‘Mr. Chairman and members of the Subcommittee:

We are very pleased to appear before you today to discuss the interagency program
relationships that exist between the Department of Defense and the Department of Veterans
Affairs, especially as they relate to the DVA Strategic Plan developed to meet the requirements
of the Government Performance and Results Act (GPRA) of 1993. The Department of Defense
supports the GPRA and is integrating its critical elements into the DoD Planning, Programming
and Budgeting System (PBS),

DoD - VA Interfaces

‘The compensation, care, and recognition afforded America’s veterans by the Department
of Veterans Affairs heips to ensure that DoD is able to continue to recruit and retain a quality
armed force, which is an clement of one of DoD's corporate-level goals. The DVA assistance
programs provided to our servicemembers--both active and reserve~-coupled with the knowledge
that, as veterans, they will be provided certain additional benefits and entitlements, contribute
directly to the sustainment of a robust military force, The Department of Defense interfaces with
Veterans Affairs in many if not most of the programs covered by the DVA Strategic Plan, to
include such major areas as healthcare services, compensation benefits, Servicemen’s Group Life
Insurance, the Montgomery G.L. Bill, housing loan assistance, and burial and cemetery services.

In order to meet the needs of the servicemembers that DVA serves today, as well as the
veterans that will be served in the future, DoD works closely with DVA to define accurately the
characteristics and needs of our military members, particularly as they transition into the nation’s
veteran population. By ensuring that VA-sponsored benefits and programs are well-publicized,
DoD assists its own recruiting and retention programs.

Improving Awareness of VA Benefits and Services

DoD strongly supports DVA's strategic objective to improve the awareness and
knowledge of VA benefits and services for veterans and servicemembers. In that regard, DVA
and DoD have established aggressive information exchange programs. For example, the military
services now transfer directly to DVA the medical records of servicemembers who are being

released from active duty. This records exchange provides immediate access to medical


25

portant to restate the fact that this is a draft, not a final document.
As far as the draft is concerned, AMVETS does not have any major
Problems with its content. We will be continuing our dialogue with

‘A until the final document is presented.

I must admit that when we first heard the term One VA, a few
flags went up. When you think about it though, I think that is the
way that most veterans view VA, they do not see it as separate en-
tities like the Veterans Health Administration, the Cemet Sys-
tem, Veterans Benefits Administration. I believe the Office of Man-
agement and Budget also gave them the same feedback and al-
though we applaud the concept, we will be watching the approach
and we will offer guidance.

Regarding VA’s mission statement which was addressed earlier
this morning, we some people complaining about the use of this
term, including Dr. Snook earlier in this hearing. His response, Mr.
Chairman, to your question about advocacy and the role of advo-
cacy for the VA, Dr. Snook’s response that Congress is the advocate
for veterans, was quite frankly a little bit chilling for me. Given
what Congress did this year in flat-lining the VA budget through
the year 2002, AMVETS is going to put its faith in VA’s advocacy
for veterans.

Why can VA not be the veterans advocate? If the Department of
Education is an advocate for teachers and children, why not VA?
And if not VA, who?

We believe the best way to evaluate this plan is to see if it meets
the criteria that was established and we believe that the division
of VA’s strategic plan states that it will function as a unified de-
partment delivering high quality, timely benefits and services to
veterans and their families in a cost-effective world-class manner.
This is a living document which will have changes and modifica-
tions. We believe that this is an adequate strategic plan at this
time, we will continue to monitor its change and growth.

Mr. Chairman, this concludes my statement and I will be happy
to take any questions.

[The prepared statement of Mr. Burns appears on p. 68.]
Mr. Evenern. And now the man from DAV.
STATEMENT OF RICK SURRATT

Mr. SurRatTT. Mr. Chairman, good morning. Thank you for allow-

ing us to offer our views on VA’s strategic plan.
strategic plan is a broad outline and perspective on the agen-

ys future direction. A strategic plan’s general nature and the fact

at VA’s plan is an initial one, necessarily makes it somewhat ru-
dimentary. Yet, in places, it identifies specific problems to be over-
come and provides methods, performance targets and time tables.
As VA completes more comprehensive program evaluations, we
would expect its plan to expand and evolve.
eens, this is an exercise in improvement, it is an exercise in

ange. We would expect. not to cling tig] to the old ways,
but at the same not change merely for the ve of change VA
should build on past rience, make prudent calculated eS
and go with caution and forethought, not reinvent the wheel as
first step and not overhaul if fine tuning is all that is needed. In
DAV’s view, VA’s initial plan exhibits a good-faith effort not only


COMMITTEE ON VETERANS’ AFFAIRS
BOB STUMP, Arizona, Chairman

CHRISTOPHER H. SMITH, New Jersey LANE EVANS, Illinois

MICHAEL BILIRAKIS, Florida JOSEPH P. KENNEDY II, Massachusetts
FLOYD SPENCE, South Carolina BOB FILNER, California

TERRY EVERETT, Alabama LUIS V. GUTIERREZ, Illinois

STEVE BUYER, Indiana JAMES E. CLYBURN, South Carolina
JACK QUINN, New York CORRINE BROWN, Florida
SPENCER BACHUS, Alabama MICHAEL F. DOYLE, Pennsylvania
CLIFF STEARNS, Florida FRANK MASCARA, Pennsylvania
DAN SCHAEFER, Colorado COLLIN C. PETERSON, Minnesota
JERRY MORAN, Kansas JULIA CARSON, Indiana

JOHN COOKSEY, Louisiana Te

ASA HUTCHINSON, Arkansas
J.D. HAYWORTH, Arizona
HELEN CHENOWETH, Idaho
RAY LaHOOD, Iuuvois

CaRL D. CoMMENATOR, Chief Counsel and Staff Director

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TERRY EVERETT, Alabama, Chairman

BOB STUMP, Arizona JAMES E. CLYBURN, South Carolina
FLOYD SPENCE, South Carolina VIC SNYDER, Arkansas
STEVE BUYER, Indiana FRANK MASCARA, Pennsylvania

aD


Z Statement of

Chuck Burns
AMVETS National Service Director

before the
Veterans' Affairs Subcommittee

S On The
ERVING Oversight and Investigations
WITH

PRIDE

United States House of Representatives

Thursday, September 18, 1997
Room 334

e Cannon House Office Building

4647 Forbes Boulevard
Lanham, Maryland
20706-4380

‘TELEPHONE. (301)459-9600
ax: (301)459-7924

rs: (700/344-3552


19

8

the information requested without multiple referrals or hand-off. VA has established six goals to
lead to accomplishment of this quality of service: (1) ease of access, (2) customer satisfaction,
B) courtesy, (4) do it right the first time, (5) prompt delivery of services and benefits, and (6)
effective outreach.

VA plans to increase accessibility to VA offices, facilities, and services through use of
electronic access such as the internet, improved telephone service, and addition of contact points.
VA plans to attain customer satisfaction by gaining information through surveys and other
customer feedback and using that information to learn their expectations and experiences, from
which improvement goals can be set or revised. VA intends to ensure that veterans are treated
with courtesy by employee training to emphasize its importance.

VA plans to attack quality problems by doing it right the first time, and if'a mistake does
occur, there will be a candid acknowledgment of mistakes and priority assignment to correct
them. To accomplish the general goal, VA will assess and improve the level of accuracy for all
work and correct errors in the shortest possible time as appropriate for each business line. Some
of VA’s performance goals are to make correct decisions 97% of the time; decrease BVA
remands from a rate of 43.7% to 20%; and improve the quality of disability examinations so that
99% are sufficient to adjudicate claims. VA has established a number of timeliness targets to
meet its general goal of prompt delivery of services and benefits. To accomplish this, VA will
reengineer its processes and benchmark to optimize process cycle times.

VA will accomplish its general goal of effective outreach by publicizing available benefits
through appropriate channels and at appropriate locations. It will also provide clear and easily
understood communications.

In DAV’s view, there is no more important and essential step to improve VA’s claims
processing than its focus on quality. With quality, timeliness and, inevitably, customer satisfaction
and efficiency will follow. We applaud this aspect of VA’s BPR and strategic plans. As we have
said, there must also be comprehensive quality standards, strong accountability mechanisms, and
aggressive systematic enforcement. Strains on the system, on veterans, and on employees will be
reduced with quality and timeliness. Veterans’ perceptions of VA’s faimess and effectiveness will
necessarily improve.

Of course, creating and maintaining a high-performing work force is an essential part of
the strategy. VA plans to initiate this process by collecting data from its personnel to find ways to
create the environment for a highly trained, multi-skilled, and motivated work force that reflects
the diversity of its customers and is accountable for performance.

Finally, VA has presented seyeral goals to enable it to provide maximum return on
taxpayer investment. These goals will be met through an array of strategies and performance
improvements.

The DAV believes that VA’s strategic plan represents a sincere and comprehensive effort
to begin the institution of management practices required by GPRA. Naturally, as groundwork,


15

Sufficient time remains for considerable refinement of VA’s first strategic plan
under the Results Act. Of course, the first plan will be the starting point for year
two and continued improvement. A detailed description of how VA carried out its
strategic assessment and the results of that assessment would greatly facilitate
planning efforts.

Also, major data integrity, issues continue to confront VA and could seriously un-
dermine efforts to accurately measure erformance. Finally, the essentially bottom-
up planning to date is inconsistent with Results Act intent and is likely to perpet-
uate the lack of unity between the major administrations within the Department,
despite the stated vision of functioning as a unified department.

Committee is informed that VA’s draft strategic plan is scheduled to be ready
on June 1, 1997. It is absolutely essential that the draft plan be timely to allow ade-
quate consultation and review by all stakeholders, including Congress. I look for-
ward to continued cooperation and openness in meeting the challenges of true stra-
tegic planning under the Results Act.

Sincerely,

Bos STUMP,
Chairman.

House OF REPRESENTATIVES,
COMMITTEE ON VETERANS’ AFFAIRS,
Washington, DC, August 12, 1997.
Hon. HERSHEL W. GOBER,
Secretary Designate,
Department of Veterans Affairs, Washington, DC.

Dear Mr. SECRETARY: I am pleased that the Department of Veterans Affairs (VA)
has continued its active consultations with the VA Committee. These have included

th informal meetings and a day-long meeting with a facilitator. One of the most
encouraging aspects of the consultations from the beginning has been the open and
cooperative way in which the VA has approached them.

e VA also has continued to exhibit its commitment to the long-term process of
Results Act strategic planning and to making it a central part of the Department's
culture. This involves fundamental improvements in designing, Planning and pro-
viding veterans’ benefits and services. The Department's first real strategic plan in
fiscal year 1998 is particularly important because it will be the foundation for each
succeeding year’s refinements and modifications.

The General Accounting Office has assisted the VA Committee in its review of the
August 1, 1997. draft of the plan. although the views expressed in this letter are
solely the Committee’s. The latest draft incorporates several of the stakeholder Sug.

tions made during the consultations and is considerably strengthened overall.
e Department itself has identified areas it recognizes still need improvement and
has outlined how it will address them.

My specific observations about the August 1 draft are as follows:

Overall Organization of Plan: Perhaps the biggest stumbling block stakeholders
encountered in analyzing the earlier draft of the plan was understanding its basic
organization because of its confusing structure and missing parts. It is now better
organized. more complete, and clearer.

Mission Statement: While the mission statement remains essentially unchanged
due to the plan’s improved organization it relates more clearly to the VA’s business
lines. As previously observed during the consultations, the statement’s inclusion of
the Department’s role as “principal advocate” for veterans may be an aspiration but
lacks a statutory basis. The veterans service organizations, a number of which are
chartered by Congress. have legal recognition as the advocates for veterans.

External Factors: (1) The VA has expanded the plan’s discussion of the demo-
graphic changes in the veteran a population. The characteristics and trends of the vet-
eran population will under; anges so profound over the next fifteen years that,
in the Committee's view, the discussion of demographic factors, including profiles
of veterans seeking VA health care, could be further expanded.

(2) Also, the VA Committee understands the difficulties of coordination with other
departments and agencies. Nonetheless, the VA should aggressively continue to pur-
sue cross-cutting issues with the Departments of Defense and Labor in the context
of strategic planning.

Results-Oriented Goals: (1) The VA’s draft Plan continues to lack results-oriented
goals for many programs. particularly in the Veterans Benefits Administration, be-
cause no program evaluations have been accomplished. The acknowledged lack of


4

been too little emphasis on proper attitudes and too little recognition of the major role they play in
the quality of VA performance and customer service. Because VA is going through a phase of
revival of quality, performance, and a customer-focused approach, now is the opportune time for
its managers to genuinely commit to and concentrate on that element of institutional health. One
of VA’s planning assumptions is an increase in customer expectations of accurate, timely, and
‘courteous service. Because employee indifference or negativism toward customers is inconsistent
with VA’s customer service goals, employee attitudes and convictions are indispensable to
meeting these customer expectations and realizing VA’s stated goal of “world-class” customer
service.

Following its introductory material, mission and vision statements, planning assumptions,
and discussion of external factors likely to affect the achievement of its goals and objectives, VA
describes the data it used in lieu of program evaluations in establishing its general goals and
objectives. For purposes of GPRA, “program evaluations” means ““ an assessment, through
objective measurement and systematic analysis, of the manner and extent to which Federal
programs achieve intended objectives.” VA indicates it has conducted no formal program
evaluations recently. Instead, it relied upon other data such as environmental program scans,
customer surveys, focus groups, and external reports to craft its goals and objectives. One of
VA’s general goals in its strategic plan is the implementation of a formal program evaluation
process to provide measurement and analysis information necessary to determine the outcomes
and effectiveness of programs. VA acknowledges that preliminary data from the series of
strategic program scans it conducted show that program purposes need more thorough review,
that program outcome data are sparse or non-existent, and that some essential data critical to
making informed strategic decisions are lacking.

In this respect, it has been recognized by the GPRA Implementation Committee of the
Chief Financial Officers Council, created by the Chief Financial Officers Act of 1990, that total
implementation of GPRA cannot occur immediately and will out of necessity be an evolutionary
process. We have no reason to question that VA will develop and install program evaluations
which meet the statutory requirements, and we anticipate that VA will use that data to make
appropriate adjustments and refinements in its strategic goals as is contemplated by GPRA.

VA also indicates that its schedule for future program evaluations is pending full results of
program scans yet underway. VA expects these scans to provide a basis for discussion of
‘outcome measures with stakeholders and thereafter develop a formal schedule and priorities for
future program evaluations.

VA organizes and presents its operative strategies in two major parts. Part I contains the
strategic goals of VA and each of its programs or business lines, although VA indicates that
“[g]reater detail on program initiatives specific to the individual organizations is contained in their
strategic and business plans.” Part II contains process-oriented strategies designed to help VA
‘operate as a more unified organization to improve customer service, ensure a high performing
work force, and provide maximum return on the taxpayer’s investment.


32

I intend to follow-up and if I have to follow-up with hearings on
the subject, then we will do that.

Mr. WILLIAMS. I would just like to make a comment. I appreciate
the fact that you are going to look into this because there are a
number of stories that I could tell you about involving our services
officers trying to assist veterans whose service medical records are
missing, have been misplaced from the records processing center in
St. Louis, to the regional offices throughout the country. It is a
chronic problem and the American Legion is there to assist you if
need be. So I appreciate your effort on this important topic, believe
me.

Mr. EveRETT. I thank you very much and I do understand the
complexities of the electronic transfer, but we can certainly start
off with Paper transfer and then get to electronic transfer when we
can hopefully marry the two systems together.

ain, I want to thank all witnesses for appearing. This hearing
is adjourned.
ereupon, at 11:38 a.m., the subcommittee was adjourned.]


2. On a scale of 1 to 10, how would you assess the VA's strategic
planning efforts to date? Please explain the basis for your
answer, and summarize the areas where significant improvements are
needed, if any, in the short term.

As we noted in our September 18 testimony before the Subcommittee
on Oversight and Investigations,' VA has made substantial progress
in improving its strategic plan since the June 1997 draft. The
plan is now clearer and more results-oriented. Also, the June 1997
draft plan's major gaps in general goals, objectives, strategies,
and performance goals have been filled.

However, VA still needs to make significant improvements to its
strategic. The most significant improvement would be to develop
results-oriented goals for several major program areas, in
particular the program areas administered by the Veterans Benefits
Administration (VBA). Among the actions VA could take to improve
its strategic plan in the short term are:

(1) VA can develop ‘interim" results-oriented goals, rath
than relying on placeholder goals until VA completes its
program evaluations. In preparation for its planned program
evaluations, VA has been conducting "program scans,“ which
could provide information for developing interim results-
oriented goals. VA's program scans include efforts to
identify the purposes, intents, and outcomes of VA programs.
VA has indicated that it will develop interim goals, as part
of its program scans, in early 1998. Once VA develops an
interim results-oriented goal for a program area, it should be
able to develop supporting objectives, strategies,

performance goals.

(2) VA can provide better explanations of how external factors
affect VA's achievement of goals. In some program areas,
improved discussions of external factors depend on the
development of interim results-oriented goals. In other
Program areas, in particular those administered by the
Veterans Health Administration (VHA) and National Cemetery
System (NCS), existing discussions of external factors could
be improved to link such factors as veteran demographic trends
to existing goals. For example, we have observed that the
strategic plan does not explain the linkage between the
increasing numbers of deaths among veterans and NCS plans to
undertake specific numbers of cemetery construction and land
acquisition projects.

(3) VA can improve its identification of overlaps between VA
Programs and those of other federal agencies, and its
coordination and information sharing links with other
agencies. In its strategic plan, VA states that it will use
the program scan process, and existing high-level
communication links between VA and other agencies, to identify
overlaps and opportunities to improve communication and
coordination with other agencies. Also, in several specific
program areas, the strategic plan identifies opportunities to
coordinate with other agencies. VA has noted that it is
attempting to establish high-level contacts at several
agencies for further coordination; points of contact have been
established at the Department of Labor and Social Security
Administration.

Plan (GAO/T-HEHS-
1

-215, Sept. 18, 1997).


39

CRS-2

this explanation focus on purposes rather than simply accepting the basis for the activities
as given.

Thus, the Act seeks to link the performance of activities with indicators and
measurement of the results of those activities. In part, descriptions that focus on results
contrast with most current methods by which government activities are outlined. Currently,
performance itself is generally measured through the amounts of money expended, actions
taken, manpower and resources engaged, or the number of persons, places, or things affected.
Of course, many program evaluations are always underway throughout government, but
GPRA asks that the evaluation process be extended beyond the current horizon of problem-
‘treating programs, to the ordinary activities of the federal government at every level: what
is the activity trying to accomplish, and how do we know if it accomplished it.

The Format for Compliance: GPRA Concepts and Terms

GPRA instructed GAO and the Office of Management and Budget (OMB) to provide
‘guidance to agencies as they designed their strategic plans. The format developed by OMB
and GAO applies across the federal government, and establishes a common framework both
for comparing the effects of GPRA among agencies, and for determining the feasibility of
a comprehensive, government-wide plan, to be in place as early as FY2002. Within the
framework are certain concepts and terms acquired from contemporary movements within
the study of public administration, and applied to federal agencies. As interpreted by OMB
and GAO, a strategic plan contains six elements:

A comprehensive agency mission statement;
Long-term goals and objectives for all major agency functions and operations;
Strategies to achieve the goals and objectives, and the resources needed;

‘The relationship between long-term objectives, and annual performance goals;
Identification of key factors beyond the control of the agency that could interfere with
achievement of the strategic goals; and

© A description of how program evaluations guided the formation of strategic goals, and
a schedule of future evaluations.

A mission statement is an abstract of the purpose of a government function as seen from
the agency perspective. Goals and objectives are statements by an agency (or office) of what
the mission attempts to accomplish in terms of outcomes or results. Strategies are
descriptions of how general goals and objectives will be achieved, in terms of resources and
operations. Program evaluations are assessments of programs, and include evaluations of
the their internal operations and of the success with which they meet their stated purposes.
External factors, are factors beyond the agency's control but which could affect its strategic
performance, such as demographic, economic, political, or technological changes.

In a strategic plan, general goals elaborate policy, programmatic, or management
directions that follow from the agency mission, and objectives are more specific statements
of something to be accomplished within those directions. For example, VA has a general
goal of improving the health care of veterans, which is furthered by an objective of
increasing the number of veterans using the VA health care system. Within these objectives
are performance goals, which are specific milestones to be attained each year. GPRA
requires that agencies establish annual performance plans, with performance goals identified,
as part of the annual budget process.


Conclusion

DoD and DVA have a jong history of interaction, cooperation, and coordination on our
related programs at the operational level. We believe that the opportunities for further partnering
between DVA and DoD, will serve to strengthen the existing alliance between these two
organizations whose missions are so closely interrelated. Strategic planning underway in both

‘organizations will provide both DVA and DoD greater efficiencies and improved performance in

the future.


35

STATEMENT OF THE HON. LANE EVANS

HOUSE COMMITTEE ON VETERANS AFFAIRS
SUBCOMMITTEE ON OVERSIGHT & INVESTIGATIONS

HEARING ON VA’S STRATEGIES FOR GOVERNMENT
PERFORMANCE AND RESULTS ACT (GPRA)
COMPLIANCE

| WOULD LIKE TO COMMEND THE CHAIRMAN
AND THE RANKING MEMBER FOR CALLING THIS

IMPORTANT HEARING.

GIVEN THE VA’S RESPONSIBILITY FOR
PROVIDING HEALTH CARE AND HARD-EARNED
BENEFITS TO OUR NATION'S VETERAN
POPULATION, AND GIVEN THE RELATIVE SCARCITY
OF FUNDS THAT THE VA HAS AT ITS DISPOSAL,
THERE IS PERHAPS NO OTHER AGENCY IN THE
FEDERAL GOVERNMENT THAT CAN BENEFIT MORE

FROM STRATEGIC PLANNING THAN THE VA.


67

3

Finally, both agencies are committed to improving conditions for women
and minority veterans. Representatives from both agencies participated in the
recent National Summit on Women Veterans’ Issues, which identified issues
and concerns of women veterans on the eve of the 21st century.

VETS uses statistical information developed by the DVA’s National
Survey of Veterans to assess how well our employment service efforts targeted
to minority veterans are doing. African American veterans still experience
unemployment rates above the national average. We are continuously seeking
to improve our service delivery systems and to sensitize our service providers
to the unique experiences and needs of all minority veterans.

Working in close partnership, and speaking with one voice on veterans
issues, VETS and the Department of Veterans Affairs will succeed in helping
America’s veterans participate fully in the life of this great nation.

Thank you, that concludes my prepared testimony. I will be glad to
answer any questions you may have.


104

2. Can you explain in general terms what the GPRA expects of
federal agencies in general, and the VA in particular? In your
view, are the goals and objectives of GPRA realistic, or does the
GPRA expect too much from the federal agencies?

In passing the Government Performance and Results Act of 1993, the
Congress expected VA and other agencies to shift their
decisionmaking away from a preoccupation with their day-to-day
activities, and toward a focus on the results of their activities
on citizens’ lives. For VA, this means focusing on the impact of
its programs on veterans and their families. To move agencies
toward a focus on results, the Congress required VA and other
agencies to

(1) develop a strategic plan with results-oriented goals,
objectives and strategies for achieving them,
performance goals to measure progress in achieving them;

(2) prepare annual performance plans showing the progress
agencies plan to make in achieving their goals each year;
and

(3) prepare annual performance reports showing whether annual
performance goals were met and, if they were not met,
providing plans for achieving them.

We consider GPRA's requirements realistic, as long as both VA and
the Congress continue to work toward meeting them. In crafting
GPRA, the Congress understood that the management changes required
to implement the Act would not come quickly and easily. Thus, the
Congress set up a phased implementation of the Act's requirements
over several years. VA needs to continue to make progress in
developing its strategic plan, and to develop annual performance
plans. This will require continued support of the planning process
‘by top VA management. ‘The Congress can help VA by continuing to
monitor VA's efforts to implement GPRA, and by continuing its
consultations with VA.

A key issue in VA’s continuing implementation of the GPRA is
defining the results of VA programs. VA officials have stated that
one difficulty in developing results-oriented goals is that the
purposes of some VA programs are unclear. Also, we recognize that
defining results for some VA programs will raise politically
sensitive issues. Resolving these issues will require continued
consultations among VA, the Congress, and veterans service
organizations.

3. Can you compare the VA's efforts to comply with the
requirements of the GPRA with the efforts to date of other federal
agencies?

In September 1997, we reported on our reviews of 27 agency draft
strategic plans, including our July 11, 1997, observations of VA's
draft plan.’ We found that much work remained if agency strategic
plans were to fulfill the Results Act's requirements, serve as
bases for guiding agencies, and assisting congressional and other
policymakers. VA's strategic plan is no exception to this
observation. For example:

(1) VA was one of several agencies whose draft strategic
plans had goals that were not as focused on results as
they could have been.

*Managina for Results: Critical Issues for Improving Federal
Agencies’ Strategic Plans (GAO/GGD-97-180, Sept. 16, 1997); The
(GAO/HEHS-97-174R, July 11, 1997).

2



45

‘The draft strategic plan, acknowledging that three of these four elements (results-
oriented goals, program evaluations, and agency coordination) have not been fully
addressed, does plan to address them. VA has indicated that it views strategic
as a long-term process and intends to continue refining its strategic plan in consultation
with the Congress, veterans service organizations, and other stakeholders.

Another challenge for VA is to improve its financial and information technology
management, so that the agency's ongoing planning efforts under the Results Act will be
based on the best possible information. VA's draft strategic plan addresses several
financial and information technology issues, such as the need for cost accounting systems
for VA programs and the need to improve VA's capital asset planning.

Improvements From the June
1997 Draft Strategic Plan

We found that VA's June 1997 draft strategic plan was confusing, because of
numerous layers of goals, objectives, and strategies. Also, it contained significant gaps
where goals were missing; and lacked a clear focus on results. VA officials indicated that,
based on consultations with staff from the House and Senate Veterans’ Affairs
‘committees, which included input from GAO, the draft strategic plan would be revised to
make it clearer, more complete, and more results-oriented. The August 15, 1997, version
reflects significant progress in these areas.

