directly with Veterans and their families, in addition to VAC employees. This collaboration includes workshops and discussions to better understand the experiences of Veterans and user-testing prototypes and platforms to ensure we meet their needs. This engagement has begun. For example, in December 2019, more than 50 individuals including Veterans, health professionals and intake and decision-making staff met to discuss current challenges and proposed potential solutions to be addressed through the Hub. The Innovation Hub will continue reviewing user experiences, data and analytics to redesign business processes, leverage technology and reset policy, programs and services to improve wait times.

New Governance Model and Wait Time Portfolio Team (Implemented): Senior leadership across the key areas are meeting regularly to provide strategic direction and ensure accountability in their respective areas of responsibility. A core team is also now tracking progress, monitoring results and reporting on the initiatives across the Department to reduce wait times.

Process Innovation – Report on progress and next steps

We know that additional human resources alone will not reduce wait times. We need to challenge our processes, leverage existing research and learn from our partners.

Simplified Processes (On-going): In 2018-2019, 40% of initial disability applications were processed through a streamlined decision-making model. This speeds up processing times as administrative decision-makers use models for the most common conditions, allowing nurse adjudicators to focus on the more complex applications which need their expertise. We are also examining ways to simplify our processes, notably in respect to conditions that are frequently a consequence of a first diagnosis. For example, when a Veteran applies and is approved for PTSD, we often see later applications for such conditions as bruxism (teeth grinding) and sleep apnea. We will explore if there are ways to simplify approvals for these consequential conditions to provide help more quickly to Veterans. We are also exploring ways to simplify the process for reassessments which currently allows Veterans to submit an application for a reassessment of their disability benefit when they believe their condition(s) has worsened or two years from the date of their last disability benefits decision for that condition.

Better Decision Tools (Research and analysis stage): We are working closely with our Five Eyes partners, notably Australia, and leveraging their research and evidence to better inform our tools. This will provide our decision-makers with faster access to the information they need to make decisions, and forms part of our efforts to develop a plan to meet the Minister’s mandate commitment to implement a system of automatic approval for the most common disability applications. The tools we are examining, include:

  • Table of Disabilities (TOD):  The TOD is a legislated/statutory instrument used to assess the extent of a disability for the purposes of determining disability benefits. The Table considers the relative importance of a certain body part/system to assess the level of impairment and the impact that impairment has on the individual's quality of life.
  • Entitlement Eligibility Guidelines (EEGs): The EEGs are policy statements, intended to assist in the preparation and submission of applications and in adjudication. The EEGs provide guidance to decision makers on what clinical criteria are required to meet the diagnosis claimed as a disability.

Gender Based Analysis Plus (GBA+): All initiatives as well as current practices will include GBA+ plus reviews and assessments. This will help ensure equitable treatment of all benefit processing and decision-making as the tools will take into account a variety of factors, including gender and the effect an illness/injury has on members as a result of their service.

Focus medical consultations on complex conditions (Research and analysis stage): We often require a consultation with a medical advisor for certain conditions. VAC will review the rules for mandatory referral, including examining when referrals are necessary and for what conditions, to explore ways to simplify the process.

Digitization – Report on progress and next steps

We have made progress on digitizing – scanning, uploading and sharing - within VAC systems to allow for quicker access to files. But we must continue to develop our digital platforms, as they are proven to be more efficient.

Improving the Online Application Experience (On-going): Currently there are over 110K users of My VAC Account, including current and potential clients. Further, 43% of clients who are receiving disability benefits are registered for My VAC Account. We are continuously working to enhance this tool and promote the use of online applications for Veterans, their families and CAF members. In fact, from March 2019 to March 2020 we had an increase of over 20% in users on My VAC Account.

Digitization of Hearing Loss Applications (Research and Prototyping stage): As one of the most common conditions, we are analysing possible ways to reduce the evidence required to adjudicate hearing loss and tinnitus applications. We are also currently examining ways to automate the hearing loss application process - using new digital tools to find and review and ultimately read, electronic audiograms. This is in line with the Minister’s Mandate Commitment letter.

Expand Online Options for Health Professionals (Research and analysis stage): We rely on the health professionals across Canada who treat Veterans to provide information related to the diagnosis and the severity of a Veteran’s condition. We are implementing a secure, electronic system for health professionals to collect and send the health information needed to make disability benefit decisions which will result in faster decisions.

Expected Timelines and Outcomes

We are in the process of hiring over 300 new temporary staff. This number includes both decision makers and those who support the process – like Pay Officers. With the online training regime, we expect the first cohort of new employees to begin making decisions on disability applications no later than January 2021. By March 2022, our goal is that these new employees, along with those employees we are retaining for an additional two years, will have made approximately 80,000 additional decisions. We are aiming to substantially reduce those waiting beyond 16 weeks for a decision. We will be tracking this progress and report on the increase in productivity as the team is established.

We know that human resources alone will not eliminate those waiting beyond the service standards completely. We must change the way we work. When we can, we will implement processes and digital solutions as fast as possible. For example, digital solutions are currently being explored for Hearing Loss and Tinnitus applications. These solutions build upon the system and digital improvements VAC has made through My VAC Account and other recent enhancements. They are currently being analyzed, prototyped and piloted. This work will take place over the coming eight months and allow us to set benchmarks and ultimately track and report on how these tools are helping us increase our productivity.

Establishing baseline data and setting measurable targets is key to the work and will help us define our priorities as each initiative progresses. We will prioritize the initiatives that have the greatest impact. Some of the work we undertake will require that we seek authorities. Other parts of the work will require significant research and consultations with the Veteran community and medical experts which will take a longer period of time.

Conclusion

The Department is making the changes required to produce faster decisions and reduce wait times. One single initiative will not solve current challenges. It is the collective impact of retaining staff with the right skills, digitizing wherever possible, improving the efficiency of decision-making and integrating processes.

It is important that Veterans understand the work we are doing and have clear and predictable information about their benefits. We are also implementing a comprehensive communications strategy to continue to raise awareness about the enhanced suite of well-being services and to better inform Veterans about the wait times they can expect for their respective applications.

The net result will be accelerated, standardized and fair decisions that reflect care, compassion and respect.

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