Instead of presenting four overall goals, three of which were process-oriented, VA
has reorganized its draft strategic plan into two sections. The first section, entitled
“Honor, Care, and Compensate Veterans in Recognition of Their Sacrifices for America,”
is intended to incorporate VA's results-oriented strategic goals. The second section,
entitled “Management Strategies,” incorporates the three other general goals, related to
customer service, workforce development, and taxpayer return on investment. In
addition, VA has filled significant gaps in the discussions of program goals. The largest
gap in the June 1997 draft was the lack of goals for four of the five major veterans benefit
programs. The current plan includes goals for each of these programs, stating them in
terms of ensuring that VA benefit programs meet veterans’ needs. Finally, the reorganized
draft plan increases the emphasis on results. The June 1997 draft appeared to make such
process-oriented goals as improving customer service and speeding claims processing
‘equivalent to more results-oriented goals such as improving veterans' health care. In the
August 1997 version, the process-oriented goals remain but have been placed in their own
Process-oriented section supplementing the plan's results orientation.

At the same time, VA believes that the process-oriented portions of the plan are
important as a guide to VA's management. It considers customer service very important
because VA's focus is on providing services to veterans and their families. The Assistant
Secretary for Policy and Planning, in written comments on a draft of our July 1997 letter,
stated that VA continues to believe “that processes and operations are important to
serving veterans and [VA] will continue to place appropriate emphasis on the areas of
customer service, workforce development, and management issues.” VA also contends
that the Results Act does not preclude process-oriented goals from its strategic plan. We
agree that many of the process issues VA raises are important to its efficient and effective
operation and can be included in VA's strategic plan as long as they are integrated with
the plan's primary focus on results.

Lack of Results-Oriented Goals
for Maior VA Programs

Perhaps the most significant deficiency in VA's draft strategic plan, in both the June
1997 and current versions, is the lack of results-oriented goals for major VA programs,
particularly for benefit programs. While discussions of goals for benefit programs have
been added to the current version, they are placeholders for results-oriented goals that
have not yet been developed. ‘The general goals for 4 of the 6 the major benefit program

3 GAO/T-HEHS-97-215


87

STATEMENT OF

BOB MANHAN, ASSISTANT DIRECTOR
NATIONAL LEGISLATIVE SERVICE
VETERANS OF FOREIGN WARS OF THE UNITED STATES

BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE ON VETERANS AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES,

WITH RESPECT TO

DEPARTMENT OF VETERANS AFFAIRS STRATEGIC PLAN

WASHINGTON, DC SEPTEMBER 18, 1997

MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:

Thank you, Mr. Chairman, for inviting the Veterans of Foreign Wars of the United
States (VFW) to participate in what we believe to be an issue of extreme magnitude for

the Department of Veterans Affairs and the veterans of this great country.

The Government Performance and Results Act of 1993 requires all major
‘government agencies to prepare comprehensive strategic plans as the driving force for
determining the needed resources and budgetary support in accomplishing an agency's
stated mission(s). In accordance with this mandate, the Department of Veterans Affairs is
to transmit their strategic plan to Congress and the Office of Management and Budget by
the end of this month. The key component of the plan must be on the ability to accurately
‘measure performance of the agency as a whole or, more directly, to become “outcome

oriented”.

Unlike most other federal government agencies, objectively measuring outcomes is
not necessarily a new concept for the Department of Veterans Affairs. For instance, there
have been, for a long time, statistics on quantitative issues such as the average time taken
to process claims for veterans’ entitlements. However, the real problem (and subsequent
debate) has lately been focused on the more subjective areas involving the question of how
to accurately determine the quality, more so than quantity, of the work being performed


8

operate more efficiently and effectively, and VA does have goals
at are directed at, for example, improving claims processing. So,
yes, that is a component of what VA has laid out in its strategic
plan. And that is something, then, that one can measure them
against. Are they going to meet these goals they have set in terms
of improving the Speed of their claims processing and the accuracy?

Mr. Mascara. Well obviously the strategic planning process can-
not take place over night. I saw in there that you had the June ver-
sion, and then the August version. In your view, how far along do
you believe the VA is in the strategic planning Process? And, how
long can we reasonably expect it to take the VA to complete a
workable plan, that sets forth the realistic performance goals and
establishes a framework for achieving desirable results?

Ms. FAGNONI. This is really VA’s first attempt to do a depart-
ment-wide plan, and I think they have come a long way, even in
the short period of time since they have been trying to put things
on paper and trying to communicate effectively what it is they were
trying to do. As we say in our assessment while they have made
progress in their strategic planning, they still need to make im-
provements. Particularly in becoming more specific in defining the
results of their programs and really assessing how much their pro-
grams are achieving. I guess the thing that we are looking at now
is, we would encourage VA to set some interim results goals that
are a bit more specific than some of the ones they have, particu-
larly in the benefits programs, and that they really lay out a pro-
gram evaluation schedule and adhere to it, that allows them to
look more carefully at their programs and see what they are accom-
plishing, and determine how they can measure their success in how
well they are achieving their goals. So, I think they have come a
long way. What we are trying to say, through our work and what
I am sure will be continuing work in looking at implementing the
Results Act, is for Congress and other stakeholders should to con-
tinue to work with VA and to keep VA moving along the direction
it is moving and continue to make progress. How long that will
take at this point, I would be reluctant to say. Besides, I think
partly it depends on how much continued attention there is to this
entire effort. Anything that takes over a period of years has the
danger that there will be a letup, and I think it will take continued
monitoring and consultation to keep this effort moving. It is not an
easy effort that they are unde: ing. Nor is it for any agency.

Mr. Everett. I will not prolong this, but let me say I appreciate
the gentleman’s line of questioning and if you can take the com-
puter modernization situation, I would say it often takes VA a
very, very long time to complete a business plan, and, of course,
this business plan is integral to the—Dr. Snyder.

Dr. SNYDER. Thank you Mr. Chairman. I will address this to both
of you. This is a specific question. In the Results Act, when we talk
about strategic plan, is there a time framework, are we talking
over the next 5 years, 10 years, indefinite period of time?

Ms. FAGNONI. Well, under the Results Act, the strategic plans
are required to cover 5 years. They can be extended more than
that, but it is supposed to cover a 5-year period and the plans are
supposed to be updated at least every 3 years. And, as I said, the


GOVERNMENT PERFORMANCE AND RESULTS
ACT (GPRA) STRATEGIES

THURSDAY, SEPTEMBER 18, 1997

House OF REPRESENTATIVES,
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATION,
COMMITTEE ON VETERANS’ AFFAIRS,
Washington, DC.

The subcommittee met, pursuant to call, at 9:34 a.m. in room
334, Cannon House Office Building, Hon. Terry Everett (chairman
of the subcommittee) presiding.

Present: Representatives Everett, Clyburn, Snyder, Evans,
Mascara.

OPENING STATEMENT OF CHAIRMAN EVERETT

Mr. EVERETT. The hearing will come to order. This morning’s
hearing is on planning by the Department of Veterans Affairs on
the Government Performance Results Act. I will call GPRA the Re-
sults Act. Our witnesses will explain much more precisely what the
Results Act is and requires, but basically it requires the Federal
Government’s departments and agencies to operate in a more busi-
ness-like way by having real plans that resemble those used in the
private sector.

These plans are to achieve and define measurable outcomes
linked to the operations and operating budgets that support them.
The Results Act was passed in 1993 with bipartisan support and
House Majority Leader Dick Army has made the implementation
of Results Act a high-priority. In fact, he has used the VA’s Results
Act pilot program to improve health care at VA hospitals as one of
the early Results Act success stories.

Efficient government should provide better services to veterans.
The VA has had active and cooperative consultations with the VA
Committee and is off to a positive start. But it is important to rec-
ognize that this is only the start and much remains to be done over
the next several years to continue developing and refining the plan-
ning for veterans to the point where it achieves full Results Act
compliance.

We will hear from the General Accounting Office, the Congres-
sional Research Service of the VA, as well as the Departments of
Defense and Labor. Our last panel will be several of the veterans’
service organizations who represent our veterans. I look forward to
hearing their testimony because this is an important subject. The
planning to be done will define virtually every aspect of the VA in
years to come. Our veterans are depending on Congress and the

@M


42

United States General Accounting Office

Testimony

Before the Subcommittee on Oversight and
Investigations, Committee on Veterans’ Affairs,
House of Representatives

‘Thunday
September 18, 1997

THE RESULTS ACT

Observations on VA's
August 1997 Draft Strategic
Plan

Statement of Cynthia M. Fagnoni, Associate Director,
Veterans’ Affairs and Military Heaith Care Issues,
Health, Education, and Human Services Division

GAOMT-HEHS-97-216


73

must cover the agency’s major functions, which are determined primarily by statutory
requirements, but certainly may be presented in the context of the agency view of the qualitative
characteristics of its duty to its stakeholders and customers. The purposes of the agency's
functions and the results they are intended to achieve form the basis of its goals. The plan must
also include general goals and objectives of the agency’s major functions and operations. The
agency must describe how and what operational processes, skills and technology, and resources
will be used to achieve the goals and objectives. The agency must explain how the long-term
general goals and objectives in its strategic plan relate to the performance goals for each program
activity contained in its annual performance plan under GPRA. The strategic plan must identify
factors outside of the agency and its control that could impact upon the agency’s achievement of
its general goals and objectives. Finally, the strategic plan must contain a description of the
program evaluations used in establishing or revising general goals and objectives, with a schedule
for future program evaiuations.

The agency is required to consult with Congress and seek the input of stakehholders in
developing its strategic plan. This is designed to take into account congressional and stakeholder
expectations and views on the agency's mission and goals.

VA\s plan indicates that its strategy for department-wide reform is to change the long-
standing situation in which the Veterans Health Administration (VHA), Veterans Benefit
‘Administration (VBA), National Cemetery System (NCS), and Board of Veterans’ Appeals
(BVA) operated virtually in isolation from each other. VA intends to transition away from this
“stove-pipe” operation to one in which management, planning, and operations involve
consultation and coordination between these major functions. The intent is to improve the
department's overall efficiency, effectiveness, and customer service. According to VA’s vision
statement, it will function as “One-VA” and deliver seamless service to its customers. VA also
states that its vision includes a more forward-thinking, customer-focused approach to strategic
management and that its strategic plan was developed by setting long-term programmatic and
management strategies designed to support accomplishment of the program goals. VA indicates
that it is building in the GPRA strategic management approach by developing measures of
program outcomes and “unit cost” measures of program efficiency; by developing data bases for
management information on its measures; by incorporating benchmarks for levels of performance;
by linking performance to resource needs in the budget; and by linking organizational goals and
performance with individual goals and performance.

Given the special nature of VA's customers and VA's corresponding traditional role of a
more personal and benevolent relationship with them, the DAV is pleased that VA sets the tone
for its future role in its mission statement by acknowledging its duty to serve veterans and their
families with dignity and compassion. Beyond preserving this element of customer service that
veterans expect, highly value, and sincerely appreciate, VA prefers to view itself as their “principal
advocate.” In the DAV’s view, ifit is impressed upon VA employees that they must constantly
keep their advocacy role in mind as they go about their daily business, this statement will come to
be much more than a symbolic gesture: it will in fact improve the relationship between VA and its
customers and will enhance not only customer service but also employee gratification,
satisfaction, and sense of accomplishment, We say this because we believe that there has perhaps


82

Curriculum Vitae

for
RICK SURRATT

Office Address
807 Maine Avenue, S.W.
‘Washington, DC 20024
(202) $84 3501

Biographical Data

Birth Date: May 22, 1949
Place of Birth: Carroll County, Virginia

Military Service

US. Army
Enlisted June 1966 and honorably discharged April 1969.

Education

AA Liberal Arts,
Paralegal Certificate

Relevant Experience

Assistant National Legislative Director, Disabled American Veterans (DAV), January
1996 to present.

Associate National Legislative Director, DAV, March 1994 to January 1996.

Judicial Appeals Representative before the United States Court of Veterans Appeals,
DAYV, September 1989 to March 1994.

National Appeals Officer before the Board of Veterans’ Appeals, DAV, June 1989 to
September 1989.

National Service Officer, DAV, September 1976 to June 1989.
Other Information
Principal author of DAV’s portion of Independent Budget


GOVERNMENT PERFORMANCE AND RESULTS ACT
(GPRA) STRATEGIES

HEARING

BEFORE THE

SUBCOMMITTEE OVERSIGHT AND INVESTIGATIONS

OF THE

COMMITTEE ON VETERANS’ AFFAIRS
HOUSE OF REPRESENTATIVES

ONE HUNDRED FIFTH CONGRESS
FIRST SESSION

SEPTEMBER 18, 1997

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 105-21

ae

U.S. GOVERNMENT PRINTING OFFICE
45-927 OC WASHINGTON : 1998

For sale by the U.S. Government Printing Office
Superintendent of Documents, Congressional Sales Office, Washington, DC 20402

ISBN 0-16-056384-4
a



108

On September 26, 1997, we sent a copy of the survey results to the
members of the House and Senate Veterans’ Affairs Committees. Attached
is a brief summary of the results that has been distributed to all VA
‘employees.

What other steps has VA taken to involve managers outside of central
office in the strategic planning process?

Answer: VHA, VBA and NCS seek input from their area field managers in
formating their strategic plans. VHA, in fact, requires a strategic
plan from each Veterans Integrated Service Network that is incorporated
into their Administration strategic plan. The Administrations develop
business plans which are rolled down to the field for review, comment
and implementation.

7. ‘The Paralyzed Veterans of America (PVA) have expressed concern in &
September 10 letter to Chairman Everett that the strategic plan lists
“raising the level of patient satisfaction” as the only measure of
gauging the quality of care provided to veterans with spinal cord
@yatunction (scp).

Would you agree that other measures, such as quality assurance factors,
should be included in the plan to fully assure the quality of providing
these specialized services?

Answer: We agree that other measures, such as quality assurance factors
should be used to measure the quality of care. While we appreciate
PVA's concerns in this matter, we do not agree that routine quality
assurance factors need to be specified in the strategic plan for every
single program. Strategic plans are supposed to lay out long-term
program goals and are not intended to include a laundry list of every
action that will be taken on a daily basis. VHA does, in fact use a
variety of quality measures on all of their medical programs.

‘PVA has recomended additional goals for the plan, including: doubling
the number of veterans who receive acute rehabilitation in SCI Centers;
maintaining capacity for acute care of secondary conditions in sci
Centers; expanding long-term care capacity, especially non-institutional

alternative care (respite, personal care, assisted living); and
organizing and integrating care for vaterans with multiple sclerosis

Settings, Doss the Departnent consider thers Co'se legitimate goale?
Should they be specifically set cut in the VA’s strategic piany wil

2 in SCD continue to be « mainstay of the VA health
mission?

Answer: Nancy Wilson, M.D., Director, Office of Performance Management,
will be working with PVA to address these i for Veterans Health
Administration. We will inform you of the outcome of those discussions
as soon as possible.



Iv

Written committee questions and their responses:
Chairman Everett to Department of Defense
Congressman Evans to Department of Defense ..
Congressman Evans to Congressional Research Service
Congressman Evans to General Account Office ..
Congressman Evans to Department of Veterans Affairs
Congressman Evans to Department of Labor .....
Congressman Evans to Disabled American Veterans

Page


109



30

body would suggest that it ought to be the VA or the Congress,
very frankly.

With that, Mr. Mascara, do you have any questions?

Mr. Mascara. I do, Mr. Chairman, thank you.

Mr. EvERETT. Go right ahead.

Mr. Mascara. Mr. Williams, are you satisfied with the role that
you were allowed to play in the VA strategic planning process? Do
you have any recommendations for improvement?

Mr. WILLIAMS. Mr. Congressman, we are somewhat pleased at
our role in assisting VA in their effort. We have provided our input
and some of our recommendations have been included in their plan.
However, there is considerable room for improvement and we have
been working rather closely with the Department of Veterans Af-
fairs, along with my counterparts from the other veteran service or-
ganizations. So, in the interest of brevity, to answer your question,
yes, we have been a major player in this effort.

Mr. Mascara. Okay. Either you or Mr. Surratt, how receptive
was the VA to your involvement?

Mr. SurRarT. I believe the VA takes very seriously what the vet-
eran service organizations have to say, and I think they changed
their plan based on that input, and I would like to say, even before
this process, perhaps VA and the veterans’ service organizations
had a closer inter-reaction and working relationship than a lot of
customers do with their particular Federal agency and so I think
in the area of taking seriously stakeholder and the customer into
it, the VA is to be commended.

Mr. Mascara. Mr. Burns are you satisfied with the role that the
AMVETS have been playing in this process?

Mr. Burns. I have no problem, Congressman. As my two col-
leagues have stated, we have been consulted, our input has been
provided and we feel that we have genuinely been listened to.

Mr. Mascara. I guess this is Mr. Williams, yes on page 3 of your
statement, you point out the number of FTEs that have been re-

luced.

Mr. WILLIAMS. Yes.

Mr. Mascara. And I think there is 1,200 over 2 years and then
there is a Plan to cut it an additional 133 and this raises a ques-
tion. I think I asked the question of the other panel but not in the
same context. I spoke to the overall budget and how that would re-
flect on the analysis that they are currently doing, but do you think
that the analysis that is going on, and the Government Perform-
ance and Results Act, will address the problems associated with
the reduction of FTEs?

Mr. WILLIAMS. Well, we would hope so, but also we believe any
further reduction of the FTE may have some adverse impact on
VA’s ability to meet the Results Act mandate. We have found out
that, for example, that the number of FTE that I made reference
to, Compensation and Pension Service, they are being overworked
to a certain degree with more cases involving more complex issues
and it is a very difficult task for them not only to meet the man-
dates, but also to timely and accurately serve our Nation’s veter-
ans. So to conclude my response to you, I would just indicate as
it is pointed out in my testimony, that a further reduction in the


89

the contemporary Journey of Change. It needs to be noted that a significant factor in the
Strategic Plan toward the successful completion of the Journey of Change is enactment of
legislation for both fall retention by the VA on third-party insurance collections and
Medicare subvention.

But, particularly critical are those goals in the strategic plan that have been
articulated and incorporated from the Implementation Plan for Business Process
Reengineering (BPR) in the Compensation and Pension Service. We have, for the last few
years, stated that the three primary issues for the VA concerning the claims processing
system are: (1) quality decision-making at the regional office level on initial and increased
rating compensation claims; (2) reduction of the Board Of Veterans’ Appeals decision
time-lag; and, (3) the high BVA remand rate. Solve these and all other claims processing

problems will essentially resolve because of the interrelated nature of claims adjudication

The stated goals -- the word "vision" may well be an excellent synonym ~~ in the
VA's Strategic Plan, at last, address these three issues head-on, There are very clear
performance objectives to process all claims in an average 60 days, with a 97 percent
accuracy rate, and no greater than a 20 percent BVA remand rate. Those are reinforced
by the objective to complete all appellate actions within 365 days (from the filing of the

Notice of Disagreement through the completion of a BVA decision).

‘The BPR Implementation Plan includes another solid "vision" on how the veterans
services organizations will, and should, operate in the future claims processing system,
Indeed, it projects the VSOs toward better, more comprehensive representation, We
welcome the challenge, and its inherent increased responsibility, which comes with that
expanded role. The Veterans of Foreign Wars had staff members on three of the
‘Compensation and Pension Service BPR work teams (Information
‘Technology/Telecommunications, Training, and Rules & Regulations) that developed the

implementation plan.

We are fully supporting the VBA in its current approach toward complete

implement

ion of Business Process Reengineering in the Compensation and Pension
Service, as defined in their current plan. But, there is one critical vulnerability: the success
of BPR is heavily dependent on information management and technology enhancements.
Specifically, it is clearly stated that the final development and delivery of the long-awaited
Veterans Service Network (VETSNET) is crucial, (The Chairman may recall that we
corresponded this same belief to him last year.)

3


deficiencies in VA's strategic management process and plans, including the question of
Department leadership. The VCAC report also expressed the view that VA's effort to
incrementally improve and fine tune the adjudication process was not going to be successful. The
Chairman of the National Academy of Public Administration, Milton Socolar, in his testimony
before the Senate Appropriation Committee expressed the opinion that the VA, as an institution,
lacks the capacity for integrated strategic management.

Chairman Socolar recommended VA reexamine and improve the analysis, approach, and
management of its BPR program along with a number of other fundamental management and
programmatic changes. The May 14, 1997 Report by the Government Accounting Office (GAO)
also noted that VA has made considerable progress toward developing a strategic plan. Their
criticism of the current strategic plan is that it still remains process oriented rather than truly
results oriented. GAO reiterated further in its report that VA lacks the necessary integration of
other programs within the Department as well as those of other Federal agencies, The GAO
report concluded its study by recommending that appropriate performance goals and measures
needs to be developed by VA.

The development of VA's strategic plan continues to be an evolutionary process. The
task is enormously complex. VA is under tremendous pressure to make the transition to a more
integrated, strategically managed system within a relatively short span of time in order to meet not
only GPRA requirements but the balanced budget.

The American Legion, as recently as last month, received and reviewed a draft copy of
VA's revision of its Strategic Plan for FY 1998-2003. The American Legion noted that VA has
made extensive use of information it had collected through feedback mechanism such as the
environmental scan, customer service surveys and focus groups, and external reports to develop
the goals and objectives in the strategic plan.

‘The revised strategic plan provides significantly more detailed background information and
data in preparation for evaluation of its program areas or “business lines” -- medical care service;
medical research, medical education, compensation, insurance; education; vocational
rehabilitation, housing credit assistance, burial/cemetery services.

‘The plan details information about VA’s ongoing efforts to undertake a Department-wide,
systematic benchmarking effort as a major component of the formal program evaluation process,
The American Legion believes that a disciplined benchmarking process will produce information
VA can use to measure progress or achievement toward its intended goals and objectives. The
American Legion believes also that by establishing true outcome measures for its programs, VA
will be able to make a preliminary determination and more adequately frame the issues with
stakeholders to develop a formal schedule and priorities for future program evaluations,

Over the last 2 years, the Department has put into place several internal and external
groups to address strategic issues critical to VA's future, VA has also demonstrated a
commitment to incorporate customer and stakeholder views in the decision-making process. The
concerns expressed by customers and stakeholders during VA’s environmental scan, conducted in


12

environments as we strive to develop VA into a true high-perform-
ance organization.

New customer service goals focus on the previously neglected
need at the Department to operate as a unified organization, and
to provide seamless service that veterans so rightly expect. These
goals, benchmarked against the best in business, will lead us to
providing true world-class service.

Our strategic scans of the various business lines will identify
data gaps, assess our current performance measures, and highlight
issues that still must be addressed to truly evaluate the effective-
ness of our programs. These scans will be completed in the next
several months and will provide us with the critical underpinnings
for truly effective program evaluations.

We have work to do and we have improvements to make, but we
are ready to move ahead. As I said, I am proud of what we have
accomplished to date, but we are not completely satisfied. I wel-
come candid discussion of the weaknesses that we have identified,
during this hearing and afterward.

Before I describe the plan itself, I want to mention the consulta-
tions we have had with staff of this committee and other parts of
the Congress. Discussions were at all times frank and professional
and contributed immensely to our work. Similar valuable consulta-
tions occurred with other stakeholders, including veteran service
organizations, OMB, our labor union partners and other Federal
agencies. Building on that base, consultation and cooperation will
continue.

Let me briefly describe the strategic plan. First the Department’s
mission and vision were identified, along with major planning as-
sumptions. The opening section also described the veteran popu-
lation and trends that we anticipate in coming years.

Part one of the plan contains VA’s strategic goals for all VA pro-
grams through which services and benefits are provided. It de-
scribes planned improvements, goals, and objectives. Strategies are
identified for each of our various business lines, as well as for all
our special-emphasis programs. We sought to provide sufficient in-
formation without being overly descriptive. This section also at-
tempts to outline plans for substantive program evaluations, a sub-
ject that I hope to address shortly.

Mr. Chairman, VA is genuinely committed to meeting the chang-
ing needs of our veteran clients in the 21st century and we recog-
nize that effective program evaluations are critical to that goal.

Part two of our plan attempts to identify management strategies
that reflect our strong belief that the future of VA requires true
customer service, a high performing workforce, efficient operations
and careful exercise of our fiduciary responsibility to the American
taxpayer. Our workforce goals include fostering performance ac-
countability and innovative practices. Our return-on-investment
goals include better activity-based cost accounting and an effective
capital investment program. In constructing our lan, results of the
environmental scan and various customer surveys are reflected in
the goals and objectives. However, we did not conduct formal pro-
gram evaluations.

Throughout our consultations with you and with others, that lack
of program evaluations and a closely-related subject, a need for


54

We will then establish a priority list of evaluations to be conducted and a schedule
for completion, with input from the Congress and other stakeholders. The schedule
will be dependent on several factors including the complexity of the evaluation, the
degree to which original data must be collected, and the resources available to

conduct the evaluations.

The results of program evaluations address the second area of concern expressed
during consultations, that of establishing true outcome-based performance
measures. We will assess the extent to which the programs are meeting the needs
and expectations of veterans, determine how efficiently the programs are operated
and their effect on other related programs, and recommend program changes to

include revisions to existing statutes, where appropriate.

Chairman Stump expressed his desire that VA use interim results-oriented goals,

the Veterans Benefits Administration, while true outcome measures

particularly
are being developed. VBA is committed to developing and including as many such
interim goals as possible. Examples already included in the 1998 performance plan
are Montgomery GI Bill usage rates and employment effectiveness rates for our

Vocational Rehabilitation and Counseling program. Additional short-term measures

for the 1999 performance plans will be developed.

At this point, | would like to shift focus to broader GPRA considerations and
another concern of the Congress -- improving the coordination, cooperation, and
collaboration among agencies on cross-cutting functions and programs. Our
planning efforts to date have been largely focused on the VA Strategic
Management Process and developing VA's Strategic Plan. We have not
coordinated our mission, planning and design efforts with other agencies to the
extent we would have liked. However, VA has long engaged in efforts at the
operational level to improve the interaction and coordination with those who have

related programs. For example:

With the Department of Defense, VA has many ongoing initiatives in both
the health care and benefits areas that are intended to improve the
operations of both departments and improve service to veterans and
active duty members. A pilot project with the U.S. Army is exploring
different ways to conduct separation examinations so that claims for
service connection are well grounded and their processing expedited. An
evaluation report is expected shortly, but based on preliminary findings,

this effort to improve separation exams and pre-discharge rating acti

will be expanded to other branches of the service. In addition, Joint use


96

House Veterans’ Affairs Committee
‘Subcommittee on Oversight and Investigations
Department of Veterans’ Affairs Strategic Plan
September 18, 1997
Member: Chairman Everett
Witness: Gary A. Christopherson
Question 1

Question! , part 2:
Do DoD and VA have plays to integrate patient data through an ADP system architecture?
Answer:

‘The DoD and VA have focused efforts on sharing data through the use of open systems
standards, rather than the adoption of a single ADP system. This is due to the significant costs
for either VA and/or DoD to abandon their respective existing installed systems and transition to
a common Automated Information System solution.

One example of this approach is the successful demonstration of laboratory message transaction
exchange between the DoD and VA systems using the Health Level Seven (HL7) protocol in a
test environment. HL7 is a standard protocol which specifies the implementation of interfaces
between two computer applications (sender and receiver) from different vendors for electronic
data exchange in health care environments. The formats are generic in nature and must be
configured to meet the needs of the two applications involved.

Additionally, a successful proof-of-concept demonstration for electronic laboratory data
exchange between DoD and VA systems was completed with plans for future analysis and
development towards a deployable application. The Defense Medical Information Management
activity plans to expand the DoD/VA Sharing Agreement to include electronic information
sharing as concept demonstrations evolve in other functional support areas. The ultimate goal is
to share patient, clinical and administrative data across agencies and systems to promote quality
health care and reduce costs.

While many of the technological issues are being resolved to support electronic patient record
transfer, other issues remain to be addressed to include, but not limited to, unique patient
identifier, security, firewall, data standardization, and confidentiality. DoD continues to work
with the VA towards a common solution.


%

Section I of Part I contains VA’s goal of program evaluation as required by GPRA. This
involves validation of the statutory intent of the programs, establishment of outcome measures,
and development of program evaluation protocols. VA intends to accomplish these aspects of its
plan in fiscal years 1998 and 1999. VA plans to complete at least one program evaluation for
each of its business lines by fiscal year 2000.

Section II provides the strategic goals for VHA and its programs, Medical Care Services,
Medical Research, and Medical Education. The strategic goals cover the areas of the delivery and
quality of patient care, management and work force issues, expansion of staff training, and
increasing patient satisfaction, These goals include VHA’s “30-20-10” plan from its fiscal year
1998 budget submission. This is the means by which VIA plans to provide better, more efficient
services to a greater number and variety of veterans than it has in the past. Under this plan, VHA
seeks to decrease the average cost per patient by 30%, increase the number of users of the
veterans’ health care system by 20%, and increase the portion of the operating budget obtained
from nonappropriated sources to 10% of the total. The potential for realization and the
associated problems with this plan have been the subject of much discussion by the veterans
service organizations, the Veterans’ Affairs Committees, and other committees in Congress
during deliberations in the current budget cycle. Passage of legislation for Medicare subvention is
a key element of this plan, and that is not assured at this time. Hopefully, it will be passed
because, as has often been stated, the success of the overall plan depends upon it.

A shift to managed care is a key component of VA’s plan to shift emphasis to quality and
maximum potential of the care provided to veterans. Under managed care, quality and cost-
effective care will be assured by a primary care provider who is in charge of the patient’s care and
coordinates the health services the patient needs, in the most appropriate setting.

sits second major strategy to improve outcomes in health care delivery, VHA will
establish standard performance measures that will enable both management and patients to assess
whether high quality care is being provided. For example, the Chronic Disease Index (CDI)
measures how well VHA follows nationally recognized clinical guidelines for specified illnesses,
and the Prevention Index (PI) assesses how well VHA follows nationally recognized approaches
to primary prevention and early detection recommendations related to diseases with major social
consequences. With performance measures based on clinical guidelines, VHA will use customer-
rated quality assessments, VHA's goals are to increase to 90% the proportion of veterans who
report VA health care as good or excellent and who rate the quality of VA health care as
‘equivalent to or better than that provided elsewhere. Performance goals also include increases in
the CDI and PI scores from 85% to 98% by fiscal year 2003. In the area of medical care services,
VHA also has goals to evaluate its capacity to fulfil its mission as a backup medical care provider
for the Department of Defense in the case of war or national emergency and to provide other
support during a national disaster.

VHA’s strategy for medical research is to link medical research with patient needs and
focus research on veterans’ priority health care needs. The goal is to increase to no less than
99%, by fiscal year 2003, the proportion of research projects that are demonstrably related to
VA's health care mission.


36

| AM HOPEFUL THAT THIS MORNING'S HEARING
WILL DRIVE HOME THE MESSAGE THAT THIS
COMMITTEE RECOGNIZES THE IMPORTANCE OF
STRATEGIC PLANNING. WITHOUT SUCH PLANNING,
THE VA WILL BE HARD-PRESSED TO ACHIEVE THE
RESULTS AND HIGH PERFORMANCE LEVELS
INTENDED BY CONGRESS WHEN WE PASSED THE

G-P-R-A IN 1993.

WE MUST ALSO RECOGNIZE THAT FOCUSED
STRATEGIC PLANNING DESIGNED TO ACHIEVE
REAL, QUANTIFIABLE RESULTS IS NO EASY TASK.
THE VA, LIKE MOST OTHER FEDERAL AGENCIES,
HAS BEEN STRUGGLING WITH THESE DIFFICULTIES
SINCE THE G-P-R-A WAS PASSED. STRATEGIC
PLANNING IS NATURALLY AN ONGOING PROCESS.
AND WHILE THE VA HAS A LONG WAY TO GO, | AM
PLEASED TO SAY THEY HAVE MADE GREAT
STRIDES OVER THE PAST FEW MONTHS TO PUT

TOGETHER A WORKABLE PLAN THAT CAN


48

‘Another goal in the current draft plan is to establish a VA capital policy that ensures
that capital investments, including capital information technology investments, reflect the
most efficient and effective use of VA's resources. Achieving this goal involves
developing a VA-wide Agency Capital Plan and establishing a VA Capital Investment Board
to generate policies for capital investments and to review proposed capital investments
‘based on VA's mission and priorities.

Still another goal is designed to address the need for VA-wide information
technology management to facilitate VA's ability to function as a unified department.
Achieving of this goal involves developing a VA-wide information technology strategic
plan and a portfolio of prioritized information technology capital investments. In addition,
the plan calls for the promotion of crosscutting VA information technology initiatives in
order to improve services to veterans.

‘The draft plan's discussion of information technology addresses one of the
information technology issues we have identified as high-risk throughout the federal
government-the year-2000 computer problem.’ Unless corrections are made by January 1,
2000, VA's computers may be unable to cope with dates in 2000, which could prevent VA
from making accurate and timely benefit payments to veterans.” VA's draft plan includes
as a performance goal that full implementation and testing of compliant software (that is,
software capable of processing dates beyond 1999) will be completed by October 1999.

‘Mr. Chairman, this completes my testimony this morning. I would be pleased to
respond to any questions you or Members of the Subcommittee may have.

(105768)

7, May 30,1997)
6 GAO/T-HEHS-97-216


53

innovative practices. Return on investment goals include improving cost accounting

and productivity, and establishing an effective capital investment program.

Throughout our consultations, two areas of concern were expressed: program
evaluations and outcome-based performance measures. These areas are closely
related and interdependent.

In constructing our Plan, the results of the environmental scan and numerous
customer surveys conducted by the Veterans Health Administration and the

Veterans Benet

Administration were considered and are reflected in our goals and
objectives. However, we did not conduct formal program evaluations. The intent
of program evaluations under GPRA is to ensure that VA programs are meeting
their statutory intent. This intent should not be viewed in isolation. GPRA
assumes that agencies will look beyond isolated program lines to evaluate program
effectiveness. Defining statutory intent often is not as easy as it appears. The
statutes governing veterans’ benefit programs generally do not describe intended
program results. Rather, they establish specific benefits with criteria as to whom
and under what conditions the benefits are available. Historically, Congressional
oversight has focused on program delivery rather than program outcomes. Until our
recent GPRA consultations, neither the Congress nor VA has, for the most part,
focused on outcome or results. Additionally, these benefits need to be assessed as
an integrated part of a comprehensive package of military and other federal
entitlement ben:

to veterans.

Given this background, VA is embarking upon an approach to program evaluation
that we believe is both professional and practical. This approach begins with
strategic scans of each business fine and then identifies all pertinent programs and
revalidates program intent. Recognizing the sensitive nature of certain aspects of
both program evaluation and the establishment of outcome-based program
performance goals, we will closely involve both internal and external stakeholders,

including the Congress, in identifying statutory intent and the needs and

expectations of veterans. There may be instances in which the statutory intent is
either not clear or, when clear, the language may not match everyone's

understanding of the programs as they have evolved over time.

Program outcome measures will be established so as to ensure that the results of
the programs can be evaluated. Strategic data needs will be identified and
approaches developed to meet these needs.


49

STATEMENT BY
THE HONORABLE DENNIS DUFFY
ASSISTANT SECRETARY FOR POLICY AND PLANNING
DEPARTMENT OF VETERANS AFFAIRS

BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE VETERANS’ AFFAIRS
U.S. HOUSE OF REPRESENTATIVES

SEPTEMBER 18, 1997

Mr. Chairman and members of the Subcommittee, it is my pleasure to testify this
morning on behalf of the Department of Veterans Affairs (VA) concerning the
Department's Strategic Plan FY 1998-2003. | am accompanied by D. Mark Catlett,
Acting Assistant Secretary for Management, and Nora E. Egan, Deputy Assistant
Secretary for Planning. As you know, the Plan is due to the Congress on
September 30 and remains in draft at this time. We are still in the process of
revising and improving the Plan, giving consideration to comments and suggestions

received.

‘The Department of Veterans Affairs has embraced the opportunity offered by the
Government Performance and Results Act (GPRA) to meet the changing needs of
veterans and ensure that we are able to honor, care, and compensate veterans in
recognition of their sacrifices for America. GPRA promotes a new focus on results,
service quality, and customer satisfaction that is needed and welcome, especially to
agencies such as VA whose mission is to provide benefits and services. GPRA’s

purpose, and VA's intent,

to improve planning functions, program performance
measurement, assessment of program outcomes, and program management in

order to improve service to veterans.

GPRA has imposed statutory requirements upon the Federat government for
integrating planning, budgeting, and performance accountability that previously
relied upon various management approaches. We believe that GPRA intends
planning to be an ongoing, ever-evolving process that forces us to ask the tough
questions, identify appropriate data to support decision making, and adjust our
programs, benefits, and services to meet the needs and expectations of veterans
and their families. GPRA demands that we consider, in consultation with the
Congress and other stakeholders, such questions as these:

7

Are veterans’ programs ac!
were intended?

ing the purposes or results for which they


78

VA addresses the National Cemetery System, State Cemetery Grants Program, and the
provision of headstones, markers, and memorial certificates under Section IV of Part I, a section
entitled “Commemorative Support.” Again, the general goal is to assure that burial and memorial
programs are meeting veterans’ needs. The objective is to improve availability of the services to
increase the number of veterans for which this is a practical option. The strategy is to build new
national cemeteries, expand existing cemeteries, and encourage state participation to meet
projected demand. These are appropriate approaches to fulfilling the intent of these programs.

Section V of Part I presents a wide variety of strategies to assure that the unique needs of
special veteran populations are met. These special emphasis programs are for the following
categories:

Agent Orange

AIDS

Blind Rehabilitation
Ex-Prisoners of War

Geriatrics and Long-Term Care
Homelessness

Tonizing Radiation

Minority Veterans

Persian Gulf Veterans
Posttraumatic Stress Disorder
Preservation/Amputation Care
Prosthetics and Rehabilitative Medicine
Readjustment Counseling
Seriously Mentally Ill Veterans
Spina Bifida

Spinal Cord Injury/Dysfanction
Substance Abuse

‘Traumatic Brain Injury

Women Veterans

ed

A variety of specially tailored strategies are provided for evaluation and improvement of these
programs. It is appropriate that VA give these groups of veterans and their needs added
attention.

‘The management strategies in Part Il are addressed in three sections: the first dealing with
customer service, the second with a high-performing work force, and the third with providing
maximum return on taxpayer investment. These management strategies all support VA’s
endeavor to operate as “One-VA” and to provide “World-Class” service. VA sees improvement
of the quality of life for veterans as its reason for existence, and world-class service is how VA
intends to carry out its il ‘to veterans. World-class service, according to VA, is
service comparable to the best provided by public and private sector organizations. A component
of this is “seamless” service, which VA defines as service to veterans in which they are provided



88

by the many people in the department. That is where the true impact of GPRA must

‘occur.

With that quick background, we are encouraged by the department's initial
approach in the development of the VA Strategic Plan. We have now been provided two
drafts of the plan, the second this past August 15. In between, we and the other veterans
service organizations, were personally briefed on the philosophy behind the VA's approach
to the GPRA and the proposed revisions to the first draft of the strategic plan. This
‘erudite consultation indicates a willingness from the department to reach out and seek
counsel in the preparation of quite possibly the most important plan yet devised by the
VA.

‘This approach has resulted in our commendation to the Department of Veterans
[Affairs in a response to the Assistant Secretary for Policy and Planning upon completion
of our review of the first draft strategic plan. We felt the plan was overall well-stated and
a comprehensive compilation of the important programs in the VA. We believed — and
still do so believe -- the strategic goals, objectives, and performance goals are clear,
concise, and fittingly ambitious. We did have one major and four minor suggestions for

improvement.

The four minor comments, as best as we can determine, are still not addressed in
the second draft. They were: (1) the need to develop a definition and state a separate
strategic goal for the Public Law 104-262 enrollment priority category *Catastrophically
Disabled"; (2) the possibility that the projection of an overall 11 percent growth rate in
veterans’ outpatient visits to fiscal year 2003 may be woefully underestimated; (3) the
Board of Veterans’ Appeals should have specific performance objectives on their
respective decision timeliness (from docket date to final decision); and, (4) a strong,
‘suggestion to formalize, as a performance objective, the ongoing placement of
adjudication and rating personnel by some regional offices into VA medical centers.

More important was our major comment that there was an obvious lack of
Veterans Benefits Administration programs. That has been corrected in a large way in the
second draft, which now contains most of the VBA's very important goals. All of the
‘VA's business lines are adequately covered with excellent ones involving Vocational
Rehabilitation, Education, and Insurance. We also should state that the Veterans Health
Administration's strategic goals and performance objectives are well covered as a natural
evolution from the Vision for Change and its progeny: the Prescription for Change and

2


43

Mr. Chairman and Members of the Subcommittee:

We are pleased to be here today to provide our views on the draft strategic plan
developed by the Department of Veterans Affairs (VA), pursuant to the Government
Performance and Results Act of 1993 (the Results Act). As you know, the Results Act
was one of the major steps the Congress has taken in recent years to fundamentally
change the way federal agencies go about their work. The Results Act requires agencies
to clearly define their missions, set goals, measure performance, and report on their
accomplishments. One of the act's major milestones-submission to the Congress by
federal agencies of strategic plans that define their missions and set goals-is less than 2
weeks away.

With fiscal year 1996 spending of over $38 billion, VA is responsible for administering
laws that provide numerous types of benefits to many of the nation's 26 million veterans
and their dependents and survivors. These benefits include medical care, disability
compensation, pensions, rehabilitation assistance, education benefits, home loan benefits,
insurance coverage, and burial benefits. My statement today will address the progress VA
has made in developing its strategic plan and the challenges VA continues to face in
implementing the Results Act. My observations are based on our review of VA's June
1997 draft strategic plan and have been updated to reflect revisions VA made between
June 1997 and its latest version, dated August 16, 1997.'

In summary, VA has made substantial progress in its strategic planning, based in part
on consultations with the Congress. However, as with many other agencies, VA's process
of developing a pian that meets the requirements of the Results Act is an evolving one
that will continue well after the September 30, 1997, deadline for submitting its first
strategic plan to the Congress and the Office of Management and Budget (OMB). The
August 16, 1997, draft that VA submitted to OMB for review is an improvement over the
June 1997 version, because it is easier to follow, places more emphasis on results and less
on process, and fills in some major gaps in the June 1997 draft. However, the latest draft
strategic plan continues to lack some of the key elements expected under the Results Act,
As with the June 1997 draft, the August 16, 1997, draft lacks results-oriented goals for
several major VA programs; lacks a program evaluation schedule; and contains
inadequately developed discussions of external factors and the need to coordinate with
other federal agencies.

VA is aware that it has much work to do to fully implement the Results Act and
considers its strategic planning-including conducting program evaluations and developing
results-oriented goals-to be a long-term effort. Some of this work is identified in the
current draft strategic plan. VA's success in implementing the Results Act will depend on
how successful it is in ensuring that its strategic plan focuses on results and how well it
integrates its plan with the plans of other federal agencies. The Congress will continue to
play an important role in consulting with VA in developing results-oriented goals and
overseeing VA's efforts to successfully implement the Results Act.

A Plan (GAO/HEHS-97-
174k, “sul 11, 1067). On August 1, 1997, VA provided a new draft strategie plan, revised
from’ the June 1997 version. On August 16, 1997, VA provided another version that
contains some additional material supporting the goals stated in the August 1 version.
Unless specifically noted, our comments on the August 15 version also apply to the
August 1 version.

GAO/T-HEHS-97-215


113

FOLLOW-UP QUESTION
FROM THE HONORABLE LANE EVANS:
FOR RICK SURRATT
ASSISTANT NATIONAL LEGISLATIVE DIRECTOR
DISABLED AMERICAN VETERANS

Question: Can you outline how the DAV was brought into the VA’s strategic planning process
and how receptive the VA was to your involvement?

Answer: The DAV’s most extensive involvement was not in the formulation of the strategic plan
as such, although we did participate in discussions with VA on the draft versions of the plan. We
were involved more in influencing the policies incorporated in the plan. Because policymaking is
often an evolutionary process, many varied meetings and discussions between VA and DAV and
other veterans service organizations (VSOs) quite likely played a role in shaping the goals,
objectives, and strategies included in the plan

VA consults with the VSOs on both an ad hoc and regularly scheduled basis. The Veterans
Benefits Administration (VBA) conducts quarterly meetings with the VSOs on issues of
importance and on the status of claims processing, etc. VBA conducts other meetings on special
issues as needed, These kinds of meetings are both to disseminate information and allow
exchange of ideas between VBA and the VSOs.

The DAV has representatives on several advisory committees. We have a staff member or other
employee on the following:

© Consumer Advisory Committee of the Committee on Care of Severely Chronically
Mentally Ill

‘* Advisory Committee on Prosthetics and Special Disabilities Programs
© Advisory Committee on the Readjustment of Veterans

‘© Advisory Committee on Women Veterans

© Center for Minority Veterans

© Geriatrics and Gerontology Advisory Committee

© Persian Gulf Scientific Committee

* Veterans Advisory Committee on Rehabilitation

© Voluntary Service National Advisory Committee and its Executive Committee

Many of these committees are involved in the “Special Emphasis Programs” included in Part I,
Section V, of VA's strategic plan.

One area in which we believe our input was taken most seriously and is most reflected in VA's
strategy and goals is the Business Process Reenigineering (BPR) Plan. which forms the basis of
the business plan for the Compensation and Pension Service (C&P). We met with members of thi
BPR Team during its study of claims processing problems and had a candid and extensive
discussion of the sources of the problems and their solutions. The BPR Team’s December 1996
report, Reengineering Claims Processing: A Case for Change, marked a shift in VA’s stance
regarding its claims processing. Previously, VA had essentially denied it had serious problems,
then it blamed them on external factors such as judicial review. The BPR report acknowledged
the real core problems underlying the claims backlog, among which are poor quality and a lack of
accountability for quality as well as inadequate means to measure and enforce it. The DAV has
also had representation on the BPR design teams established to develop the details for
implementation of the various aspects of the BPR plan, When a few proposals by VA personnel



CONTENTS

OPENING STATEMENTS,

Chairman Everett .
Hon. Frank Mascara .
Hon. James E. Clyburn
Hop, Lane Evans, ranking democratic member, fail Committee on Veterans’
fairs ... i"

WITNESSES

Borrego, Al, Assistant Secretary-Designate, Veterans’ Employment and Train-
ing Service, Department of Labor.
repared statement of Mr. Borrego
Burns, Chuck, National Service Director, AMVETS.
Prepared statement of Mr. Burns
Cragin, Charles L.. Principal Deputy Assistant Secretary of Defense (Reserve
Affairs), Gary Christopherson, Acting Principal Deputy Assistant Secretary
of Defense (Health Affairs), Lt. Gen. Norman Lezy, Deputy Assistant Sec-
retary of Defense (Military Personnel Policy), Department of Defense
Prepared statement of Mr. Cragin... :
Duffy, Dennis, Assistant Secretary for Policy and Planning; accompanied
by D. Mark Catlett, Acting Assistant Secretary for Management; and Nora
Egan, Deputy Assistant Secretary for Planning, Department of Veterans
Affairs

repal
Fagnoni, Cynthia M., Associate Director, an Serv-
ices Division, U.S, General Accounting Office; accompanied by Bruce D.
Layton, Assistant Director, Health, Education, and Human Services Divi-
sion, U.S. General Accounting Office; and Greg D. Whitney, Evaluation-
in-charge, Health, Education and Human Services Division, U.S. General
Accounting Office ..
Prepared statement of Ms. Fagnoni
Manhan, Bob, Assistant Director, National
Foreign Wars .
Prepared statement of Mr. Manhan
Snook, Dennis W., Specialist, Social Legislation, Education and Public
fare Division, Congressional Research Service, Library of Congress .
Prepared statement of Mr. Snook ...
Surratt, Rick, Assistant National Legislative Director, Disabled American
Veterans ....
Prepared statement of Mr. Surratt
Williams, Carroll L., Director, National Veterans Affairs and Rehabilitation
Commission, The American Legion
Prepared statement of Mr. Williams

MATERIAL SUBMITTED FOR THE RECORD

Attachment—a diagram of VA Strategic Management Process ..

Letters:
From Chairman Stump to Hon. Jesse Brown, May 20, 1997
From Chairman Stump to Hon. Hershel Gober, August 12, 1997.
From Mr. Dennis Duty to Congressman Mascara, September 26,
From Congressman Evans to Hon. Hershel Gober, August 11, 1997

Statement of Paralyzed Veterans of America ....

(a)

42
29
87
38

25
72

27
83


1. Can you describe to us the most significant challenges faced by VA
in attempting to comply with the requirements of the GPRA?

Answer: There are many challenges, but the most significant are
changing the VA culture so that we think more strategically, developing
meaningful outcome-oriented goals and outcome-based performance measures
for all VA programs, evaluating the extent to which our programs are
achieving their missions, and finally operating as *One-VA" to better
serve our veterans.

Has it been your experience that the GPRA establishes a good framework
for agency planning?

Answer: A number of frameworks have been used that had the potential to
lead to effective strategic planning, but none worked very well in
government because of the pressure of short-term budget issues and
agency heads did not find any particular value in long-range planning
that would not yield positive results during their normally short
tenures. The value in the GPRA framework is not only that strategic
planning is now mandated by law, but more importantly, perhaps, is that
Congress hae shown an interest and awareness of how effective GPRA can
be when fully implemented. Because of this interest, agencies are more
likely to focus on strategic planning.

2, Your testimony indicates that the strategic planning consultations
with Congress have been productive. Are there any improvenents you
xecommend in thie regard?

Answer: We believe the consultations were very effective and helped VA
produce a better strategic plan. We were particularly pleased with the
two-way communication that developed between VA officials and the staffs
of the Veterans’ Affairs Committees. The process could be improved by
making consultation an ongoing process and by including staffs from the
Appropriations Committees. ‘The Congress and VA should have periodic
discussions throughout the year to keep each other up-to-date on
planning issues.

3. Mr. Brickhouse, the Assistant Secretary for Human Resources,
recently put together an agency-wide human resources conference in
Topeka, Kansas several weeks ago that focused on strategic planning
issues. I believe Mr. Catlett and Ms. Egan participated in the
conference. Can you provide us with « brief overview of the topics
addressed at the conference, and tell us whether you found the
conference to be useful?

Answer: I was pleased by the process and the outcomes of the agency-
wide Human Resources Conference in Topeka, Kansas. The primary focus
was a real-time strategic change event designed to bring the some 300
conference participants, both VA executives and human resource
officials, to consensus on the principal VA human resource strategic
opportunities. The participants heard from VA executives,
representatives from other agencies, and from the private sector on
current human resource issues and VA issues which have a human resource
impact.

Using a consultant-designed process, the participants reached consensus
on four strategic opportunities which will support objectives in the
Department’ strategic plan. These opportunities include: simplifying
VA's human resource policies and procedures, developing succession plans
VA-wide, teaching human resource professionals more about VA's business,
and training employees in human resource core competencies



66

2

with VA Vocational Rehabilitation Program participants at least 90 days
before these participants complete their program. This allows us to begin to
tailor an individual job search and labor exchange program while the veteran
is still in rehabilitation. Sharing case information on a timely basis between
the VA Vocational Rehabilitation Program counselor and the employment
specialist is helping VA Vocational Rehabilitation Program graduates find and
keep jobs for which they are qualified.

Our state directors of veterans’ employment and training are working
with both the state employment service system and the DVA to provide
veterans with an effective continuum of care. Our long-term goal is to
eliminate the unproductive time between completion of therapy and the
beginning of gainful employment. I believe that this type of partnership will
help both agencies accomplish their goals.

A directive to VETS? field staff just last month stated our intention to
develop a similar MOU with the DVA for veterans participating in the
Compensated Work Therapy (CWT) Program. In Lebanon, Pennsylvania,
our Disabled Veterans Outreach Program (DVOP) specialist has had a close
working relationship with the DVA for some time. He makes on-site visits
every week to conduct job search training seminars at the DVA medical center
and he has a very high job placement rate for CWT graduates.

To improve our day-to-day working relationship with the Department of
Veterans Affairs, Ken Greenberg, from the DVA, is serving on a detail with
VETS to help us build more effective program delivery systems. By
exchanging employees, VETS and the DVA build on a wealth of historical
knowledge and experiences to improve services to veterans. This close
working relationship enables veterans to move forward and become
productive, working citizens, We intend to build on this type of successful
cooperative effort in the coming years by closely monitoring placement rates of
CWT graduates.

In another example of the continuum of care concept, we are also
working closely with the DVA to help those veterans caught in the tragic cycle
of homelessness. The DVA provides outreach, case management, residential
medical and psychological treatment, and transitional housing. In short, the
DVA gets them ready for the job market.

At the same time, VETS is working with these veterans to help them find
unsu! d employment that will enable them not only to regain their ability
to pay rent and buy food and clothes, but to regain their dignity and self-
respect. I believe our combined efforts on behalf of homeless veterans are
among the most gratifying and important activities undertaken by our
agencies. Veterans who have sacrificed personal gain and family pleasures to
protect our way of life should never find themselves homeless in this great
nation. Iam pleased that VETS’ FY 1998 budget contains a request for $2.5
million to put some muscle behind our efforts to turn homeless veterans into
productive citizens.



52

effective. | will identify some of these weaknesses this morning and welcome a

candid discussion of these during the hearing and afterward.

Before | describe the VA Strategic Plan, let me take a moment to acknowledge the
fruitful consultations that we have had with the staff of this Committee, as well as
the staff of the Senate Veterans’ Affairs Committee, the General Accounting Office
and the Congressional Research Service. The discussions were frank and
professional and have contributed immensely to the development of our Strategic
Pian. Similar valuable consultation occurred with our other stakeholders and
partners: the Veterans Service Organizations, the Office of Management and
Budget, our National Partnership Council, and, to a lesser degree, other Federal
departments and agencies. We anticipat

that consultation and cooperation will
continue and be strengthened in the coming months and years as we strive to
implement the goals, objectives, strategies, and performance goals contained in the
Pian.

Now | would

like to describe specific aspects of the Strategic Plan itself, It is
constructed around the requirements of GPRA while also reflecting the unique
nature of the Department's mission. First, the Department's mission and vision are
identified along with some of our major planning assumptions. We also describe
the characteristics of the veteran population and the trends that we anticipate in

the coming years.

Part | of the Plan addresses VA’s programs and describes our plans to improve the
programs and their benefits and services for veterans. General goals, objectives,
strategies, performance goals, and external factors are identified for each of VA's
ten business lines as well as the many special emphasis programs. The level of
detail presented is intended to provide enough information so that it is clear what
we intend to accomplish without being overly detailed. We also discuss our plans
to institute a process of substantive program evaluation. VA is deeply committed
to ensuring that benefit and service programs meet the changing needs of our
veteran clients in the 21* century.

Part Il of the Plan identifies management strategies that reflect our strong belief
that effective program results can be achieved only if we also provide outstanding

customer service; if we create and maintain a high-performing workforce; and if we

operate efficiently and carefully exercise our fiduciary responsibility to the
taxpayers. Earlier | discussed the six dimensions of customer service and the
employee survey that will be used to improve workforce performance. Other

workforce goals include enhancing performance accountability, recognition, and


101

CRS-2

could also founder on horizontal disagreements between overlapping functions. VA's plan
‘was the result of this attempt to conduct a comprehensive Department-wide review and
Danning effort, wit all parts ofthe Department expected to work toward a document with

‘The Department could be given high marks for producing a plan that made clear the
method by which the plan was developed. However, a complete evaluation of VA's strategic
plan, both for the conduct of VA operations, and for the extent to which that plan can be
‘coordinated with those of other federal agencies, awaits data from program evaluations VA
has yet to perform. VA has included plans for such evaluations in the strategic plan it
‘submitted in compliance with GPRA’s September 30, 1997 deadline, and subsequent revisions
of VA plans may well be guided by data from those evaluations.

Question 2. Can you explain what the GPRA expects of the federal agencies in general, and
the VA in particular? In your view, are the goals and objectives of GPRA realistic, or does
GPRA expect too much from the federal agencies?

GPRA requires that the Executive Branch describe itself in terms of the effectiveness of
its efforts as well as provide a detailed account of what it does. The Act established a series
of steps and a timetable to produce an accounting of government functions from the bottom
‘ip, and it requires that this explanation focus on purposes rather than simply accepting the
basis for the activities as given.

The Act also required OMB and GAO to assist agencies to achieve consistent
compliance. The subsequent compliance format developed by them applies across the federal
government, and establishes a common framework so that the effects of GPRA among
agencies may be compared. As interpreted by OMB and GAO, a strategic plan contains six
elements:

‘© A comprehensive agency mission statement;

Long-term goals and objectives for all major agency functions and operations;

Strategies to achieve the goals and objectives, and the resources needed;
The relationship between long-term objectives, and annual performance goals;

«Identification of key factors beyond the control of the agency that could interfere with
achievement of the strategic goals; and

‘© A description of how program evaluations guided the formation of strategic goals, and
a schedule of future evaluations.

The Act does not relieve VA of any specific requirements, nor does it impose on VA.
requirements unlike those for other agencies. The complexity of VA's mission may have
expanded the scope of VA’s strategic plan beyond those produced by other agencies, but any
aspects of GPRA that might have had specific relevance for VA only have not been identified.

One objective of GPRA is to determine the feasibility of a comprehensive, government-
wide plan, to be in place as early as FY2002. Whether the objective of a rational government
with measured effects is achievable within the time-frame suggested by GPRA is uncertain,
but the goal remains a clearly defensible ideal,


26

to comply formally with GPRA, but also to actually give more
meaning to its programs, to perform its tasks with efficiency and
effectiveness we rightfully expect of a government agency, and to
improve the quality, timeliness and level of service to veterans. It
appears VA understands well its mission, appreciates its stakehold-
ers’ expectations and has good ideas on how to fulfill its mission.
While it is much easier to present a good plan than it is to execute
it, VA’s efforts so far suggest that its plan is much more than just
to improve appearance.

VA knows its stakeholders demand the changes necessary for it
to fulfill its mission with the highest standards of performance,

roficiency and service. VA’s mission statement demonstrates that

'A’s appreciation for its role goes beyond the mechanics of its as-
signed tasks. The law makes it VA’s responsibility ultimately to en-
sure veterans receive all due consideration and benefits to which
they are entitled. Therefore, for VA to assume the posture of the
veteran’s adversary or even to deal with a veteran at arm’s length
would violate its heightened duties to the veteran. The veteran’s in-
terests are VA’s interests. As a final guarantor of veterans’ rights
by law, VA is necessarily their advocate, and VA’s mission state-
ment does not simply acknowledge that, but proudly declares it.
The spirit with which VA approaches its mission is just as impor-
tant as the technical soundness of its strategy.

VA's goal of world-class customer service is also consistent with
its benevolent relationship with veterans. VA sees seamless service
delivery as an essential of world-class service. By seamless, VA
means coordinated service by an agency whose separate functions
cooperate and operate as an integrated whole, rather than compart-
mentalized service from disconnected units.

This approach by the Veterans Health Administration has yield-
ed positive results, and there is potential for department-wide im-
provements. For example, improved coordination between the Vet-
erans Benefits and Veterans Health Administrations could improve
disability claims processing. Lack of coordination results in incon-
sistent decisions betwee! ’s business lines. For example, rating
boards not infrequently hold that a veteran’s service connected dis-
ability is not serious enough to prevent work, when Vocational Re-
habilitation and Counseling Service has determined the disability
is so profound it makes it infeasible for the veteran even to pursue
a course of training and vocational goal.

We see instances where indebtednesses are created against vet-
erans because they were not notified of impending foreclosures on
their VA-guaranteed mortgages in cases of default by non-veterans
who assumed the loans. The excuse of the loan guarantee service
is that it had no current address in its files, even though the veter-
an’s current address was on file in the Compensation and Pension
Service because the veteran was on the Compensation and Pension
rolls. We caution, however, although this unified approach has its
benefits, it also has its limits. The diversity of VA’s products limits
the transferability of methodologies and strategies.

VA's new emphasis on quality and getting it right the first time
has more potential to improve performance, efficiency and customer
service, we believe. If the practice is to not do it completely and
correctly the first time, it is done with the expectation it will rou-


22

STATEMENT OF ESPIRIDION “AL” BORREGO

Mr. BorREGO. Thank you. Good morning, Mr. Chairman and
members of the subcommittee. I am pleased to represent the Sec-
retary of Labor Alexis Herman and to present testimony on how
the Labor Department’s Veterans’ Employment and Training Serv-
ice interacts with the goals and strategies presented in the strate-
gic plan of the Department of Veteran irs.

In the process of developing its strategic plan, the Department
of Veterans Affairs sha early drafts with the Department of
Labor, specifically the Veterans’ Employment and Training Service,
and asked us to comment on the goals and strategies which impact
DOL programs. In turn, my agency shared our strategic plan with
the VA.

VETS has had a strong working relationship with the DVA, due
in large part to the committed support of former Secretary Jesse
Brown and current Secretary-designate Hershel Gober. Both agen-
cies are dedicated to bringing the highest quality services to our
Nation’s veterans. I look forward to building on that relationship
in the future.

VETS and the VA coordinate policy and share information in a
number of ways. The Secretary of Veterans’ Affairs and the Direc-
tor of the Vocational Rehabilitation and Counseling Service are ex-
officio members of the Secretary of Labor’s Advisory Committee on
Veterans’ Employment and Training. This committee keeps the
Secretary of Labor informed and advised about issues affecting a
wide range of benefits and services for veterans. Their participation
ensures the Labor Department has timely knowledge of and input

into DVA programs where our activities coincide.

While VETS. interacts with the Department of Veterans Affairs
in only a few of its many activities, I believe it is important to note
that we have had a good working partnership for quite some time.
In areas specifically mentioned in the strategic plan—vocational re-
habilitation and counseling, compensated work therapy, services to
homeless veterans, the Transition Assistance Program, the Dis-
abled Transition Assistance Program and targeted services to
women and minority veterans—we interact with the DVA on a con-
tinuous basis. In the past, the Department of Veterans Affairs
joined the Labor Department in administering the Service Mem-

rs Occupational Conversion Training Act (SMOCTA), a highly
successful pilot program.

In the performance goal of assuring that the vocational rehabili-
tation meets the needs of veterans, the DVA has stated that its
first objective is to increase the number of disabled veterans who
acquire and maintain suitable employment. Since 1995, VETS has
had a Memorandum of Understanding with DVA that brings to-
gether our employment service representatives with VA Vocational
Rehabilitation Program participants at least 90 days before these
participants complete their program. This allows us to begin to tai-
lor an individual job search and labor exchange program while the
veteran is still in rehabilitation. Sharing case information on a
timely basis between the VA Vocational Rehabilitation Program
counselor and the employment specialist is helping VA Vocational
Rehabilitation Program graduates find and keep jobs for which
they are qualified.


105

(2) Like most agencies' plans, VA had not fully identified
Program overlaps and duplication with other federal
agencies, and had not coordinated its strategic planning
with other agencies.

(3) Unlike a majority of agencies‘ plans, VA's draft plan
discussed program evaluations. However, VA's plan did
net include some of the information on program
evaluations required by the Office of Management and
Budget, such as the general scopes and methodologies of
future evaluations.

As we noted in our response to Question #1, VA acknowledges many of
the areas where its strategic plan needs improvement. In the
strategic plan, and responses to comments by GAO and others on its
draft plans, VA has indicated ways in which it will make its
strategic plan more complete, and more fully compliant with GPRA‘s
strategic planning requirements.

One area where VA has been noteworthy has been in its consultations
with stakeholders--in particular, the Congress. VA and staff of
the House and Senate Committees on Veterans' Affairs held
consultation sessions to discuss VA's June 1997 draft strategic
plan, and VA has held consultation sessions with representatives of
veterans service organizations. In transmitting its publicly
issued strategic plan to the Congress, VA provided detailed
responses to comments on its draft plan from the Congress, GAO,
veterans service organizations, and other stakeholders.

4. tere are critica from both within and outside the federal

who believe GPRA hinders agency productivity, and diverts
ists on, money, and resources from the real world of a
operations. How would you respond to this criticism of the GPRA?
In your view, has the GPRA had a positive impact on the VA's
planning process?

There is no question that improving the efficiency and
effectiveness of day-to-day operations is an important goal for
every federal agency. A large portion of VA's strategic plan is
devoted to plans to improve the efficiency and effectiveness of VA
operations, and improve services to VA's customers--veterans and
their families. However, in passing GPRA, the Congress required VA
to develop a strategic plan that looks beyond its day-to-day
operations, and considers how VA programs affect VA's customers.
For example, assuring that VA's vocational rehabilitation program
operates efficiently is important; however, under GPRA, VA needs to
look beyond the program's operations and consider the results of
the vocational rehabilitation program--helping veterans obtain and
keep jobs.

As we noted in our September 18 testimony, we agree with VA that
many of the process issues in its strategic plan are important to
va‘s efficient and effective operation, and can be included as long
as they are integrated with the plan's primary focus on results.
VA could do a better job in its strategic plan of achieving this
integration. For example, VA's plan includes performance goals to
schedule physician appointments with patients in a more timely
manner. While these are important goals for VHA to pursue, the
strategic plan does not link them to VHA‘'s general goal to improve
the overall health care of veterans.

We believe that GPRA has had a positive impact on VA's planning
process. Pirst, we consider it significant that VA has produced
one strategic plan, bringing together the planning efforts of all
0£ VA's components. Second, VA has been open and cooperative in
its consultations with the Congress and other stakeholders. VA has
also been responsive to stakeholder concerns--even when that means
disagreeing with stakeholders. We have already seen, in
improvements to VA's strategic plan, the benefits of VA's
willingness to consult with stakeholders.

3



34

COORDINATION AND PLANNING ENVISIONED BY THE

G-P-R-A.

AS THE TESTIMONY WE HEAR TODAY WILL
FURTHER UNDERSCORE, THERE IS MUCH MORE
WORK TO BE DONE ON THE PART OF THE VA AND
ITS PARTNER AGENCIES TO PLAN FOR THE
CHALLENGES OF THE NEXT CENTURY. UNLESS THE
VA CONTINUES TO FOCUS ON STRATEGIC
PLANNING AND COMPLIANCE WITH THE G-P-R-A, |
FEAR THAT WE WILL BE UNABLE TO MEET THE
NEEDS OF OUR DESERVING VETERANS DURING THE

COMING GENERATIONS.

| SHARE THE CHAIRMAN’S INTEREST IN THIS
ISSUE, AND | LOOK FORWARD TO THIS MORNING’S

TESTIMONY. THANK YOU.




58

JOINT STATEMENT BY
THE PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE
FOR RESERVE AFFAIRS
CHARLES L. CRAGIN

THE ACTING PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE
FOR HEALTH AFFAIRS

GARY CHRISTOPHERSON
&

THE DEPUTY ASSISTANT SECRETARY OF DEFENSE
FOR MILITARY PERSONNEL POLICY

LIEUTENANT GENERAL NORMAND LEZY
HOUSE COMMITTEE ON VETERANS’ AFFAIRS.
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
HEARING
ON

DEPARTMENT OF VETERANS’ AFFAIRS STRATEGIC PLAN

SEPTEMBER 18, 1997

For official use only until released by the subcommittee


112

In addition, VA and VETS are working together to provide state of the art technology and
training to field staff directly involved with serving VR & C clients, continuing the dialogue
between the leadership of both agencies relating to future policy and oversight cooperation and
coordination and initiating joint oversight field visits as a follow-up to the nationwide training.

A VA staff member knowledgeable about the Compensated Work Therapy (CWT) program of
the VA just completed a very succesaful 2 month detail with VETS. It became clear during his
time at VETS that many CWT managers are unaware of the DVOP/LVER program and that
many DVOPs and LVERs are unaware of the existence of the CWT program. This is
unfortunate, because there are many areas of the country where the DVOPs and LVERs have
highly successful working relationships with their local CWT program, resulting in CWT
graduates transitioning into unsubsidized employment, Better informed DVOPs, LVERs and
CWT managers will result in more employment for CWT graduates, thus meeting the goals of
both the VA and VETS. The VA and VETS have agreed that at meetings of DVOPs/LVERs, a
representative of the VA will be invited to speak to the group about the CWT program, and at
meetings of VA personnel, a representative of VETS will be invited to explain the DVOP/LVER
programs, A memorandum of understanding is being drafted to formalize this agreement.

‘The VA and VETS share interests and goals in the area of homelessness, as well. VETS and the
VA will continue to participate in groups such as the Interagency Council on the Homeless, work
together at stand downs, and work with homeless service providers, to see that duplication of
effort is minimized, ifnot eliminated, and that our limited resources are used to the benefit of the
greatest number of veterans possible.

VETS and the VA continue their partnership in connection with the Transition Assistance
Program (TAP). The TAP manual was just revised to make it a more effective tool for TAP
facilitators. Both VETS and the VA want to expand TAP to more areas and increase the
percentage of soon-to-be-separating servicemembers and their spouses who attend the
‘workshops. Both parties also want to increase the availability of electronic services at the
workshops, to make it easier to access information on VA benefits and jobs. VETS and the VA,
working with the Department of Defense, will continue to improve the TAP program, which has
been found to be a highly effective avenue to information for service families.

‘The interaction between VETS and VA has increased this year, and this communication will
continue as both work to implement their respective Strategic Plans.

Sincerely,

EE oe


16

VHA also plans to improve its health care and training programs by placing greater
emphasis on primary care, to review its partnerships with medical schools, and to provide an
educational and training experience for medical residents and other trainees that is comparable or
superior to their other academic training opportunities. VHA’s goal is to increase to 95% by
fiscal year 2000 the proportion of medical residents and other trainees who rate their health care
experience as good or superior to other academic training.

The DAV believes that these goals correspond to appropriate outcomes and the mission of
the VA health care delivery system. They appear to be objective, quantifiable, and measurable.
‘We believe that the targets are both appropriate and achievable with the necessary resources and
management determination. The performance measures appear adequate and appropriate to
assess outputs, service levels, and outcomes of VHA’s activities.

VBA customer service and efficiency improvements envision easy access to benefits and
services, rapid and accurate claims processing, and clear, understandable, timely, and informative
communications along with better training for employees, planning and performance measures,
and accountability for outcomes. VBA has established strategic goals to improve responsiveness
to customers, improve service delivery and claims processing, ensure the best value for taxpayers’
investments, and ensure a satisfying rewarding work environment for employees.

VBA has established core measures focused on performance and accountability which are
intended to provide a common view of the success across all benefit programs and to establish a
“line-of-sight” for accountability down to each employee administering the benefit programs.
Believing that a balance of all core measures is critical to determining success or failure, VBA will
place equal emphasis on each of its measures. They are: customer satisfaction, timeliness,
accuracy, unit cost, and employee development and satisfaction.

Business Process Reengineering (BPR) is at the center of VBA’s plan for solving its
problems and meeting its service, performance, and efficiency goals, Guiding principles of BPR
include more and better interaction with veterans; resolution of issues at the earliest opportunity;
quality (get it right the first time); partnerships among VA, veterans, and veterans’ advocates; and
increased accountability for employees, veterans, and VSO representatives. Under the BPR
vision, better service and increased efficiency will be achieved by the combined contributions of
better trained employees, innovative technologies, and new and redesigned business processes,

VBA’s plan incorporates performance monitoring and will utilize benchmarking to ensure
achievement of the improvements included in the goals for each of its benefit lines. These benefit
lines are divided into the following categories:

© INCOME SUPPORT (Compensation, Pension, and Insurance Programs)

* EDUCATION SUPPORT (Veteran and Dependent Education Programs)


28

which both concurred that the Department lacked the capacity for
full integrated strategic management and programmatic revisions.

The General Accounting Office reported also in its May 14 report
on VA’s BPR initiatives, that appropriate performance goals and
measures need to be developed by VA in order for its plan to be
effective. Last month the American Legion had the opportunity to
review a draft of VA’s revision of its strategic plan for fiscal year
1998 to 2003. The American Legion appreciated the fact that VA
has made extensive use of information it had gathered through
feedback mechanisms such as environmental scans, customer serv-
ice surveys and focus groups as well as external reports to develop
the goals and objectives in its strategic plan.

The revised strategic provides significantly more detailed infor-
mation and data and preparation for evaluations of ms a depart-
ment-wide benchmarking effort as a major component. The Amer-
ican Legion believes that a disciplined benchmarking process will
reduce information VA can use to measure progress or achievement
toward its intended goals and objectives.

We are further concerned with the substantial reduction of FTE
in VA over the past several months. We believe that further reduc-
tion in the FTE will adversely impact on VA’s efforts and ability
to meet the GPRA mandate. The loss of 1,200 FTE in 2 years, in
our judgment, has contributed to VA’s continuing problems and its
ability to serve veterans, dependents and survivors in a timely and
accurate manner. We are aware that 133 FTE are scheduled to be
lost in the compensation and pension service. We believe a further
loss of FTE by well experienced adjudicators will result in further
delay in approving the delivery of benefits. The American Legion
is of the opinion that any future staffing cuts should be shifted to
the out years so as to allow the Department to achieve and solidify
Froerese at this important juncture of its strategic goals and
plannin;

The Veterans Health Administration Initiatives, in our judg-
ment, reaffirm the viability of the health care system. We believe
that the ongoing efforts by VHA will provide better health care and
improved services to the Nation’s veterans who are eligible and
have access to care. The American Legion believes that the Amer-
ican people will settle for nothing less than the beset for its citizens
who, at one time or another, were known as soldiers, sailors, ma-
rine and airmen.

In closing, the American Legion is equally committed and inter-
ested in the Department’s strategic initiatives as it proceeds along
the long, narrow road to improve services to our Nation’s veterans
in the form of health care, compensation, pension and all the other
generous benefits bestowed by a grateful Nation to its veterans.
The American Legion is eager to play a major part in the Depart-
ment’s plan and demonstrate our willingness and desire to work
and complement VA’s vision for the 21st century.

Mr. Chairman, that concludes my statement. Thank you.

{The prepared statement of Mr. Williams appears on p. 83.]

Mr. EVERETT. Thank you very much Mr. Williams.

Mr. Manhan.



94

The medical education section espouses the popular trend in modem medicine to reduce costs
and emphasize primary care by decreasing the number of physicians trained in speciality and sub-
speciality fields. While this may follow managed care economic models, the plan does not
reference the necessity for VA to maintain its expertise in specialized services, such as spinal
cord dysfunction medicine, through advanced training in these specialties or sub-specialities

On page 16, “Strategy 1” states, “Strategies of managed care will transform VHA’s health care
delivery system so that patients can be treated in the most appropriate setting.” The inference
here, as it could be interpreted by local managers, could be that the only appropriate setting is the
cheapest setting. PVA is concemed that roadblocks at access points under managed care models
could deny veterans access to needed specialty services or appropriate specialized inpatient or
long-term care. For example, PVA has already seen many instances where severely spinal cord
injured veterans, many of whom have spent years in VA long term care facilities, have been told
they would be discharged to contract nursing homes. The community nursing homes, totally ill-
equipped to care for the complexities of these disabilities were described as more “appropriate
venues of care” where the true incentive behind the move was to cut VA costs at the expense of
the welfare of the veteran patient.

PVA’s concems over the section of the draft report regarding spinal cord injury/dysfunction are
contained in the attached September 15, letter to Mr. Dennis Duffy, VA Assistant Secretary for
Policy and Planning., In summary, we object to having the plan cite improvements in patient
satisfaction as the only measure of quality SCD medicine. « Patient satisfaction, while an
important component of measuring the health care product, certainly does not address all the
factors in the care of a patient by the hospital, the provider, and through the state-of-the-art of
modem medicine. Apart from the measurement instruments cited in our letter, additional goals
for the VA SCD program should include; 1) Double the number of veterans who receive acute
rehabilitation in SCI Centers; 2) Maintain capacity for acute care of secondary conditions in SCI
Centers; 3) Aggressively expand long-term care capacity, especially non-institutional alternatives
(respite, personal care, assisted living); 4) Organize and integrate care for veterans with multiple
sclerosis around interdisciplinary teams coordinated by centers of excellence.

Sincerely,

John C.Beflinger
Deputy Executive Director


9

plan that VA officially submits to the Congress and OMB in a cou-
ple of weeks will be their first strategic plan under the Results Act.

Dr. SNYDER. And what block of time, then, would that likely be,
1998 through 2003?

Mr. WHITNEY. Yes sir. That is the period the VA’s plan that they
are preparing now is covering.

Dr. SNYDER. As you may know, I am a family doctor and people
in health care, we tend to whine a lot about all the dramatic
changes that have occurred in health care over the last decade.
And as I look, say, at the National Park Service, I see their mission
as being essentially the same as it has been for 5 years ago or 10
years ago. When you look at areas in government that are provid-
ing health care, whether it is the Indian Health Service or the De-
partment of Defense, their health facilities and VA health facilities,
it would seem that if there has not been some dramatic change
within the agencies, there is going to need to be. I think there has
been some fairly dramatic change as they are adapting to all the
marketplace changes that have gone on. Is some of the concerns
that you have about the VA, similar to concerns you would have
about, say Department of Defense health services, or Bureau of In-
dian Affairs health services?

Mr. SNOOK. I think so. First of all, a strategic plan could lay out
very carefully I think, what trade offs are necessarily made in the
disbursement of resources among various kinds of objectives that
it might seek. And in VA, with a tremendous changeover occurring
as a result of moving from a hospital-based system to an outpatient
care system, from a system that was initially designed to provide
intensive care and treatment for veterans as they returned from
wartime to one which provides basic care, the internal tensions
that must be going on there must be very great, and the strategic
plan does not reveal those tensions, but one would assume they are
there. Now I would think that over the long period of time, that
VA, as with other agencies, will have to begin to make explicit, ex-
actly how it does intend to address demographic changes and the
changes in the practice of medical care.

Dr. SNYDER. And we have the whole issue of medical education,
also the role of the VA system. You are firing off there. The whole
role the VA health care system plays in medical education, I would
think is one that is going to be a tricky one for them to sort out,
too, much differently than a private hospital.

You talk about external factors, do you, is Congress considered
an external factor in this process? When you look ahead, or when
the VA looks ahead at the strategic plan, where do they put the
role of Congress? How do they integrate into their plan? For exam-
ple, I am thinking now of the efforts by this Committee and others
to bring about the Medicare subvention demonstration project, and
that was clearly part of the budget process for this next year and
we seem to be, hopefully temporarily, stymied on that issue, but
clearly we are stymied right now. How, if you are planning a plan,
I mean, how do they write in these plans the impacts that Con-
gress’ action or inaction can have? I means, I guess I am saying,
is it a dream? Is the plan intended to be a dream?

Mr. SNOOK. No, I do not think it is a dream at all. I think that,
if anything, it understates how far they can and will be going with


17

* VOCATIONAL REHABILITATION (Education and Employment of Disabled Veterans)
HOUSING CREDIT ASSISTANCE (Loan Guaranty Program)

‘VBA’s general goal for each of these programs is to assure they meet the needs of veterans and

VBA’s objectives for the Income Support programs are to evaluate their effectiveness and
then suggest or make any indicated and appropriate modifications. This will entail program scans,
along with analysis of the results.

VBA'’s objectives for the Education Support program involve several steps to evaluate the
educational needs of veterans and develop administrative or legislative proposals to make the
programs fill veterans’ needs. The objectives for Vocational Rehabilitation are to increase the
number of rehabilitated disabled veterans who acquire and maintain suitable employment and
Provide for all services necessary to enable veterans with service-connected disabilities to achieve
maximum independence in daily living. Related performance goals involve analysis of veterans’
needs and expectations, compare program capabilities with the needs and expectations, determine
ways to make the program meet the needs and expectations, enhance partnering, evaluate the
impact of the program upon the participants’ quality of life, ensure that veterans are evaluated for
independent living services where a vocational goal is infeasible, and maximize participation of
Vietnam veterans’ children with spina bifida.

Similarly, the strategies and goals of the Loan Guaranty Program is to analyze veterans?’
needs and analyze and compare the capabilities of the program with those needs to identify
possible changes. This includes strategies to employ technological improvements to improve
management of the program. The strategy and performance goals for the specially adapted
housing program include better information on the program, evaluation of its sufficiency, and
recommendations to Congress. We would interject here that the Independent Budget for
Veterans Programs: Fiscal Year 1998 recommends that Congress adjust the current $38,000
grant to reflect increases in the cost of housing since the grant was last adjusted nearly 10 years.
ago in 1988. The plan also includes goals to analyze the effectiveness of the Native American
Direct Loan Pilot Program to make recommendations to Congress regarding its extension.

«

The strategies and goals for VBA’s programs essentially involve program evaluation. This
is a requisite of GPRA. We recognize the necessity of program evaluation. Quite frankly, we
expect these evaluations to show that some of these programs have lost some of their
effectiveness because of inadequate resources or because the rates have not been adjusted to keep
pace with the rise in the cost of living. Just as VA is expected to act to improve programs based
upon the data it gathers, we hope that Congress will be equally conscientious in acting to provide
necessary resources and indicated changes. At the same time, we hope that reductions in
programs will not be conveniently viewed as the solution to less than adequate performance in
cases where restraints on resources account for the deficiencies.


83

STATEMENT OF CARROLL L. WILLIAMS, DIRECTOR
NATIONAL VETERANS AFFAIRS AND REHABILITATION COMMISSION
THE AMERICAN LEGION
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE ON VETERANS’ AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES
ON
THE DEPARTMENT OF VETERANS AFFAIRS STRATEGIC PLANNING UNDER
THE GOVERNMENT PERFORMANCE AND RESULTS ACT

SEPTEMBER 18, 1997

Mr. Chairman and Members of the Subcommittee, The American Legion appreciates the
opportunity to present its views on the Department of Veterans Affairs implementation of the
Government Performance Results Act (GPRA) of 1993

The GPRA mandate has presented a major challenge for the Department. The American
Legion believes VA has made considerable progress in developing the blueprint for their strategic
plan, including the development of a spectrum of initiatives and changes intended to conform with
the requirements of GPRA and for improved delivery of services and benefits to both today’s and
tomorrow's veterans. The American Legion is extremely supportive of VA’s efforts, however,
The American Legion has some concerns

VA's initial strategic planning efforts have not been without controversy and criticism. As
an example, last year, as part of the Business Reengineering (BPR) plans, a number of field
restructuring initiatives were developed. With some, The American Legion thought there was
adequate supporting data and justification for their achievement. There were several which would
have involved the closure of some regional offices and major workload shifts. The plans for these
initiatives lacked the necessary supporting documentation and justification as required by law in
Title 38 U.S.C

There was nothing, other than VA’s promise that such changes would result in projected
service improvements and substantial cost savings. Upon further examination and consideration,
the Secretary stopped action on these initiatives

The American Legion is concerned that many ongoing and planned initiatives, while well
intentioned, provide conceptually appealing solutions which lack the necessary performance goals
and measures. Similarly, the current system cannot, at present, provide the type of information
and data needed for effective operational management, forecasting, and determining true resource
needs,

Recently, The American Legion noted the comments, conclusions and recommendation of
the Veterans Claims Adjudication Commission (VCAC) regarding the shortcomings and


5

sults. The latest version is clearer and easier to follow, more com-
plete and better organized to focus more on results and less on
process. In addition, VA has filled significant gaps in the discussion
of program goals. The largest gap in the June draft was the lack
of goals for four of the five major veteran’s benefit programs. The
current plan includes goals for each of these programs, stating
them in terms of ensuring that VA benefit programs meet veterans
needs.

While VA’s current draft plan represents progress, VA, like many
other agencies, will need to continue to improve its strategic plan-
ning well after the September 30 deadline. Perhaps the most si
nificant deficiency in VA’s draft strategic plan, in both the earlier
and current versions, is the lack of results-oriented goals for major
VA programs, particularly for the benefit programs. While discus-
sions of goals for benefit programs have been added to the current
version, they are placeholders for results-oriented goals that have
not yet been developed. The objectives supporting VA’s general goal
for its compensation and pensioning area, for example, are to
evaluate the compensation and pension programs to determine
their effectiveness in meeting the needs of veterans and their bene-
ficiaries, and modify these programs as appropriate.

VA has noted that developing results-oriented goals will be dif-
ficult until it has completed program evaluations. Evaluations can
be an important source of information for helping the Congress and
others ensure that agency goals are valid and reasonable, providing
baselines for agencies to use in developing performance measures
and performance goals, and identifying factors likely to affect agen-
cy performance. VA expects to set priorities for evaluating its pro-
grams sometime in fiscal year 1998, to complete the highest prior-
ity evaluations by the end of fiscal year 2000, and to complete at
least one evaluation in each of ten major program areas by fiscal
year 2003.

Another observation we made about VA’s June draft plan was
that VA’s discussion of external factors that could affect its strate-
gic planning was incomplete. VA’s current draft has added discus-
sions of the implications of demographic changes on VA’s programs.
For example, VA notes that the death rate for veterans is increas-
ing, which will lead VA to explore various options for meeting in-
creased demands for burials in VA and State veterans’ cemeteries.
What is missing in the draft, however, is a link between the pro-
jected increase in veteran deaths and the proposed schedule of spe-
cific cemetery projects.

In our comments on the June draft, we also noted that VA has
not clearly identified the areas where its programs overlap with
those of other Federal agencies, nor has it coordinated its strategic
planning efforts with those of other agencies. VA’s current draft
strategic plan addresses the need to improve coordination with
other Federal agencies and State governments. This will involve
identifying overlaps and links with other Federal agencies, enhanc-
ing and improving communications links with other agencies, and
keeping State directors of veterans’ affairs and other State officials
apprised of VA benefits and programs, and of opportunities for col-
laboration and coordination.



111

U.S. DEPARTMENT OF LABOR

SECRETARY OF LABOR
WASHINGTON, D.C.

The Honorable Lane Evans Noy | 4 leer

Ranking Democratic Member

Subcommittee on Oversight and Investigations
House Committee oni Veterans’ Affairs

USS. House of Representatives

Washington, D.C. 20515

Dear Congressman Evans:

This is in response to your letter, asking what steps the Department of Labor intends to take to
ensure greater joint cooperation with the Department of Veterans’ Affairs on strategic planning
issues of mutual concer to the Departments.

The Veterans’ Employment and Training Service's (VETS) Strategic Plan includes an annual
goal of increasing by 10% the entry into suitable employment of those veterans who have
completed the VA's Vocational Rehabilitation & Counseling (VR & C) program. The VA's
Strategic Plan also has a goal of increasing the number of disabled veterans who acquire and
maintain suitable employment and are considered rehabilitated.

Through three quarters of activity for Fiscal Year 1997, our cooperative efforts have increased
placement rates over FY 96 by 10%. At the current rate of quarterly placement increase, I would
expect that we will exceed FY 96 placements by at least 12-15 %.

To ensure a continuing increase in placements/successful rehabilitations, the VA and VETS
recognize that improved coordination, cooperation and measurable interactions between the two
agencies are necessary. In that context, personnel in the agencies are formulating, for joint
agency approval and publication, an Operating Guide for Improved Customer Service for
. This will be followed by nationwide training at various sites for

approximately 700 select VETS, VA and State Employment Security Agency staff directly
involved in providing services to these disabled veterans. The publication and dissemination of

‘are scheduled for completion in January 1998, with follow-up training
oped to be completed by July 31, 1998.

‘The other areas being jointly pursued with respect to VR & C include revising quarterly
reporting to capture-data more relevant to the common needs of both agencies and Congress,
increasing joint efforts to market the Chapter 31 program to eligible veterans and successfully
rehabilitated veterans to employers, and revising the basic training curriculum offered by the
National Veterans Training Institute so that participants will: 1) increase their ability to provide
veterans with more meaningful guidance to explore various occupations and make better carcer
choices; 2) gain greater knowledge and skill to effectively work with employers; and 3) leam
how to follow up with veterans so as to assist in job retention.

WORKING FOR AMERICA’S WORKFORCE


81

Mola: "Yj 9 cannat speak goad of my comoada, J will mat spank il of him.”
DISABLED AMERICAN VETERANS

NATIONAL SERVICE and LEGISLATIVE HEADQUARTERS
'807 MAINE AVENUE, S.W.
WASHINGTON, D.C. 20024
(202) 554.3501,

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS

The Disabled American Veterans (DAV) does not currently receive any money from any
federal grant or contract.

During fiscal year (FY) 1995, DAV received $55,252.56 from Court of Veterans Appeals
appropriated funds provided to the Legal Service Corporation for services provided by DAV to
the Veterans Consortium Pro Bono Program. In FY 1996, DAV received $8,448.12 for services
provided to the Consortium, Since June 1996, DAV has provided its services to the Consortium
at no cost to the Consortium.


107

4. How would you assess the VA's efforts to work with the Department of
Defense, HUD and the Department of Labor in strategic planning on
interagency issues effecting veterans?

Answer: VA and other departments and agencies continue to work at the
operational level in areas of mutual interest to improve coordination
and interaction with the ultimate aim of improving service to our
customers. From a strategic planning standpoint, our efforts, and those
of other departments and agencies, have focused on completion of our own
strategic plans, thus only limited coordination has occurred between
agencies. We would anticipate much greater coordination from a
strategic planning standpoint in the coming months and years. Some of
the operational efforts on interagency issues that have occurred and are
ongoing include:

© VA and DoD have in place 751 agreements covering 6,195 shared
services and services provided to CHAMPUS/TRICARE enrollees. We
continue to develop additional agreements each year.

© VA has worked with DoD closely to improve the timeliness of receiving
military medical records when compensation claims have been filed.

* VA and DoD have worked closely to improve awareness of benefits for
soon-to-be-discharged veterans through the Transition Assistance
Program (TAP) and Disabled Transition Assistance Program (DTAP) .

* VA continues to work with HUD on housing and home loan issues as well
as homelessness issues.

* VA and Labor have worked together for a number of years on veterans
employment issues.

In your view, should there be more coordination with the other agencies
than there has been to this point?

Answert Yes. VA intends on establishing closer links at the high
executive level and the working-level to better understand the
soordination that takes place between VA and other agency prograns
Although, much of the coordination with other is routine, VA
can improve this coordination by including other agencies in our program
evalpations in an effort to identify program overlaps.

5. How receptive - if you can tell us at this point - have other
Agencies been toward joint planning with VA on interagency iesues
affecting veterans?

Answer: VA shared a draft strategic plan with a number of agencies
king for coments, but there was little interaction with other
agencies concerning the development of the VA strategic plan, per se,
before a draft plan was developed. VA will be more proactive in
developing the next strategic plan by working with other agencies to
jointly develop goals and objectives for those VA prograns that overlap
other agency programs. Other agencies have been receptive to other
types of planning efforts euch as medical sharing and military medical
record timeliness issues with DoD, housing and home loan issues wit
HUD, employment issues with Labor, and homelessness issues with = number
We received comments to our draft strategic plan
from DoD, Labor, HHS, SSA, and GSA. All of these agencies expressed a
willingness to work with VA on common issues.

. Your testimony indicates that VA conducted an extensive survey of
employee views on strategic planning. Can you outline how this survey
was conducted and provide the Subcomittes with a copy of its results?

Answer: VA conducted an extensive employee survey earlier this year
regarding their perceptions of all aspecte of the workplace including
strategic planning. An Office of Personnel Management survey instrument
adapted to fit VA was used. ‘The aurvey was made available to every VA
employee in the field as well as Central Office.

We have disseminated to each VA facility their own employee survey
results and will help facilities interpret their own data. Secondary
analyses are being conducted at the Departmental level to determine if
any particular subgroups’ response patterns require special attention.

We are developing a Departmental policy that will establish Departmental
priorities and procedures for setting accountability. In approximately
two years (FY 2000), all employees will be resurveyed using the same
instrument to determine if any progress has been made in addressing
‘employee concerns



92

Bob Manhan, Assistant Director
National Legislative Service
Veterans of Foreign Wars of the United States

Bob Manhan has worked for the Veterans of Foreign Wars of the United
States (VFW) for the past 12 years. He started as a Service Officer in the
Washington Office's National Veterans Services and later moved to the Board of
Veterans Appeals. For the past eight years, he has been working as a member
of the National Legislative Service staff as Assistant Director.

Prior to becoming a member of the VFW, Bob served in the U.S. Army for
three decades both an enlisted man and a commissioned officer. His overseas
assignments included Europe, the Middle East, and both North and
Southeastern Asian countries. Most of his assignments involved troop duty with
infantry and artillery units with two different attache postings. Bob's formal
education includes an undergraduate degree from UCLA, and a MBA from
Shippensburg College. His military professional education includes the Army

War College.

ooeoeoeoe

The Veterans of Foreign Wars is not in receipt
of any Federal grant or contract.

(07)


60

treatment records, reducing the time required to accomplish disability compensation claim
determinations and expediting response times to veterans and former servicemembers.

Exchanging Information

DoD has been exchanging data with DVA in a number of program areas for more than
two decades. These information exchanges support program management objectives for both
agencies for the Montgomery G.I. Bill, Servicemen’s Group Life Insurance, reconciliation of
DoD retired pay with DVA disability pay, and Government-wide debt collection. Business
process improvements have been implemented in meeting DVA requests for military personnel
information, and there is a ongoing dialogue between DoD and DVA on process improvements.

‘Through our cooperative efforts to re-engineer the way death gratuity benefits are paid,
DVA and DoD were able to dramatically reduce the average processing time in both agencies
from six months to less than 10 days. The increase in the electronic exchange of information,
where feasible and practical, and the adoption of other inter-agency business process
improvements, support DVA’s goal of improving service delivery and benefit claims processing.
‘These practices ensure that the DVA receives from DoD the information needed to respond to
veterans’ disability claims and benefit requests in the most timely manner possible. DoD
continues to work with DVA to identify data gaps and sources of data that would better serve
DVA in identifying and validating veterans’ benefits. Our efforts to identify and share
information can benefit from advances in new technology. We would support opportunities for
the development of more on-line program access between DoD and DVA.

Support for Health Care

DoD and DVA share a common goal of transforming our respective health care delivery
systems to managed, patient-centered, primary care systems that assure high quality cost-
effective care, The DoD managed care initiative, TRICARE, integrates resources of the direct
ccare system with purchased care in order to meet the needs of DoD beneficiaries. Additionally,
Congress has recently passed legislation to authorize Medicare payments to DoD under a
demonstration project which allows DoD and HHS to begin implementing a program for
Medicare-cligible beneficiaries to enroll in the TRICARE program.

In addition to sharing ideas, programs, and a number of facilities with DoD, DVA has an
‘ongoing responsibility to serve in the role of medical backup to DoD in the event of a war, a

national emergency, or during a Federal disaster response. The memorandum of understanding,


56

believe this is a good start and the Plan provides a road map for the future. We are
committed to improving our Strategic Management Process and fully intend to
implement the goals, objectives and performance goals contained in the Strategic
Plan. Our annual performance plan and budget will implement the Strategic Plan
and we will track and report accomplishments in the annual performance report.
‘We will adjust the Plan in the coming years to reflect changes in the environment in
which we operate, the results of program evaluations, and the extent to which our

accomplishments match our intents.

| thank you for the opportunity to appear before this subcommittee to present our
views. Mr, Catlett, Ms. Egan, and | would be pleased to answer any questions you

may have.


18

to date. I would ask Ms. Egan to respond in more detail to the
specifics.

Ms. EGAN. Thank you. The survey that we conducted, and it was
a census survey, provided the opportunity for some 230,000 em-
ployees to respond. We worked in conjunction with the office of Per-
sonnel Management, using a government-wide survey instrument
that assesses not only what our employees feel about our strategic
planning efforts, but how they feel about their work environment,
the degree to which they feel involved in problem solving at the de-
partment level or at their local level, and what they see as the
strengths and weaknesses in the department with regard to cus-
tomer service. There were actually 18 dimensions. The information
we got back is providing us with a very rich database. Our employ-
ees are telling us that they recognize that customer service and un-
derstanding our mission are the most important things to VA. But
we still have to build on that. The information is going to be used
at the department level to look at how we might refine our ap-
proach to accomplishing our mission, particularly with regard to
customer service or with education and training and succession
planning for our employees. The information is also being rolled
down. Every single employee will receive information on the results
of the survey. Managers and employees, and the labor management
councils at the local level are going to be encouraged to embrace
the findings and identify areas where we can strengthen ourselves
or, where problems have been identified, the things we can do to
resolve them. At all times we will be keeping the focus on how we
are improving our ability to take care of those whom we are
charged to serve.

We are involving managers by cascading levels of information,
not just for the survey, but for the strategic plan, through the de-
partment down to the administrations where their business plans
are developed, down to the Veterans Integrated Service Networks
(VISN) level, the area level, the facility level. There is a sense of
connectivity between what we are doing at the department level
and what we are doing at the facility level. Information is not just
going down, it is also then rolling back up to us, so we can adjust
our course or make decisions —getting us where we need to go.

It is an ambitious plan, but hopefully we can keep it going.

Mr. Mascara. Did the survey provide for individuals to offer in-
formation and remain anonymous so that they might be forthright
in answering the survey or the questions?

Ms. Eaan. Absolutely, that was one of the main things we were
concerned about. As managers we wanted to make sure we could
create an environment in which people felt comfortable responding.
We also worked with our Labor Partnership Council and that was
an issue that, of course, the union was concerned about, too. One
of the reasons we went with the Office of Personnel Management.
is that they have a lot of experience with confidential administra-
tion of surveys. The forms went to the employees, they put them
in a sealed envelope, which went back to the contractor. Most im-

antly, we will be able to benchmark our results against other

‘ederal agencies and some private sector corporations.

Mr. Mascara. Thank you Ms. Egan.

Thank you Mr. Chairman.


47

above, VA cites the lack of completed evaluations as a reason for not providing results-
oriented goals for many of its programs.

‘The first general goal of VA's plan is to conduct program evaluations over a period
of several years. VA plans to identify distinct programs in each of its 10 major program
areas and then prioritize evaluations of these programs in consultation with the Congress,
veterans’ service organizations, and other stakeholders. VA expects to complete this
prioritization sometime in fiscal year 1998, complete the highest-priority evaluations by
the end of fiscal year 2000, and complete at least one evaluation in each of the 10 major
program areas by fiscal year 2003.

Lack of Coordination W
Other Federal Agencies

In our comments on the June 1997 draft strategic plan, we noted that VA has not
clearly identified the areas where its programs overlap with those of other federal
agencies, nor has it coordinated its strategic planning efforts with those of other agencies.
‘Three areas where such coordination is needed (and the relevant key federal agencies)
are

— employment training (Department of Labor),

~ substance abuse (departments of Education, Health and Human Services, and
Housing and Urban Development), and

- telemedicine (Department of Defense).

In addition, we noted that VA relies on other federal agencies for information; for
example, VA needs service records from the Department of Defense to help determine

whether veterans have service-connected disabilities and to help establish their eligibility
for Montgomery G.I. Bill benefits.

VA's current draft strategic plan addresses the need to improve coordination with
other federal agencies and state governments. This will involve (1) identifying overlaps
and links with other federal agencies, (2) enhancing and improving communications links
with other agencies, and (3) keeping state directors of veterans' affairs and other state
officials apprised of VA benefits and programs and of opportunities for collaboration and
coordination.

Financial and Information Technology
‘Improvement Goals in VA's Draft Strategic Plan

As we noted in our comments on VA's June 1997 draft strategic plan, VA has made
progress in financial management and information technology. Like other federal
agencies, VA needs accurate and reliable information to support executive branch and
congressional decision-making. The "Management Strategies" section of VA's current
draft strategic plan addresses some financial management and information technology
issues. Since VA has identified the need to devote a portion of its strategic plan to
process-oriented goals, it is appropriate that some of these goals should focus on
improving its management in these areas.

VA's current draft plan includes a goal to establish an effective departmentwide cost
accounting system. For example, a cost accounting system could allow a Veterans Health
Administration (VHA) medical facility to appropriately price excess services for sale to
the private sector or other federal agencies. Also, a cost accounting system could allow a
‘Veterans Benefits Administration (VBA) regional office to determine how much of its
costs were attributable to each of the benefit programs it administers. According to the
plan, this system wouid include two cost accounting systems already in development:
‘VHA's Decision Support System (DSS) and VBA's Activity Based Costing (ABC) system.

6 GAO/T-HEHS-97-216


51

The environmental scan was conducted in 1996 and looked at events, trends,
directions, and strategic issues through interviews with key individuals and
stakeholders, questionnaires, and secondary research in order to provide
information that can be used to address critical issues. Interviews were conducted
with members of Congress, Congressional staff, the General Accounting Office, the
Office of Management and Budget, Veterans Service Organizations, representatives
of agency management, and non-federal stakeholders such as the American Medical
Association. In addition, a written survey was conducted of State directors of
veterans affairs, The organizational assessment was conducted through a survey
of all VA employees in partnership with the Office of Personnel Management and
our National Partnership Council. Approximately 125,000 employees responded to
the survey and the results offer tremendous insight into the VA work environment

and provide a baseline for evolving into a truly high-performing organization.

Customer service performance goals were developed with the focus on operating as
@ unified organization, without stovepipes, to provide seamless service to veterans.
The goals cover six dimensions of customer service: access, satisfaction, courtesy,
quality, timeliness, and outreach. Achievement of these goals, benchmarked against

the best in business, will lead to the provision of world-class service.

Strategic scans of our business lines are intended to identify data gaps, assess the
extent to which appropriate program performance measures are in place, and
identify issues that must be addressed in order to evaluate the effectiveness of
programs. Scans have been completed on the burial benefits, health care, loan
guaranty and education business lines. Similar scans will be completed for
compensation, pension, and the remaining major programs in the coming months.
In the context of program evaluation, these scans address the major issues: the
extent to which program intent is clearly established in statute and whether

appropriate program performance measures are in place.

The Strategic Plan is the culmination of efforts undertaken over the past two years

and yet the Plan represents only a snapshot in time considering the continued

evolution we anticipate over the coming months and even years.

| am proud of what we have accomplished to date but also acknowledge that we
are not completely satisfied with our Plan. We have been forthright throughout the

consultation proces:

clearly identifying the weaknesses in our planning process
and in our Plan. We know that we have work to do and improvements to make

before we can be confident that the planning process and the Plan are fully


much of the plan seems to involve generic principles and goals and abstract concepts, but it also
reveals that VA has already invested a great deal of preliminary analysis, self examination, and
thoughtful, careful planning. Additionally, it reveals that VA has honestly acknowledged its
shortcomings and understands well the core problems it must overcome to become a world-class
provider of benefits and services. The vision is the right one for veterans. The plan suggests that
VA knows the proper direction and intends to go that way. The DAV is satisfied with the plan.
If its execution is as good, we will have every reason to be encouraged that veterans are about to
be better served, in a manner that truly befits them and recognizes their sacrifices for America.
‘We urge the Congress to provide VA the support and resources necessary to carry out and fully
succeed in this important and monumental undertaking,


13

meaningful outcome-based measures, came up again and again.
Program evaluations under GPRA are expected to address statu-
tory intent, which will not be so easy. We believe statutes govern-
ing VA programs generally do not describe intended results, rather,
more often they establish specific benefits and criteria for receipt.
Even Congressional oversight has focused almost exclusively on de-
livery, not on outcomes. And, given this background, we are taking
an approach that we believe is both careful and practical. The stra-
tegic scans of each of our business lines come first. We then hope
to identify the pertinent programs, revalidate our statutory man-
dates, and formulate the key questions to be addressed. Recogniz-
ing the sensitive nature of certain aspects of both program evalua-
tions and outcome-based performance goals, we expect to involve
our stakeholders at every step.

We anticipate instances where our statutory intent may be a
matter of disagreement among the various players, especially
where the common understanding of our programs has evolved in
directions different from original intent. These evaluations will pro-
vide a firm basis for establishing true outcome-based performance
measures. In the meantime, we have taken Chairman Stump’s sug-
gestion that we use interim results-oriented goals to the extent pos-
sible in our 1997/1998 performance plans.

At this point, I want to shift quickly to another concern for the
Congress: better cooperation among agencies. Now, admittedly,
planning to date has largely centered on our own internal strategic
Management process in development of this first department-wide
plan. But I would point out that we have long cultivated coordina-
tion with related non-VA programs. I will not bother you with the
details, I know they will be explained in some detail with the next
panel. But we have participated in numerous government-wide
seminars and training sessions on GPRA, to share our best prac-
tices. And we have exchanged our draft strategic plan with many
other agencies. The plan explicitly addresses elimination of dupli-
cate effort and greater coordination of services among multiple Fed-
eral agencies. We are fully aware of the need to enhance such
cooperation.

In summary, Mr. Chairman, VA’s strategic plan represents a
huge and, I believe, unprecedented effort. We believe it is a good
start, a road map for the future. We are committed to a strategic
management Process refined by experience. Our annual perform-
ance plan and our budget will reflect the plan and we intend to
track and report our accomplishments. The plan will change in
coming years to reflect the environment in which we operate, the
results of meaningful program evaluations, and the extent to which
our accomplishments match our intents.

thank you for this opportunity to present our views. Mr.
Catlett, Ms. Egan and I are pleased to answer any questions you
or the committee may have.

[The prepared statement of Mr. Duffy, with attachment, appears

on p. 49.

Mr. EVERETT. Thank you very much and you know that I appre-
ciate my working relationship with the VA. Over the past years we
have faced and talked about some difficult issues and I appreciate
the ability to do that and do it candidly. I remember years ago, I


55

facil
and Elmendorf AFB. In addition, we are exploring, with OMB, the
feasibility of using DoD's DEERS/RAPIDS enrollment system for VA

ies with the Air Force are in operation at Albuquerque, Nellis AFB,

enrollment. If this use proves successful, we would gain by using proven

information technology as well as data transfer.

With the Department of Labor, we have expanded our mutual efforts to
provide job placement assistance for veterans, especially disabled
veterans. VA's Vocational Rehabilitation & Counseling Service and the
Department of Labor's Veteran's Employment and Training Service (VETS)
have renewed their long standing commitment to working together

through the re-issuance of a Memorandum of Understanding. As a result,

a number of joint training conferences will be held in FY 1998 to enhance
opportunities for job placement. Of course, Labor and VA both continue
to participate in the Transitional Assistance Program and the Disabled
Transitional Assistance Program, which help all veterans, including

women and minorities.

Finally, VA and the Department of Health and Human Services continue to
work together on a wide range of research and epidemiological initiatives
concerning Agent Orange, Persian Gulf, HIV, and other areas of concern
for veterans. Most importantly, VA and HHS’ Health Care Financing
Administration, have now signed an agreement to conduct a pilot test of
Medicare reimbursement to VA for health care for higher income
nonservice-connected veterans. We are eager to work with Congress to

authorize the pilot project.

Many other examples could be cited.

We have participated in numerous government-wide seminars and training sessions
on GPRA to exchange best practices and we exchanged draft Strategic Plans with
many agencies. Comments received on our draft plan were helpful and generally
included pledges of continued support and cooperation. Our Plan includes a
specific goal to identify and address overlaps or duplicate efforts and to improve
the continuity and coordination of detivery of veteran services and benefits among
multiple Federal agencies and we fully intend to do so. We are acutely aware of

the need to enhance cooperation and coordination among Federal agencies.

In summary, our VA Strategic Plan FY 1998 - 2003 represents the efforts of VA

senior management staff, and consultations with numerous stakeholders. We


2

Administration for improved results in the services and benefits
they have earned.

T now will welcome Panel 1, but prior to that, while Panel 1 is
being seated, if any of the other members would like to make a
statement or, otherwise we will get right to the hearing.

Thank you very much.

I would like to recognize Dr. Dennis Snook of the Congressional
Research Service and Ms. Cindy Fagnoni, Associate Director of
Health, Education, and Human Services Division of GAO and ask
her to introduce her panel.

Ms. FAGNONI. Thank you. With me today I have Bruce Layton
and Greg Whitney.

Mr. EVERETT. Thank you very much.

Ms. FaGNont. Thank you.

Mr. Everett. Dr. Snook, if you will begin, I will appreciate it.
By the way, with your cooperation please, I would like to hold your
statements to 5 minutes. your entire statements will be entered
into the record. Thank you.

STATEMENTS OF DENNIS W. SNOOK, SPECIALIST, SOCIAL LEG-
ISLATION, EDUCATION AND PUBLIC WELFARE DIVISION,
CONGRESSIONAL RESEARCH SERVICE, LIBRARY OF CON-
GRESS; CYNTHIA M. FAGNONI, ASSOCIATE DIRECTOR,
HEALTH, EDUCATION AND HUMAN SERVICES DIVISION, U.S.
GENERAL ACCOUNTING OFFICE; ACCOMPANIED BY BRUCE
D. LAYTON, ASSISTANT DIRECTOR, HEALTH, EDUCATION,
AND HUMAN SERVICES DIVISION, U.S. GENERAL ACCOUNT:
ING OFFICE; AND GREG D. WHITNEY, EVALUATION-IN-
CHARGE, HEALTH, EDUCATION AND HUMAN SERVICES DIVI-
SION, U.S. GENERAL ACCOUNTING OFFICE

STATEMENT OF DENNIS M. SNOOK

Mr. SNOOK. Thank you Mr. Chairman. Good morning Mr. Chair-
man and members of the subcommittee. The Congressional Re-
search Service appreciates the invitation to appear before you as
you consider the strategic plan prepared by VA. My brief remarks
provide additional introduction to the concepts that GPRA instructs
agencies to use in responding to the Act’s requirements and to how
those concepts and terms relate to the VA efforts to develop the
strategic plan. As required by GPRA, the GAO has prepared a for-
mal evaluation of the VA plan. and my counterparts from that
agency will present that evaluation.

Mr. Chairman, GPRA envisions a rational government with
measured effects. In order to achieve such an ideal, the Act re-
quires that the Executive Branch describe itself in terms of the ef-
fectiveness of its efforts as well as provide a detailed account of
what it does. Through this coherent and comprehensive look at the
interrelated aspects of federal functions, GPRA encourages more ef-
ficient operations by providing Congress more objective information
on_achieving statutory objectives on the relative effectiveness and
efficiency of federal programs and spending.

GPRA set in motion a process by which such a plan could be pro-
duced: the Act established a series of steps and a timetable to
produce an accounting of government functions from the bottom up,


12

STATEMENT OF

RICK SURRATT
ASSISTANT NATIONAL LEGISLATIVE DIRECTOR

DISABLED AMERICAN VETERANS
BEFORE THE
COMMITTEE ON VETERANS’ AFFAIRS
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
UNITED STATES HOUSE OF REPRESENTATIVES
SEPTEMBER 18, 1997

Mr. Chairman and Members of the Subcommittee:

‘On behalf of the more than one million members of the Disabled American Veterans
(DAV) and its Women’s Auxiliary, I am pleased to present our views on the draft Strategic Plan
of the Department of Veterans Affairs (VA).

In accordance with the Government Performance and Results Act of 1993 (GPRA), VA is
required to submit to:the Office of Management and Budget (OMB) and Congress, no later than
September 30, 1997, its strategic plan for program activities covering fiscal year 1998 and at least
the four fiscal years following. On August 15, 1997, having revised its June 1997 draft plan after
consultation with key stakeholders, VA released a draft of its 5-year Strategic Plan for fiscal years
1998 - 2003.

While the Strategic Plan is the agency’s blueprint for its program operations and roadmap
to achievement of its organizational mission, it is only the starting point, is out of necessity rather
broad and sweeping, and is only one of several elements of GPRA. Thus, standing alone, iti
theoretical and only suggestive of the level of VA’s future compliance with GPRA. Even with the
best of plans, actual “performance and results” depend on several other factors, some of which are
intangible. Perhaps the most important example of such factors is the level of resolve within the
agency to impose meaningful reforms, overcome entrenched and powerful resistance to change,
and truly improve outcomes. Accordingly, as with any plan, we typically are able to judge only its
potential. Nonetheless, its premises, assumptions, concepts, policies, approach, thoroughness,
and technical soundness can be evaluated, and these are all very significant. Of course, to
determine if the plan formally conforms to GPRA, we need only to survey it for such elements as
goals, strategies, and accountability mechanisms.

GPRA's purpose is to improve the effectiveness of Federal programs by holding agencies
accountable for achieving program results. The GPRA framework requires an agency to define its
mission, set goals for accomplishment of its mission, develop and articulate methods to attain its
goals, establish performance measures to determine progress and level of success in achievement
of goals, and use performance data to improve overall mission accomplishment. .

The strategic plan lays the foundation for efficiently and effectively fulfilling the agency’s
mission. It follows naturally that the agency’s mission must be clearly defined as a first step in
formulating the strategy for its fulfillment. The agency’s mission statement in its strategic plan


27

tinely have to be done again, and veterans come to expect that they
will have to appeal to get a proper decision. I do not need to ex-
plain how that affects efficiency and customer service.

Mr. Chairman, the DAV agrees with VA’s statement in its plan
that its reason for existence is to improve the quality of life for vet-
erans. Though its strategic plan is preliminary and though we can-
not fully evaluate it until it is carried out, VA appears to have
charted the right course for itself.

That concludes my statement Mr. Chairman, I would be happy
to answer any questions you may have.

[The prep: statement of Mr. Surratt appears on p. 72.]

Mr. EvereTT. Thank you very much, Mr. Surratt.

Mr. Williams.

STATEMENT OF CARROLL WILLIAMS

Mr. WILLIAMS. Thank you very much. Good morning Mr. Chair-
man and members of this subcommittee.

The American Legion appreciates this opportunity to provide its
comments and views on the Department of Veterans Affairs efforts
at implementing relevant revisions to its system under the Govern-
ment Performance Act of 1993. The Results Act mandate has
sented a major challenge for the Department, in the opinion of the
American Legion. We believe the VA has developed a range of ini-
tiatives and changes intended to conform with the requirements of
the Results Act, as well as for improved delivery of services to both
today’s and tomorrow’s veterans. Our written testimony, as cus-
tomary, is a part of the record and we encourage this committee
to review and assess our statement in detail on this important
issue.

Nonetheless, I would like to just orally express some of the con-
cerns the American Legion has with VA’s efforts at implementing
changes in accordance with the Results Act.

First off, the American Legion is very supportive of VA’s efforts,
however, we do have several concerns. The Department’s initial
planning effort was not without controversy and criticism. For ex-
ample, as part of VA’s business re-engineering plan, a number of
field or regional offices restructuring initiatives were developed.
Some were adequately supported by acceptable data and justified
in our judgment. Several of the initiatives entailed the closing of
regional offices and shifts in major work loads. The plans for these
initiatives lacked the necessary documentation and proper legality
under the law as defined in U.S. Code Title 38.

After considerable thought and lengthy deliberation by then Sec-
retary Jesse Brown, those initiatives were stopped. The American
Legion is concerned that many ongoing initiatives, while well in-
tended, provide conceptually appealin solutions which lack certain
performance goals and applicable performance measures. Similarly,
the current system cannot at present provide the type of informa-
tion and data needed for effective operational management, fore-
casting and determining true resource needs. Just recently, the
American Legion noted comments and recommendations of the Vet-
erans Claims Adjudication Commission and the testimony of the
Chairman of the National Academy of Public Administration,


10

and strategies.

2. Does the plan format and naming scheme need to be changed to make the
plan easier to use?

It was a little difficult to understand at first glance, but then once you get into the
actual program information, it is user friendly. The only suggestion we have is to
cut out some of the length in the preface, introduction, mission, vision, etc. This
should be combined to one page, there is a lot of repetition.

3. Is there anything important missing?

We have not had enough time to go over every program with a fine toothed comb,
but overall I don't see any major gaps. I would be interested in seeing some of the
results from VA program evaluations by their customers, Congress, VSOs, etc.

4. Does the strategy (content) represent the "right direction" for VA?
Understanding first that this is not a final document, then Yes. We believe VA is
heading in the right direction and more importantly is keeping the communication
lines open with their consultation process. We feel confident that when there is a
problem, we only need to make them aware and it will be addressed.

The vision of VA's strategic plan states, it will function as a unified department
delivering high quality, timely benefits and services to veterans and their families
in a cost-effective, world class manner.

This is a living document which will have changes and modifications. Even in
their plan, it states, "We are learning and will continue to learn what our customers
consider important, what to measure, and how to continually improve and modify
measures." You can't fault them for that. We believe this is an adequate strategic
plan at this time and will continue to monitor it's change and growth.

Mr. Chairman, this concludes my report and I will take any questions at this time.


63

veterans, and the education support programs established to meet those needs, are constantly
under review by both DoD and DVA.

Life Insurance Programs

The Servicemen's Group Life Insurance (SGLI) and the Veterans Group Life Insurance
(VGLD) programs are extremely attractive to military servicemembers, both active and reserve.
DVA runs these group life insurance programs for military personnel. DoD tracks member
eligibility and collects and transfers premiums to DVA. The interface on these programs is
virtually seamless, with the agencies working closely together to develop and implement
legislative proposals, prepare and distribute forms, and resolve problems. We support DVA’s
strategic planning goal that premium rates must be kept at reasonable and affordable rates for our
military personnel, and that the SGLI and VGLI programs should maintain rates that are
competitive with commercial products,

Home Loan Guaranty Program

Under the current Home Loan Guaranty Program, DVA guarantees loans made to
servicemembers, veterans, reservists, and unremarried surviving spouses for the purchase or
refinancing of homes. We support DVA’s goal of identifying housing-related issues concerning,
servicemembers and the recruitment of new servicemembers. We are prepared to assist with the
assessment of the existing program and in the development, approval, and implementation of
new proposals.

Interagency Cooperative Efforts

‘The Assistant Secretary of Defense for Health Affairs and the Under Secretary for Health,
Veterans Affairs are continuing a high-level program of cooperation and have established a
DoD/VA Executive Council made up of senior DoD and DVA healthcare executives. In the
spirit of a May 1996 report to the Vice President entitled," Strategies for Jointly Improving VA
and DoD Health Systems,” the Executive Council is overseeing a number of joint efforts to
reduce costs and improve health care for veterans, active duty military personnel, retirees, and
dependents. Examples of key initiatives include: a Veterans Health Coordinating Board, a
program to standardize disability discharge physicals, joint clinical practice guidelines, and

‘numerous other programs to capitalize on the resources and experiences of both departments.


20

STATEMENTS OF CHARLES L. CRAGIN, PRINCIPAL DEPUTY AS-
SISTANT SECRETARY OF DEFENSE (RESERVE AFFAIRS), DE-
PARTMENT OF DEFENSE; GARY CHRISTOPHERSON, ACTING
PRINCIPAL DEPUTY ASSISTANT SECRETARY OF DEFENSE
(HEALTH AFFAIRS), DEPARTMENT OF DEFENSE; LT. GEN.
NORMAN LEZY, DEPUTY ASSISTANT SECRETARY OF DE-
FENSE (MILITARY PERSONNEL POLICY), DEPARTMENT OF
DEFENSE; AL BORREGO, ASSISTANT SECRETARY-DES-
IGNATE, VETERANS’ EMPLOYMENT AND TRAINING SERVICE,
DEPARTMENT OF LABOR

STATEMENT OF CHARLES L. CRAGIN

Mr. CRAGIN. Good morning, Mr. Chairman. Well, thank you very
much, it is always a pleasure to appear before the Committee on
Veterans’ Affairs and its Subcommittees. Mr. Chairman and mem-
bers of the subcommittee, on behalf of the Secretary of Defense, we
appreciate the opportunity to appear before you today to address

e cooperation and coordination that exists between the Depart-
ment of Defense and the Department of Veterans Affairs wi
spect to the day-to-day operation of a variety of programs that re-
quire us to maintain effective interagency relationships.

Many of the goals and objectives of the DVA strategic plan will
directly support these ongoing relationships and will serve to en-
hance their effectiveness. I have provided prepared testimony
which I request be incorporated in the record. But let me briefly
summarize that testimony.

Mr. EVERETT. The complete testimony will be put into the record.

Mr. CRAGIN. Thank you Mr. Chairman. First let me emphasize
that the compensation, care and recognition afforded America’s vet-
erans by the Department of Veterans Affairs helps to ensure that
DOD is able to continue to recruit and retain a quality armed force.
Recruiting and retention are important elements of one of our own
corporate-level goals. The DVA assistance programs provided to our
active and reserve service members and veterans, contributes di-
rectly to the recruitment and sustainment of a robust military
force. The Department of Defense interfaces with Veterans’ Affairs
in many program areas covered by the DVA’s strategic plan, to in-
clude health care services, compensation benefits, serviceman’s
group life insurance, the Montgomery GI Bill, housing loan assist-
ance and burial and cemetery services. DOD works closely with
DVA to accurately define the characteristics and needs of our mili-
tary members to include those needs that will take effect upon
their transition into the Nation’s veteran population.

We strongly support DVA’s strategic objective to continue to im-
prove the awareness and knowledge of VA benefits and services for
veterans and service members. D has been exchanging data
with DVA in a number of program areas for over two decades to
support the objectives of the Montgomery GI Bill, Servicemen’s
Group Life Insurance, reconciliation of DOD retired Bey, and DVA
disability pay, and Government-wide debt collection. Business proc-
ess improvements have been implemented and there is continuous
dialogue between DOD and DVA to identify data requirements and
sources. The expeditious exchange of program records provides for


37

ACTUALLY BE USED AS A BLUEPRINT FOR SUCCESS
DOWN THE ROAD.

| LOOK FORWARD TO THIS MORNING'S
TESTIMONY, AND AGAIN | APPLAUD TERRY AND JIM
FOR CALLING THIS EXTREMELY IMPORTANT

HEARING.


57

suee, ¢ Aueag peyepdy
uonjoefoig g uOnduNssy «
sjeop englyoy
}SOUO;SAIIW B SaiGayeNns -
yeos wesGolg we}-Buo7 »
UOISSIW SexEINOBYy «

(128, g) uelg a1Be}xe135
jejuewyledeg dojeaag

t

UOeUUOJU] eounoseY -

uoneUUosyy
6Buruueld BOUBULIOLSd «|

uoneuuojuy Buluuelg sseulsng .|

realy weiboig Aq
ueld 216a}e.9¢$
jejuowjedeg juewsjduwy

| 0} ja6png jenuuy dojeseg

yodey
Ayqewunossy jenuuy
jueussossy
weiBolg snonujuod
SUBId
| eoURUOLeg eekojdwy
uonenjeag wesBoig

; @OURULIOPad 10}}U0
| pue suejg juewejdui

y

epenses S| OU

uojde21q eunyny pue sjespy +

2 SODIAIOS Ose JEYM :UOISSIN +

UOISIA Puke UOISSI
sjuewpedeq Aypowjes

~<a

dnosy jueweBeuew 9)60;e.)5

sanss| 9169}e.9S$
eBeuew pue Aynuep]

uonessi6eq MON
S19pIO eARNDeXxy
ueog je}UeWUOUIAUR

ee ee]

JPPoW (dINS) Sse001g JUoWeBeURYW d16e}e115 WA


23

Our State directors of veteran’s employment and training are
working with both the State employment service and the DVA to
provide veterans with an effective continuum of care. Our long-
term goal is to eliminate the unproductive time between completion
of therapy and the beginning of gainful employment. I believe that
this type of partnership will help both agencies accomplish their

‘oal.

B A directive to VETS field staff just last month stated our inten-
tion to develop a similar MOU with the DVA for veterans partici-
pating in the Compensated Work ‘Therapy Program. To improve
our day-to-day working relationship with the Department of Veter-
ans Affairs, Ken Greenberg, from the DVA, is serving on a detail
with VETS to help us build more effective delivery systems. We are
also working closely with the DVA to help those veterans caught
in the tragic cycle of homelessness. The DVA provides outreach,
case management, residential, medical and psychological treatment
and {ransitional housing. In short, DVA gets them ready for the job
market.

At the same time, VETS is working with these veterans to help
them find unsubsidized employment that will enable them not only
to regain their ability to pay rent and buy food and clothes, but to
regain their dignity and self respect. I believe our combined efforts
on behalf of homeless veterans are among the most gratifying and
important activities undertaken by our agencies. I am pleased that
VETS’ fiscal year 1998 budget contains a request for $2.5 million
to put some muscle behind our efforts to turn homeless veterans
into productive citizens.

Finally, both agencies are committed to improving conditions for
women and minority veterans. Representatives from both agencies
participated in the recent National Summit on Women Veterans’
Issues, which identified issues and concerns of women veterans on
the eve of the 21st century.

VETS uses statistical information developed by the DVA’s Na-
tional Survey of Veterans to assess how well our employment serv-
ice efforts targeted to minority veterans are doing. We are continu-
ously seeking to improve our service delivery systems and to sen-
sitize our service providers to the unique experiences and needs of
all minority veterans.

Working in close partnership, and speaking with one voice on
veterans issues, VETS and the Department of Veterans Affairs will
succeed in helping America’s veterans participate fully in the life
of this great Nation.

Th: you, that concludes my prepared testimony. I will be glad
to answer any questions you may have.

(The prepare statement of Mr. Borre; appears on p. 65.]

Mr. RETT. Thank you very much. We have about 10 minutes
to get to the Floor. I have one question. Are you going to have any
questions? Let me tell you, I appreciate all of your testimony, but
let me bring up a point of contention that, and I know you just as-
sumed this position, but I am going to give you a challenge and let
me just say as hard as I can, that frankly, if this challenge is not
met, I feel like this Committee and the National Security Commit-
tee, they are going to come down on DOD and VA, like a ton of
bricks. Now, I will note for your consideration that the Chairman


90

All this means is that, basically, as the C&P Service's BPR goes, so goes the core
of the VA's Strategic Plan, (Eligibility Reform, as defined in Public Law 104-262, gives a
heavy priority for VA medical care to service-connected, compensable veterans.)
‘Carrying that theme further, the keystone becomes VETSNET. In other words, the

suceess or failure of the VA's Strategic Plan is directly proportional to the success or

failure of the VBA's ability to bring on-line soon VETSNET, or a similar system.

Consequently, VETSNET must be allowed to replace the current Benefits Delivery
‘Network (BDN), which is universally condemned by our service officers as being
extremely cumbersome and archaic in providing much assistance toward performing
adequate veterans’ advocacy. However, we are not blind to the realization that
VETSNET is a very controversial subject. We are also aware of the many concerns of

Congress as you, Mr. Chairman, have particularly well articulated,

But, we are not sure that all of us have a common definition for VETSNET. Of
great concem is a seemingly prevailing belief that VETSNETT is one system solely
dedicated to replacing the VBA's BDN. (The National Academy of Public Administration,
in their recently released report Management of Compensation and Pension Benefits
Claim Processes for Veterans, compounds this belief, in our opinion.) Actually, it is
several systems that share data and information over the department's projected high speed
data network. Even more important to us, itis the underlining software applications such
as the Claims Processing System (CPS), the Automated Reference Material System
(ARMS), the Claims Automated Tracking System (CATS), and Case Management. Thus,
not only is VETSNET critical to the VA in support of the goals espoused in the
Compensation and Pension BPR Implementation Plan and the performance objectives

stated in the VA's Strategic Plan, the four just-mentioned applications are also absolutely

essential to our future at

for effective veterans’ representation and advocacy

That is why we were very disturbed to see both the House and the Senate, in their
appropriation markup report language, direct the transfer of $5 million from VETSNET to
other programs. Because the VA only requested $2.4 million for FY 98, we can only
assume that the Congress’ intention is to “kill” VETSNET. That is very bad news. With
this being done without any attempt to inform interested parties, we don't see how one can
interpret it to mean anything other than a plan to redefine the current veterans’ entitlement
program, not for improvement but to save money. The fight now seems focused no


44

PURPOSE AND REQUIREMENTS
OF THE RESULTS ACT

‘The Results Act is the centerpiece of a statutory framework to improve federal
agencies' management activities.’ The Results Act was designed to focus federal agencies’
attention from the amounts of money they spend or the size of their workloads to the
results of their programs. Agencies are expected to base goals on their results-oriented
missions, develop strategies for achieving their goals, and measure actual performance
against the goals.

The Results Act requires agencies to consult with the Congress in developing their
strategic plans. This gives the Congress the opportunity to help ensure that their missions
and goals are focused on results, are consistent with programs' authorizing laws, and are
reasonable in light of fiscal constraints. The products of this consultation should be
clearer guidance to agencies on their missions and goals and better information to help
the Congress choose among programs, consider alternative ways to achieve results, and
assess how well agencies are achieving them.

‘The Results Act requires VA and other agencies to complete their first strategic plans
and submit them to the Congress and OMB by September 30, 1997. OMB requested that
agencies provide it with advance copies of their strategic plans by August 16, 1997, for
review and interagency coordination. In addition, the Results Act requires agencies to
submit their first annual performance plans to the Congress after the President submits
his fiscal year 1999 budget to the Congress. OMB requested that agencies integrate, to
the extent possible, their annual performance plans into their fiscal year 1999 budget
submissions, which were due to OMB by September 8, 1997. OMB, in turn, is required to
include a governmentwide performance plan in the President's fiscal year 1999 budget
submission to the Congress. As required by the Results Act, GAO reviewed agencies’
progress in implementing the act, including the prospects for agency compliance.*

IMPROVEMENTS AND REMAINING CHALLENGES
IN_YA'S AUGUST 1997 DRAFT STRATEGIC PLAN

VA's August 16, 1997, draft strategic plan represents a significant improvement over
the June 1997 draft. The latest version is clearer and easier to follow, more complete,
and better organized to focus more on results and less on process. At the same time, VA
has still not fully addressed some of the key elements required by the Results Act; the
draft plan has

~ a lack of goals focused on the results of VA programs for veterans and their
families, such as assisting veterans in readjusting to civilian life;

limited discussions of external factors beyond VA's control that could affect its
achievement of goals;

~  alack of program evaluations to support the development of results-oriented
goals; and

~ insufficient plans to identify and meet needs to coordinate VA programs with
those of other federal agencies.

*Other parts of the framework include the Chief Financial Officers Act of 1990, the
Paperwork Reduction Act of 1996, and the Clinger-Cohen Act of 1996.

The Governmen cormance R
Will Be Uneven (GAO/GGD-97-109, June 2, 1997).
2 GAO/T-HEHS-97-215


85

1996, were used by VA in the development of its strategic plan. Findings and recommendations
offered by VCAC were also considered by VA.

The American Legion believes that the Department is learning and will continue to lean
what their customers consider important, what to measure, and how to continually improve and
modify measures by entertaining information from its customers and stakeholders. The American
Legion further believes that under GPRA, VA is learning a great deal about strategic planning and
its significance as it improves on its delivery of services to veterans and other beneficiaries.

The American Legion remains committed to the Department's efforts as it continues to
identify and find solutions to link resources to priorities and performance. The American Legion
is confident that VA, in implementing GPRA, will result in quality improvement practices,
exploitation of more modern technology, sharing of information and benchmarking which will
help forge an alliance with its partners and stakeholders, both inside and outside the Department

For years, veterans coming to VA regional offices seeking benefits and services to which
they were entitled have been confronted by a system that was largely unresponsive to their needs.
It was not considered “user friendly.” Through the BPR plan and other initiatives, VA appears to
be making a determined effort to institute fundamental changes and improvements which will be in
line with the needs of veterans and, at the same time, fulfill the GPRA mandates. The American
Legion recognizes that this is essentially an ongoing evolutionary , if not revolutionary, process
within the Department. Some actions under this plan have been initiated in FY 1997 and others
are scheduled to be phased-in beginning in FY 1998, and others are still under development

VA has clearly set for itself a number of very ambitious service improvement goals for FY
1998, while continuing to reduce staffing levels in each of its program areas or business lines.
Overall employment in VBA has been reduced from 12,603 FTE in FY 1996 to 11,943 FTE in.
FY 1997, and in FY 1998, it will be further cut to 11,400 FTE, which is a substantial decrease of
some 1,200 FTE in 2 years. This, unfortunately for the agency and veterans, follows the pattern of
VA budgets for the last 10 years. Such sustained losses contributed, in our judgment, to VA’s
continuing problems in its delivery of services.

In particular, The American Legion is concemed by the plan to cut 133 FTE for the
Compensation and Pension Service (C&P). Unfortunately, this comes on the heels a reduction of
over 400 FTE this fiscal year which mostly involved the more experienced adjudicators who took
buyouts as an inducement to retire. A further loss of FTE may well compromise C&Ps ability to
fully and effectively implement the strategic initiatives planned. If the FY 1998 goals cannot be
fulfilled, The American Legion believes this places the targets and goals of the remainder of the
BPR plan in jeopardy. The American Legion would rather see any staffing cuts shifted to the out
years in order for the Department to achieve and solidify progress at this critical stage in its
strategic goals and plans.

VA's initiatives involving the VA health care system will, in our opinion, further reaffirm

the viability of the system, provide better health care to veterans, and improve overall service.
Even in a period of reassessment of the proper role of the Federal government, The American

45-927 98-4


62

Disability Evaluation Process
DoD supports DVA’s objective of exploring and establishing stronger linkage, including
programmatic links, between the DoD and the DVA disability evaluation systems. In fact, DoD

uses the DVA Schedule for Rating Disabilities (VASRD) when determining ratings for

compensable disabilities. A representative from the DVA is a member of the DoD Disability
Council.

We are working together to assess the impact of current compensation programs. As a
result, we hope to identify more and better ways to serve our disabled military members
immediately upon their release from active service. When a veteran is entitled to disability
compensation from DVA and military retired pay from DoD, certain offsets to that pay may be
required. This is also true for widows, who may be entitled to Dependency and Indemnity
‘Compensation and Survivor Benefits. DoD and DVA work closely to reconcile the required
offsets to entitlements and to ensure that veterans and widows are aware of such interactions.

Support for Education

Certain DVA-managed programs, in particular the Montgomery G.L. Bill, greatly assist
DoD in the recruitment of new servicemembers into the armed forces. Since the inception of the
MGIB program in 1985, over 2.5 million servicemembers have enrolled, most of whom remain
eligible to use the benefit. We support DVA's strategic goal and are engaged with them in their
Educational Assistance Business Process Reengineering effort to find ways to improve the
processing of MGIB benefits, and to make the system more user-friendly for veterans and
servicemembers alike, The MGIB-Selected Reserve was established to encourage enlistments,
reenlistments, or service in the Selected Reserve. More than 1.1 million National Guardsmen
and Reservists have gained eligibility for this entitlement. Reservists move frequently, changing.
units and their status in the reserve components. This necessitates the continued timely exchange

of eligibil

yy data between DoD and DVA. Both DVA and DoD are currently working on the
redesign of the reserve component MGIB system (o facilitate more timely and accurate data
exchange.

Improving educational opportunities to attract prospective servicemembers, enhance the
qualifications of those serving (both active and reserve), and better support the needs of veterans

is a goal that DoD clearly shares with DVA. The educational needs of military members and


86

Legion believes that the American public's commitment to veterans and veterans programs
remains very strong. The American Legion believes further that VA is committed to finding ways
and solutions to improve service, maintain high quality of care, and become more efficient

Mr. Chairman, The American Legion is equally committed and interested in the
Department's strategic planning initiative as it focus on preserving and improving its delivery of
services to our nation’s veterans, dependents and survivors. The American Legion looks forward
to being a major participant in VA's ongoing efforts in the development of appropriate
performance goals and measures needed to implement the necessary changes to meet the
expectations and demands of its customers and stakeholders. The American Legion’s Gl Bill of
Health offers proposals which would be compatible with VA's vision for the 2st century

Mr. Chairman, that concludes my statement


31

FTE, in that area can have an adverse affect on the VA’s ability
to meet the mandates of the Results Act.

Mr. Mascara. Well I would be hopeful that the analysis would
include an honest approach to the problems that we are seeking to
solve. I do not know Tow they could divorce themselves, those peo-
ple who are responsible for the final draft of the Results Act
should——

Mr. WILLIAMS. Well when you are talking about the individuals
that we were referring to, you are talking about experienced adju-
dicators and it takes years to learn that t; of work and with this
reduction, I think they are going to lose the experience that is re-
quired, which is necessary to meet these mandates. And as I indi-
cated earlier, it may adversely impact on their ability to provide
timely and sufficient service to our Nation’s veterans.

Mr. Mascara. Thank you very much.

Mr. WILLIAMS. You are welcome, sir.

Mr. Mascara. Thank you Mr. Chairman.

Mr. EVERETT. Thank you. I want to thank this panel. As always,
we enjoy getting your testimony. I was particularly interested in,
I agree also in the observation that the performance objectives to
process all claims within 60 days is extremely important and with
a little modesty, I would point out and I see Mr. Catlett is still
here, that as Chairman of the Pensions and Benefits Subcommittee
2 years ago when the VA’s target was 106 days, that it was this
Committee Chairman that suggested that they put it at 60 days.
So I am pleased to see that that has happened.

rain, I want to thank this panel for showing up and giving us
the benefit of their testimony.

Mr. SurRatT. Mr. Chairman, I would like to make one final com-
ment, if I may.

Mr. EVERETT. Please.

Mr. Surratr. I think the DAV has viewed this subcommittee and
the Veterans’ Affairs Committee as a veterans advocate. We view
ourselves as advocates and we view the VA as a veteran’s advocate
and as long as we all quibble and quarrel over who is the principal
advocate, only the veteran can benefit, so let us continue that
competition.

ir. EVERETT. I have to agree with you. I do thank all today’s
witnesses for their testimony. We will continue to ask GAO to
evaluate VA’s strategic planning as we will have hearings periodi-
cally to monitor results at compliance and advocacy of strategic
lanning, We look forward to continued cooperation with all parties
interested and let me just finally say, I was extremely concerned
in my comments to DOD. I do not intend to let the issue rest on
the fact that we cannot simply transfer a piece of paper from the
active military, reserve or the guard, over to the VA and it be the
same piece of paper with the same medical history.

I come out of a business background and I can assure you that
this has cost hundreds of thousands of dollars, literally, hundreds
of thousands of dollars and I do not care if it is bureaucrat finger-
pointing, I do not care if we have food fights going on somewhere,
it is going to stop. As I pointed out earlier, the members of this
Subcommittee are also members, most of them, of the National Se-
curity Committee and this is asinine that this situation exists and


7

The next item is the annual performance plan; at this point
under the Results Act, agencies were supposed. to have submitted
their first attempts at annual performance plans to OMB this
month. Those plans are supposed to show for the next fiscal year,
in this case for fiscal year 1999, what the agency hopes to accom-
plish, what are its goals and measures for that particular year. So
it is taking the overall strategic plan and focusing on a specific
year.

What is probably the most difficult piece of the Results Act is
going to be exactly how the strategic plan and annual plans link
up with the budget requests. Right now the annual plan and a
budget request go together, and the hope is that there will be links
between an agency’s goals and objectives for a specific year and
what it is asking for in its budget, and ideally and ultimately the
goal of the Results Act is for budget decision makers to have some
information about an agency’s performance and the results it is
achieving, to help inform budget decisions.

Chairman Mr. Mascara, for any questions he may have.

OPENING STATEMENT OF HON. FRANK MASCARA

Mr. Mascara. Well, I will be very brief. I tried to read this and
it is vey esoteric and arcane and very boring, so I gave up and I
said, “Well maybe, I can just ask a question that you can answer
in 30 words or less.” What I am attempting to ascertain, is, does
your study deal with the current budgeting and the amounts of
money being spent on these programs? Are you able to determine
whether there is insufficient funding, and that is part of the prob-
lem, and does yor study include that particular phase of whether
or not the Federal Government was funding these programs at a
sufficient level. You know, you could study, and study and study,
but the VA does not have the money to do its job, does your report
say that? Is there a sufficient amount of money to achieve the re-
sults of your study?

Ms. FaGNONI. What we focused on is the first step in this proc-
ess, which is VA attempting to lay out its overall goals and what
it hopes to achieve. With that in place, over the coming years,
under the Results Act, we will be looking at, for an individual year,
what is VA asking for, and how does its performance look and how
is that measuring up. But at this point, the information is not
there for us to put all those pieces together. But the hope is under
the Results Act that, over time, that information will be there to
allow somebody to look at the program result and say, what do we
get for our money, is it enough?

ir. Mascara. If we implement the results of your study, will the
amount of time that it takes to expedite a claim to the VA, is that
going to improve?

Ms. FAGNonI. Well actually——

Mr. Mascara. I have heard people in here say, “Well it used to
take 300 days, now it only takes 160-some days,” and, I mean, is
this a part of your study to determine the efficiency of delivering
services?

Ms. FAGNONI. Well, actually, in VA’s strategic plan, it has a piece
that is focused more broadly on what it hopes to accomplish with
its programs. Part of its strategic plan is also looking at how it can


46

areas~compensation and pensions, education, vocational rehabilitation, and housing credit
assistance-are stated in terms of ensuring that VA is meeting the needs of veterans and
their families. The objectives supporting VA's general goal for its compensation and
pension area are to (1) evaluate compensation and pension programs to determine their
effectiveness in meeting the needs of veterans and their beneficiaries; and (2) modify
these programs, as appropriate. For the three other major benefit program areas, the
objectives suggest possible results-oriented goals and are supported by strategies aimed at
evaluating and improving programs. For example, the objectives under vocational
rehabilitation include increasing the number of disabled veterans who acquire and
maintain suitable employment and are considered to be rehabilitated. The strategies
under this objective include evaluating the vocational rehabilitation needs of eligible
veterans and evaluating the effect of VA's vocational rehabilitation program on the quality
of participants’ lives.

‘VA has noted that developing results-oriented goals will be difficult until program
evaluations have been completed. Given the program evaluation time periods stated in
the draft strategic plan, which calls for evaluations to continue through fiscal year 2002,
results-oriented goals may not be developed for some programs for several years.
Another difficulty VA has cited is that, for many VA programs, congressional statements
of the program purposes and expected results are vague or nonexistent. VA officials cited
VA's medical research and insurance programs as examples of programs with unclear
purposes. This is an area where VA and the Congress can make progress in further
consultations.

1 Discussion of R

Another observation we made about VA's June 1997 draft strategic plan was that
‘VA's discussion of external factors that could affect its strategic planning was incomplete.
Discussions of external factors were often limited to whether the Congress would
appropriate sufficient funds or make substantive legislative changes. Assessments of
factors outside VA's control, such as economic, social, and demographic changes, are also
important in setting VA's goals and in assessing VA's progress in meeting them. However,
the discussions of external factors related to the plan's individual goals generally did not
link demographic changes in the veteran population to VA's goals.

VA's current draft has added discussions of the implications of demographic changes
on VA programs. For example, VA notes that the death rate for veterans is increasing,
which will lead VA to explore various options for meeting increased demands for burials
in VA and state veterans’ cemeteries. Meanwhile, the goal to ensure that VA's burial
Programs meet the needs of veterans and their families is accompanied by a detailed list
of specific cemetery construction and land acquisition projects and by a specific target for
expanding burials in state veterans’ cemeteries. The discussion of external factors related
to this goal focuses on the Congress’ willingness to fund VA's proposed projects and the
cooperation of the states in participating in the State Cemetery Grants Program. What is
missing in the draft is a link between the projected increase in veteran deaths and the
proposed schedule of specific cemetery projects. Similarly, we recently reported that
National Cemetery System strategic planning does not tie goals for expanding cemetery
capacity to veterans’ mortality rates and their preferences for specific burial options.‘

Lack of Program Evaluations

We noted that the goals in VA's June 1997 draft strategic plan were not supported by
formal program evaluations. Evaluations can be an important source of information for
helping the Congress and others ensure that agency goals are valid and reasonable,
providing baselines for agencies to use in developing performance measures and
performance goals, and identifying factors likely to affect agency performance. As noted

ana
97-192, Sept. 10, oy
4 GAO/T-HEHS.97-215


6

VA is aware that it has much work to do to fully implement the
Results Act. Some of this work is identified in the current plan.
VA’s success in implementing the Results Plan will depend on how
successful it is in ensuring that its strategic plan focuses on results
and how well it integrates these plans with the plans of other Fed-
eral agencies, and the Congress will continue to play an important
role in consulting with VA in developing results-oriented goals in
overseeing VA’s efforts to successfully implement the Results Act.

Mr. Chairman, this completes my statement this morning. I
would be pleased to respond to any questions you or members of
the subcommittee might have.

(The prepared statement of Ms. Fagnoni appears on p. 42.]

Mr. EVERETT. Thank you very much. Dr. Snook the VA’s mission
statement, includes being the principal advocate for America’s vet-
erans in ensuring that they receive their benefits and services. Is
that consistent with the VA statutory mandate?

Mr. SNOOK. There is nothing in the statute that gives VA the au-
thority to regard itself as the principal advocate for veterans, and,
furthermore, I think that the statement itself runs contrary to the
view expressed by Congress, I think, that it is the principal advo-
cate by passing laws that improve benefits for veterans.

Mr. EVERETT. I appreciate that response. Is the Results Act just
some sort of management fad with a statutory input, or, how po-
tential important can this be?

Mr. SNOOK. Well I think public administration scholars have long
tried to improve the operations of the Federal Government, and
this is another example of those attempts. Previous attempts, how-
ever, tended to accept government as it was already structured,
and attempted to provide a more efficient operation through evalu-
ating its various levels of performance. I think this one follows
from a school of thought that says that government should look to
see its results first, to try to determine whether the things that it
is doing are appropriate. In that regard, a coherent strategic plan,
both from an individual agency’s perspective, and from the Federal
Government as a whole, would be a very important document, and
it would allow all of government to determine its appropriate place
by looking at the effect of what it actually does. In that regard, I
think it could but let me commend you for the work that you all
have done with this. We appreciate it very much and certainly it
has been very valuable to the committee.

Ms. FAGNONI. Thank you.

Mr. EVERETT. Would you please explain in more detail, how the
VA’s annual performance plans and future budget requests relate
to each other?

Ms, FAGNONI. Well, the strategic plan, the annual performance
plans and the budget requests are three components that, together
under the Results Act, the whole goal is really trying to enable a
closer and clearer link between what the Government is spending
and what the results are, or the difference the spending is making
in people’s lives. The first component, and what agencies are cur-
rently working on, is the strategic plan which is supposed to set
out the overall mission of the agency, the overall goals and objec-
tives, and strategies for achieving those goals and objectives.


40

CRS-3

According to GPRA, performance goals must be measurable, and the Act emphasizes
the need for agencies to develop performance indicators. Such indicators measure progress
toward goals, such as the number or ratio of persons entering a rehabilitation program who
regain lost abilities, rather than simply quantifying input into agency activities, such as
dollars spent or employee-years, or as simple output from agency program operations, such
as clients served or benefits paid. Program evaluations guide the relationship between an
agency’s mission and its general goals and objectives, and form the basis for broad agency
strategies. The analysis generated by periodic evaluations assists in the reassessment of
policy or the redirection of resources to better accomplish the stated mission.

The Strategic Plan of the Department of Veterans Affairs

VA divides its strategic plan into two parts, reflecting a commitment to the balanced-
scorecard approach favored by some schools of management. In the balanced-scorecard,
general programmatic or policy goals are elaborated separately from management or process
goals. In theory, this approach would permit internal operational improvements to be given
performance milestones, which could then be linked to performance indicators that would
measure whether programs are successful in carrying out the VA mission.

VA’s mission statement lists the Department’s range of programs, services, and
benefits, combining that list with a general statement of the reasons for those functions,
together with a commitment that VA employees will serve veterans “with dignity and
compassion.” VA’s statement asserts that the Department will act as “principal advocate”
for veterans and their families, “ensuring that they will receive medical care, benefits, social
support, and lasting memorials.”

VA’s strategic plan organizes its mission goals around 10 different program areas,
which it labels lines of business. These lines cover all programs:

medical care

medical research

medical education

service-connected disability compensation
means-tested, wartime service pensions
education

rehabilitation *

insurance

home loans

© burial, cemetery or commemorative services.

eoeceecee

In some of these lines, the strategic plan identifies clear and measurable goals that could
be measured through performance indicators, In others, the identification of performance
goals that could be linked directly to general mission goals awaits systematic program
evaluation and the data such evaluations would provide. In these instances, VA has listed
program evaluations as their short-term objectives, with performance goals met by the
conduct of the evaluations themselves.


19

Mr. EvereTt. Dr. Snyder.

Mr. Evans, our ranking member, has joined us. And by the way,
I would like to make his letter to Secretary Gober, part of the per-
manent record and so ordered.

(The information follows:)

HOUSE OF REPRESENTATIVES,
COMMITTEE ON VETERANS’ AFFAIRS,
Washington, DC, August 11, 1997.
Hon. HERSHEL Goer,
Acting Secreta
Department of Veterans Affairs, Washington, DC.

Dear Mr. GOBER: I am pleased to note the significant improvements the Depart-
ment of Veterans Affairs (VA) has made in its Draft Strategic Plan. The August 1,
1997 version of the plan is much more readable than the earlier version. While work
continues to be needed i in identifying goals which can be measured in terms of “re-
sults”, the latest draft is clearly a step in the right direction.

I also want to commend the VA for the extensive efforts made to consult with
Congressional staff and other stakeholders in the development of the plan. In spite
of the progress which has been made, I remain concerned regarding the long time
lines projected for evaluation of the VA’s programs. The failure to have significant
program evaluations in the recent past has made VA compliance with the Govern-
ment Performance and Results Act extremely difficult. I encourage you to take ap-
propriate steps to ensure the program evaluation components of the plan are on a
“fast track”. These evaluations are essential if results oriented goals are to be devel-
oped and achieved.

Again thank you for the remarkable work which has been accomplished over the
past two months. A Assuming that this progress continues, I trust that we will have
a dramatically improved plan by the start of the coming fiscal year.

Sincerely, LANE Evans,
Ranking Democratic Member.

Mr. Evans. Sir I have an opening statement that I would ask
might be included in the record. No questions at this time.

[The prepared statement of Congressman Evans appears on p.
35.)

hr. EVERETT. I want to thank the panel for its testimony today,
and now we will have Panel 3.

Charlie Cragin, the Principal Deputy Assistant Secretary of De-
fense (Reserve Affairs), Gary Christopherson, the Acting Principal
Deputy Assistant Secretary of Defense (Health Affairs); Lieutenant
General Norman Lezy, The Deputy Assistant Secretary of Defense
(Military Personnel Policy); Al Borrego, Assistant Secretary-Des-
ignate for the Veterans’ Employment and Training Service, Depart-
ment of Labor

If you will, begin your testimony, please and by the way, wel-
come to this place.


14

was serving in the U.S. Air Force Intelligence Service and I was
sitting in a meeting and the head of that group, a Captain Kelly,
I never will forget his name, asked us about a very complex situa-
tion. All of us, all four of us came up with the same answer, and
he looked at us and said well you know if you guys all agree, then
somebody is not thinking. And I think that tet can sort of de-
scribe, if you will, the tension that also exists between this Com-
mittee and the VA. Let me also say that while perhaps oversight
has historically focused on program delivery rather than program
outcomes, this Committee is extremely interested in, I think some
of you know, in program outcomes, and we will continue to stress
that focus.

Before I ask my first question, I will ask unanimous consent to
place in the record, letters from Chairman Stump to the Secretary
of Veteran Affairs, dated May 20, 1997, and August 12, 1997, re-
garding the VA’s draft strategic planning under the Results Act.

‘ithout objection, so ordered.

(The information follows:)

House OF REPRESENTATIVES,
COMMITTEE ON VETERANS’ AFFAIRS,
Washington, DC, May 20, 1997.
Hon. JESSE BROWN,
The Secretary of Veterans Affairs,
Department of Veterans Affairs, Washington, DC.

DEAR MR. SECRETARY: As you are aware, the Government Performance and Re-
sults Act (Results Act) requires the Department of Veterans’ Affairs (VA) to formally
file its strategic plan with Congress by September 30, 1997. Full and effective Re-
sults Act implementation is a priority for the Committee and is consistent with the
‘ype of strategic planning the Committee has long urged VA to do.

e VA Committee has concerns about the Department's progress in implement-
ing the Results Act. While I am encouraged that VA is not on the “trouble fist” that
the Office of the Majority Leader recently conveyed to the Office of Management and
Budget, I agree that it is appropriate for VA to be on the “watch list.” H
my statement of concerns about the progress and substance of VA’s Results Act ef-
forts is not intended as a criticism of the cooperation or openness shown in consult-
ing with the Committee. To the contrary, I believe VA exhibits a strong commitment
to making the changes in thinking and action necessary to achieve the objectives
of the Results Act.

In the required consultations with Congress, VA has participated in a number of
meetings and briefings and has provided the Committee with draft vision and mis-
sion statements, as well as with some drafts of plan elements and performance
measures. The VA Committee is consulting extensively with the General Accounting
Office and the Congressional Management Institute in reviewing the draft materials
submitted thus far I have the following observations about what we have seen:

Vision and Mission Statements: VA has not yet articulated adequate vision and
mission statements. VA’s draft vision statement is essentially inward looking and
does not capture the contemporary expression of VA's mission that it should. The
draft mission statement should be considerably more specific about the benefits VA
is mandated to bring to veterans and their families. It should reflect each of VA’s
major activities as set forth in title 38 of the United States Code.

Strategies: The Committee does not have a sufficient picture of VA’s strategies to
comment at this point.

Goals and Performance Measures: VA's performance measures appear to be large-
ly process rather than results oriented. recognize the difficulty of defining with

recision and measuring what VA’s programs should be achieving as outcomes. The
committee will continue its dialogue with VA as the performance measures are
refined.

Coordination: Both from the standpoints of efficiency and improving services to
veterans, VA should give more attention to coordination with other entities impor-
tant to achieving the goals for veterans, particularly with the Departments of De-
fense and Labor.


3

and it requires that this explanation focus on purposes rather than
simply accepting the basis for the activities as given.

Thus, the Act seeks to link the performance of activities with in-
dicators and measurements of the results of those activities. Cur-
rently, performance itself is generally measured through the
amounts of money expended, actions taken, manpower and re-
sources engaged, or the number of persons, places, or things af-
fected. GPRA asks that the evaluation process be extended to the
ordinary activities of the Federal Government at every level: what
is the activity trying to accomplish, and how do we know if it ac-
complished it?

The Act establishes a method for determining the feasibility of
a comprehensive, government-wide plan, to be in place as early as
fiscal year 2002. As interpreted by OMB and GAO, a strategic plan
contains six elements: comprehensive mission statement; long-term
goals and objectives; strategies to achieve those goals and objec-
tives; the relationship between long-term objectives and annual
performance goals; identification of key factors beyond the control
of the agency; and a description of how program evaluations might
help with the process.

In the strategic plan, general goals elaborate policy, pro-
grammatic, or management directions that follow from the agency
mission, and objectives are more specific statements of something
to be accomplished within those directors. For example, VA has a
general goal of improving the health care of veterans, which is
furthered by an objective of increasing the number of veterans
using the VA health care system. Within these objectives are per-
formance goals, which are specific milestones to be attained each
year. GPRA requires that agencies establish annual performance
plans, with performance goals identified, as part of the annual
budget process.

According to GPRA, performance goals must be measurable, and
the Act emphasizes the need for agencies to develop performance
indicators. Such indicators measure progress toward goals, such as
the number or ratio of persons entering a rehabilitation program
who regain lost abilities, rather than simply quantifying input into
agency activities, such as dollars spent or employee-years, or as
simple output from agency program operations, such as clients
served or benefits paid.

The VA’s strategic plan identifies clear and measurable goals for
some agency functions that could be measured through perform-
ance indicators. In others, the identification of performance goals
that could be linked directly to general mission goals awaits sys-
tematic evaluation program evaluation and the data such evalua-
tions would provide. In these instances, VA has listed program
evaluations <s their short-term objectives, with performance goals
met by the conduct of the evaluations themselves.

Achieving the GPRA objective of rational, results-linked govern-
ment program operations will take time. In addition GPRA does
not fully distinguish between performance linked to mandatory pro-
gram operations, and performance in which the agency is permitted
considerable discretion in the pursuit of goals outlined and author-
ized by Congress.


110

‘One-VA Survey
Most Favorable Five Least Favorable Five

Hote are tho top five survay tems Horo ae the bottom five items
=fhghest percentage of WA-wcle highest percentage of VA-wide
‘agreement. dieagreemont.

Pay rises depend on bow wet
‘simployees perform the

Q411, This organization practices:
2er0 tolerance for discrimination
gender, race, nabonal orig,
teligion, age, cual backaround,
‘semual onentation. or disability}

QHZ, There {ss positive
‘relationship between men-

Stag ag nee
‘how VA compares to other feceest agencies?

+

ee depencereses



69

Mr. Chairman and members of the subcommittee, I am Chuck Burns, National
Service Director of AMVETS.

Thank you for the opportunity to express AMVETS’ views on the draft Strategic
Plan of the Department of Veterans Affairs (VA). AMVETS has not received any
Federal grant of contract during the current or previous two fiscal years.

As you know, The Results Act (Public Law 103-62) requires Federal agencies to
develop and refine specific goals, objectives and performance measures with a
focus on outcomes, not activities, in order to improve the efficiency and
effectiveness of federal programs. The law also specifies that agencies must
consult with Congress and other stakeholders in the process of defining the
department's missions and visions. I am happy to report that as far as AMVETS is
concemed, VA has met with us and other Veterans Service Organizations on
several occasions regarding their strategic plan. The latest of these meetings was
on July 24, 1997.

As a result of input from Congress, VSOs and their customers, VA has published
the draft of their Strategic Plan FY 1998-2003. I believe it is important to restate
the fact that this is a draft, not a final document. As far as the draft is concerned,
AMVETS does not have any major problems with its content. We will be
continuing our dialogue with VA until the final document is presented. I would
like to highlight a few of the more promising sections of the draft.

I must admit when we first heard the term "One-VA," a few flags went up. Yet,
when you think about it, that's the way veterans view VA. They don't see it as
several entities like the Veterans Health Administration, National Cemetery
System and the Veterans Benefits Administration. They say," I need help and I'm
going to the VA". The Office of Management and Budget (OMB) also gave them
the same feedback. Although we applaud the concept, we will be watching the
approach and will offer guidance.

According to the VA plan, the department's mission is to honor, care, and
compensate veterans. "To serve America's veterans and their families with dignity
and compassion, and to be their principal advocate in ensuring that they receive
the care, support, and recognition earned in service to this Nation." We agree with
this mission statement. We especially applaud the use of the word "advocate." I
have heard people complaining about this term used in conjunction with VA, but I
think it is more than appropriate. Why can't VA be the veterans advocate? Isn't
the Department of Education an advocate for the children of this nation? If not
VA, than who?

The best way to evaluate this plan is to see if it meets the criteria that was
established.

1. Does the VA strategic plan meet the six GPRA requirements? Is it
compliant?

We believe it meets the six requirements. It provides a comprehensive mission
statement, long term goals and objectives for major functions, strategies to achieve
goals and objectives, performance goals, key external factors and program
evaluations. We will work with VA on some specific problems with objectives


24

of the National Security Committee is also a member of this Com-
mittee as well as the next in line and our ranking member is one
of our senior Democrats on that Committee. And, what I am talk-
ing about, frankly, is the failure of a standardized medical record,
electronic or paper, which could greatly improve the handoff of in-
formation. I will be honest with you. I know you have said that you
appreciate the work you have done in the last 20 years on the GI
Bill and all that kind of stuff, but we are talking about something
here that is extremely important, and I want you to know, right
now, that I intend to look at this over and over again. Mr. Buyer,
who is Chairman of the National Security Personnel Subcommittee,
is also a member of this Committee. We think this is extremely im-
portant. I do not want to see any bureaucratic finger pointing any,
assing the buck. I would like to see something done about this,
cause we are hurting veterans health care by not having a com-
mon medical record between the two of you and that has got to be
done and it has got to be done in a hurry.

I kope I am being very clear on this.

Mr. CRaGIN. Mr. Chairman, I think you are being unequivocally
clear. I note that my colleague, Mr. Christopherson is chomping to
at least make an observation with respect to the challenge you
have laid down to both Departments.

Mr. EveRETT. Well, I appreciate that and I am going to at this
time dismiss this Panel. We have a vote going on and I, again, ap-
preciate your testimony here.

Mr. CraGin. Thank you Mr. Chairman.

Mr. Everett. I will have additional questions for the record. We
are going to recess for a few minutes and we will be back for the
final panel, hopefully, in just a few minutes.

e858)

Mr. EVERETT. I will now ask our fourth Panel to step forward.
Rick Surratt, Assistant National Legislative Di r for DAV; Car-
roll Williams, Director of National Veterans Affairs and Rehabilita-
tion Commission of the American Legion; Chuck Burns, National
Service Director for AMVETS and Bob Manhan, the Assistant Di-
tector for National Legislative Services of Veterans of Foreign

‘ars.

Mr. Burns, if you will proceed, and we will et each person in
order. I will ask you to hold your comments within 5 minutes and
T assure you will get all your statements in the record. Thank you.

STATEMENTS OF CHUCK BURNS, NATIONAL SERVICE DIREC-
TOR, AMVETS; RICK SURRATT, ASSISTANT NATIONAL LEGIS-
LATIVE DIRECTOR, DISABLED AMERICAN VETERANS; CAR-
ROLL L. WILLIAMS, DIRECTOR, NATIONAL VETERANS AF-
FAIRS AND REHABILITATION COMMISSION, THE AMERICAN
LEGION; BOB MANHAN, ASSISTANT DIRECTOR, NATIONAL
LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS

STATEMENT OF CHUCK BURNS

Mr. Burns. Thank you, Mr. Chairman. We appreciate this oppor-
tunity this morning to comment on the Results Act.

As a result of input from Congress, VSOs and their customers,
VA has published a draft of their strategic plan. I believe it is im-


10

respect to improving the overall medical care system. VA has a
very ambitious plan for providing itself, providing its facilities with
resources beyond norm: appropriations, because of actions on the
part of facility directors in the future. So, I think that over the long
run, you are going to see a very aggressive VA medial care system
expanding and attempting to address more veterans, with more
gervices and doing so more efficiently and with different sources of
nds.

Dr. SNYDER. Are these plans written in a contingent fashion? I
mean it does not get as much detail as talking about Medicare sub-
vention, but are they written in such a way, if we get these things,
then we can aggressively pursue third-party payments. If we do
not, then our plan will go this direction. Because if I were the VA
Tight now, I would look over here and I would think I do not know
what they are Boing. to do on this Medicare subvention.

Ms. FAGNONI. Well, to some extent, for example in this section,
they have an overall goal of improving the health care of veterans.
That is one of their major goals, and they do talk about, and one
of the goals and objectives to achieve that goal is to increase the
nonappropriated funds sources of income. Now they got the medical
care cost recovery piece of that, but not the Medicare subvention.
And they do mention that as an external factor, that their effort
is in part contingent on some actions by the Congress. They have
tried to factor that in. But, also, again this is a plan at the depart-
ment-wide level and as I am sure you know, underneath that plan
VHA has its own much more detailed planning effort, Prescription
for Change that lays out in more detail some of the efforts it has
underway.

Dr. SNYDER. Thank you, Mr. Chairman.

Mr. EVERETT. Thank you, Dr. Snyder. Let me mention for the
record that our friend colleague, Congressman Clyburn had some
emergency dental work to be done and he hopefully may be here
before the end of the hearing, but I know that he apologizes for
missing your testimony, but on the other hand we can fully under-
stand why he is not here and his statement will be entered into
the full record.

I would like to thank this panel and we will have additional
questions for you for the record please.

Ms. FAGNONI. Thank you.

Mr. EVERETT. Thank you.

I would like to call Panel 2 please. Mr. Dennis Duffy, Assistant
Secretary for Policy and Planning for the Department of Veterans
Affairs, and please ask him to introduce his panel.

STATEMENT OF DENNIS DUFFY, ASSISTANT SECRETARY FOR
POLICY AND PLANNING, DEPARTMENT OF VETERANS AF-
FAIRS; ACCOMPANIED BY D. MARK CATLETT, ACTING AS-
SISTANT SECRETARY FOR MANAGEMENT, DEPARTMENT OF
VETERANS AFFAIRS; AND NORA EGAN, DEPUTY ASSISTANT
SECRETARY FOR PLANNING, DEPARTMENT OF VETERANS

_Mr. Durry. Good morning, Mr. Chairman. It is a pleasure to tes-
tify today on behalf of the Department of Veterans Affairs concern-
ing our strategic plan through the year 2003. I wish to congratulate


29

THE STATEMENT OF BOB MANHAN

Mr. MaNHAN. Thank you very much Mr. Chairman. The VFW
appreciates being part of your overall hearing to discuss a very im-
portant issue, the Department of Veterans Affairs Strategic Plan.
i am accompanied at the witness table this morning by Mr. John
McNeill who is the VFW’s Assistant Director of Veterans Benefits.

For the past several years, the VFW has always identified three
problem areas that should be fixed in the processing of claims.
They are: first, to improve the quality of the decision making at the
regional office level. Second, is to reduce the Board of Veterans Ap-
peals decision time lag from start to stop and third to reduce the

igh BVA remand rate.

fe are very satisfied, in fact we are delighted to see for the first
time, that part of the strategic plan that we have discussed this
morning sets specific goals to address these areas. The first is that
there will be a clear performance objective to process all claims
within 60 days, with a 97 percent accuracy rate and with no great-
er than a 20 percent BVA remand rate. Those are very positive
statements or objectives.

Along with this, the Business Process Reengineering, or the BPR
implementation plan includes another very favorable strategy on
how veteran service organizations will and should operate in the
future claims processing system. We look forward to working very
much with this procedure. However, the VFW sees one critical vul-
nerability and that is the success of BPR is very heavily dependent
on information management and technology enforcement. Specifi-
cally, it is clearly stated that the final development and delivery of
the long-awaited veterans service network, which we all know by
the acronym VETSNET, is crucial. Consequently, VETSNET must
be allowed to replace the current benefits delivery network, BDN,
which is universally condemned by our service officers as being ex-
tremely cumbersome and archaic in providing the necessary assist-
ance and information our service officers need in the field to better
advise and counsel veterans.

That is why the VFW is very concerned to see that both the
House and Senate in their very recent appropriation markup report
language, direct the transfer of $5 million from VETSNET to other
programs. This is icularly disconcerting, because the VA only
requested $2.4 million for VETSNET in fiscal year 1998. Lacking
any other information, the VFW can only conclude that it is Con-
gress’ intention to kill or abolish VETSNET.

This concludes my very succinct summary or our written state-
ment which I know will be part of the record. Thank you Mr.
Chairman.

[The prepared statement of Mr. Manhan appears on p. 87.]

Mr. Everett. Thank you very much. I would say a couple of
things. I do not have any questions, but I would say that the Act-
ing Secretary of VA made the suggestion to this Committee Chair-
man to transfer that money, not the Congress.
ani MANHAN. Thank you very much. The VFW was unaware of

it.

Mr. EVERETT. In addition, I would say that the advocates of vet-
erans are sitting at this table and it is chilling to me that some-

45-927 98-2


98

Director, JR&IO, also co-chairs many current work groups and sits on active task forces on
DoD/VA interagency issues. The following list identifies some of the projects that have been
funded by DoD and fully staffed by both agencies for policy decisions and operational business
process improvements using the task force, working group, and subject matter workshop
approaches:

‘© The transfer of medical records to the VA when a service member separates from active duty.

© The Personne! Information Access project and a follow up project to test a prototype system
for electronic exchange of information between DoD, VA, and the National Personnel
Records Center.

Re-engineering of the death gratuity benefit determination and payment process in “imminent
death” cases, which reduced waiting times for survivors from six months to less than a week.
Both agencies were awarded the Vice President's Hammer Award from the National
Performance Review for this effort.

* Business process improvements in the area of retirement of clinical records for Service
members and their family members from Defense medical treatment facilities to the National
Personnel Records Center,

‘+ Location, description, and points of contact for World War Il mustard gas test participants.


91

longer on how to improve the current claims processing system but, instead, its actual

survival in the form that we now know it.

The Senate Appropriations Subcommittee markup version goes far beyond this in
what we can further describe as an enthusiastic acceptance of the NAPA report. Their
expanded report language certainly leads us to believe that the Senate Appropriations
‘Committee fully intends to mandate the NAPA panel's findings and recommendations.
‘One of those recommendations is the "immediate" suspension of VETSNET, with the
attendant redistribution of all supporting resources. That, of course, really equates to the
termination of the program. (It is interesting to note also that another recommendation is

to temporarily stop all C&P BPR actions.)

Our initial review of the NAPA report certainly does not indicate it to be a panacea
for all that currently ails the claims processing system. To be sure, there are some
‘excellent recommendations, as was the case for the report by the Veterans’ Claims
Adjudication Commission, The real danger here is the unilateral action by the Senate
Appropriations Subcommittee. We just cannot automatically create legislative remedies
without critical dissection of such an important report, as that from the academy. This
must include dialogue from all interested parties, particularly the veterans service

‘organizations, Until that occurs, there must be removed any report language or proposed

legislation that mandates the "blind" acceptance and implementation of the findings and

recommendations contained in the NAPA report.

Mr. Chairman, you have, in the past, always conducted your legislative
responsibilities on our veterans with the utmost professionalism and candor. This is both
appreciated and applauded. The need for you, and your colleagues, to continue doing so
is greater than ever. The eventual success of the VA's Strategic Plan will only happen
with a dedicated, open partnership among Congress, the Department of Veterans Affairs

and the veterans service organizations. We certainly believe that will occur.

‘Again, Mr. Chairman, we thank you for the opportunity to participate in this important
hearing and are prepared to answer any questions you or the Subcommittee members may

have,


11

you and Committee staff on conducting what I hope will be the
first of many hearings on VA’s strategic direction. I think it is ab-
solutely critical that Congress, the Executive Branch and the vet-
eran service organizations enter into a long-term dialogue on en-
suring that we meet the very real needs of veterans into the 21st
century.

I am accompanied today by Mark Catlett, our Acting Assistant
Secretary for Management and Nora Egan, our Deputy Assistant
Secretary for Planning.

As you know, the plan is due to Congress in less than 2 weeks
and we are still in the process of revising it, based on comments
we have received from various stakeholders.

I can truly say to this committee that VA recognizes the Govern-
ment Performances and Results Act as a real opportunity to ensure
that we remain able to meet the changing needs of veterans in rec-
ognition of their sacrifice for America. GPRA promotes a focus on
results, on service quality and on customer satisfaction. By now it
is also clear to us that GPRA treats planning as an ongoing process
of asking and, I hope, answering the tough questions. We have al-
ready had to consider fundamental questions like, do veterans pro-
grams actually achieve their intended purposes? ‘And what are vet-
erans and the American taxpayer getting in return for the dollars
that are expended on these veterans programs?

We are proud of our strategic plan and I am especially proud of
the many employees whose efforts produced it, particularly those
on my own planning staff. Still, as these questions illustrate, the
plan is only a point of departure, not a final destination. We are
optimistic about this journey into the strategic planning process,
but we are also mindful that the road is a long one.

Four years ago, we began by seeking and obtaining GPRA pilot
status for our national cemetery system, our loan-guaranty pro-
gram, and the New York VA Regional Office. These pilot programs,
gave us certain insights that have strengthened our efforts.

Movement accelerated 2 years ago, when VA top managers par-
ticipated in an intense 2% day planning conference led by then
Deputy Secretary Hershel Gober. That conference led directly to
formation of VA’s strategic management process. And, as you know,
my written statement included a diagram of that process, through
which we have already achieved, I believe, some major milestones.
We have reaffirmed the Department’s vision and goals. We have es-
tablished a one-VA approach to world-class customer service, and
we have developed for the first time a department-wide strategic
plan. We have also set the stage for further progress with a thor-
ough environmental scan, an organizational assessment survey of
all VA employees, development of what I believe to be truly mean-
ingful customer service goals, and initiation of strategic scans of all
of our various benefit and program lines.

Last year’s environmental scan allowed us to assess the
strengths and weaknesses of the Department and review key veter-
ans issues through the eyes of our stakeholders, who responded to
us through a series of interviews and questionnaires. In addition,
almost 126,000 VA employees responded to a recent organizational
assessment, which is producing tremendous insights into our work


97

House Veterans’ Affairs Committee
Subcommittee on Oversight and Investigations
Department of Veterans” Affairs Strategic Plan

September 18, 1997
Member: Chairman Everett
Witness: Gary A. Christopherson
Question 2

Question 2:

There are a number of electronic tape data exchanges currently taking place between DoD and
VA. DoD is working toward a common pay and personnel ADP system for all military services.
Are VA requirements being considered in the design of the common pay and personnel system?
Absent VA’s participation on the DoD working group, how will DoD accommodate VA’s needs?
If so, at what level in the DoD and VA is this being managed? (Department or Administration)

Answer:

There are several exchanges of data with the VA via tapes sent from the Defense Manpower Data
Center. Examples of some of these exchanges are the D214 File, the Veterans Affairs
Compensation File, and the Veterans Affairs Reconciliation Program. These files and data are
used by both agencies to update records and to reconcile transactions on benefits and
compensation payments for former Service members.

‘The common pay and personnel system under development is called the Defense Information
Management Human Resource System (DIMHRS). This system is being developed around
standard personnel data elements that comply with the Defense Personnel Data Model (DPDM).
‘The Department has welcomed VA participation in our business process reengineering program,
and we currently are engaged in several joint DoD/VA ventures, The VA was an active
participant in the personnel data modeling workshops, and their requirements have been
incorporated in the DPDM. The Joint Requirements and Integration Office(JR&IO) will define
functional requirements for DIMHRS. When the design and development process begins,
sometime during FY1998, subject matter area workshops will be conducted to cover broad areas
of military personnel management and pay. Prior to the start of each phase or series of
workshops, a careful review will be made to ensure participation of appropriate functional
experts and major stakeholders. As a prominent stakeholder in military personnel and pay
information, VA will be contacted for direct input and participation for the subject matter areas
that are determining factors in, and have direct impact on, entitlement and award of veterans
benefits and compensation.

Initial contact with VA on DIMERS issues will come directly from the Joint Requirements and
Integration Office, acting on behalf of the Under Secretary of Defense for Personnel and
Readiness. As its predecessor (the Information Management Office) did in the past, the JR&IO
maintains a senior level project manager who coordinates military personnel projects with VA
and serves as a liaison for the many interagency projects that have been worked in the past. The


102

CRS-3

Question 3. Can you compare the VA's efforts to comply with the requirements of the
GPRA with the efforts to date of other federal agencies?

Strategic plans are products of an agency's internal review, and it follows that such plans
are more difficult to develop within complicated federal bureaucracies than in agencies in
which the mission, and plans for its future implementation, are readily understood by
‘examining the agency's authorizing legislation. In a smaller agency, one person (or a fairly
small group) working in conjunction with the agency’s chief administrator, could probably
produce an effective document within a reasonably short period of time.

VA, because it is such an immense structure encompassing a multitude of programs and
operations, and because it responds to literally millions of individuals in the most personal of
circumstances, could not produce a coherent, comprehensive strategic plan without assigning
the responsibility for such a task to a specific office or team of individuals. It was necessary
for the office charged with oversecing the development of the Department’s plan to introduce
a format for gathering the necessary information needed from throughout the Department.

‘The team subsequently assimilated data from offices with differing perspectives on VA's
overall mission, Finally, they generated a product that underwent intense scrutiny from both
the OMB and from Congressional committees. While the process by which VA produced its
plan differed from some agencies, the product met requirements that GPRA placed on other
federal agencies.

Question 4. There are critics from both within and outside the federal agencies who believe
GPRA hinders agency productivity, and diverts attention, money, and resources from the
real world of agency operations. How would you respond to this criticism of the GPRA?
In your view, has the GPRA had a positive impact of the VA's planning process?

Many, perhaps most, agencies were able to comply with GPRA strategic planning
requirements without hiring additional staff solely for the purpose of achieving that
compliance. To the extent that existing staff were drawn from other activities to work on
GPRA activities, it could be concluded that GPRA requirements substituted for other work
that could have been done. However, GPRA requirements are specific approaches under
which agencies are to conduct the planning process, and some planning process was generally
ongoing in most agencies anyway. While these earlier planning exercises may have used
somewhat different techniques, and varied from one agency to another, the introduction of
4 consistent format cannot be assumed to have substantially changed the amount of personnel
time involved in planning efforts.

In VA, with its broad mission and varied responsibilities, the introduction of the GPRA
planning process required intensive effort and time from a planning staff. While the ultimate
results of that personnel investment await future evaluation, it could be concluded that the
activity itself improved understanding of the massive VA operations for many people involved
in the planning process.


65

Espiridion “Al” Borrego
Assistant Secretary-Designate
Veterans’ Employment and Training Service
House Committee on Veterans’ Affairs
Subcommittee on Oversight and Investigations
September 18, 1997

Good morning Mr. Chairman and Members of the Subcommittee. I am
pleased to represent Secretary of Labor Alexis Herman and to present
testimony on how the Labor Department’s Veterans’ Employment and
Training Service interacts with the goals and strategies presented in the
strategic plan of the Department of Veterans Affairs.

In the process of developing its strategic plan, the Department of
Veterans Affairs (DVA) shared early drafts with the Department of Labor,
specifically the Veterans’ Employment and Training Service (VETS), and
asked us to comment on the goals and strategies which impact DOL programs.
In turn, my agency shared our strategic plan with the VA.

VETS has had a strong working relationship with the DVA, due in large
part to the committed support of former Secretary Jesse Brown and current
Secretary-designate Hershel Gober. Both agencies are dedicated to bringing
the highest quality services to our nation’s veterans. I look forward to
building on that relationship in the future.

VETS and the VA coordinate policy and share information in a number
of ways. The Secretary of Veterans Affairs and the Director of the Vocational
Rehabilitation and Counseling Service are ex-officio members of the Secretary
of Labor’s Advisory Committee on Veterans’ Employment and Training. This
committee keeps the Secretary of Labor informed and advised about issues
affecting a wide range of benefits and services for veterans. Their
participation ensures the Labor Department has timely knowledge of and
input into DVA programs where our activities coincide.

While VETS interacts with the Department of Veterans Affairs in only a
few of its many activities, I believe it is important to note that we have had a
good working partnership for quite some time. In areas specifically mentioned
in the strategic plan — vocational rehabilitation and counseling, compensated
work therapy, services to homeless veterans, the Transition Assistance
Program (TAP), the Disabled Transition Assistance Program (DTAP) and
targeted services to women and minority veterans -- we interact with the DVA.
on a continuous basis. In the recent past, the Department of Veterans Affairs
joined the Labor Department in administering the Service Members
Occupational Conversion Training Act (SMOCTA), a highly successful pilot
program.

In the performance goal of assuring that vocational rehabilitation meets
the needs of veterans, the DVA has stated that its first objective is to increase
the number of disabled veterans who acquire and maintain suitable
employment. Since 1995, VETS has had a Memorandum of Understanding
(MOU) with DVA that brings together our employment service representatives


“al

BIO OF CHUCK BURNS, AMVETS NATIONAL SERVICE DIRECTOR

Chuck Bums assumed the duties of AMVETS National Service Director in April
of this year. Prior to joining AMVETS, Mr. Burns served as Assistant Legislative
Director for The American Legion National Headquarters here in Washington.
He is a decorated Marine Corps, Viemam veteran, having served his country as a
helicopter machine gunner/crew chief during one tour in Vietnam.

Mr. Burs brings more than twenty years' public affairs experience to the National
Service Director's position. He founded his own public affairs firm in New
Orleans in the early 1980's, representing the Charity Hospital system, among other
clients, before the State Legislature. On moving to Washington some ten years
ago, he joined the public affairs/public relations firm of Burson-Marsteller where
he represented several of the country's largest health care companies as well as a
veterans service organization.

He is a graduate of the University of Notre Dame with a B.A. in Government and
International Relations.


16

program evaluations is the most serious single deficiency in the VA’s preparations
for strategic planning under the Results Act. This regrettable failure to comply with
a Results Act requirement has put the VA possibly two Yeats or more behind where
it should be in its strategic planning. At this point. the VA apy to be doing what
it can to catch up by establishing a schedule for program evaluations. The schedule
should be as rigorous as possible.

(2) While moving toward program evaluations and the data integrity necessary to
perform them, the VA Committee e: the VA to develop interim results-oriented
goals rather than to rely on placeholders. Those goals can then be progressively vali-

lated and adjusted as necessary. Without results-oriented goals derived from pro-
gram evaluations, the VA cannot complete its strategic plan and attain full compli-
ance with the Results Act.

The VA Committee fully appreciates how far the VA has come in a short time

i forts. These efforts will define virtually every aspect

with ite strategic planning
of the Department in the future and will in large part determine its ability to per-
start

form its missions on behalf of veterans. I believe the VA is now off to a

Sincerely, Bor S:
Chairman.

Mr. EvERETT. Mr. Duffy, the committee advocated this general
sort of strategic planning long before there was a Results Act, as
Chairman Stump has observed and the VA is now off to a good
start. But it is only a start as you mentioned, and implementation
is ahead. Without consistent follow-up and annual formance and
budget plans, and emphasized by VA’s top leadership and I stress
that, the planning process could lose its momentum before it
amounts to too much. How is the VA going to make this s planning
and annual performance planning its permanent approach to pro-
viding federal benefits and services to veterans and their families?
Not a quick fix here, we want long-term solutions.

Mr. Durry. We have taken very seriously our commitment to a
long-term strategic management process at the department level
and I can speak without reservation as to top management’s com-
plete buy-in to a process which is intended to tie our strategic plan-
ning, budget formulation, resource allocation and program evalua-
tion efforts into one continuous whole, so that indeed the strategic
plan drives budget formulation and resource allocation and so that
indeed we are able to identify for you the real value of these pro-
grams to the veterans we have an obligation to serve.

Mr. EVERETT. How is the coordination of issues, the so-called
cross-cutting issues, been accomplished with other Federal depart-
ments and agencies who also have veterans programs that inter-
faces with the VA, how much coordination has there been under
the Results Act? This appears to be the least-developed of the VA’s
planning. Why is that?

Mr. Durry. I would fully concur with your observation that it is
the least-developed part of our strategic planning initiatives to
date. I think the reason for that is the lack of maturity in our plan-
ning process. I think we are struggling like all other Executive de-
partments and agencies in putting together a meaningful and sub-
stantive strategic plan that is completely compliant with the Gov-
ernment Performance and Results Act requirements. Clearly, we
have had substantial success working with the Department of De-
fense, Health and Human Services, Social Security and other Exec-
utive departments and agencies on issues of mutual concern to vet-
erans. But, beyond sharing with them copies of our draft strategic
plan and reviewing copies of their draft strategic plans and at-


99

Congressman Evans to Charles L. Cragin, Principal Deputy Assistant
Secretary of Defense (Reserve Affairs), Department of Defense

Question for Mr. Cragin: Can you outline for the members of the Subcommittee what
additional steps the DoD intends to take over the next year to better coordinate with the
VA on strategic planning issues?

A. First, let me state that the goals, strategies and performance measures in the VA.
stategic plan are consistent with and effectively complement DoD's corporate goals, as
expressed in the DoD Quadrennial Defense Review. They continue to support the
programs that require DoD-DVA interface. DoD will continue to work closely with
DVA on all our respective cross-cutting issues, including those addressed in the DVA
Strategic Plan, We support the DVA performance goal to develop the capability to
effectively transfer records electronically between DoD and DVA. Since late 1995, there
has been a Memorandum of Understanding between the Veterans Affairs’ Under
Secretary for Benefits and the Under Secretary of Defense for Personnel and Readiness to
transfer medical records of service members leaving active duty directly from the
Military Services to DVA. DoD and DVA are currently engaged in an interagency
working group, under the auspices of Presidential Review Directive-5, to recommend
ways of working better together to capitalize on resources and emerging technologies to
better serve service members, veterans and their families, The DoD/VA Executive
Council, established by the Assistant Secretary of Defense for Health Affairs and the
Under Secretary for Health, Veterans Affairs, will continue to oversee joint efforts to
reduce costs and to improve health care for veterans, active duty military personnel,
retirees and dependents, Many of the DoD-DVA related programs support the DoD
corporate goals of maintaining highly ready joint forces and fundamentally reengineering
the Department of Defense. DoD will continue to work with the VA through existing
joint mechanisms on strategic planning issues that are relevant to both departments.


21

more timely response to the claims of veterans and former service
members.

DOD and DVA share a common goal of transforming our respec-
tive health care delivery systems to managed, patient-centered, pri-
mary care systems that assure high quality cost-effective care. In
addition to sharing ideas, programs and a number of facilities with
DOD, a memorandum of understanding provides for planning and
procedures to support DVA’s responsibility to serve as a medical

ackup to DOD in a national emergency situation.

In the immediate future, we hope to be able to expand collabo-
rative medical research efforts in order to maximize research op-
portunities and to enhance the research dollars available to both
agencies. DOD supports DVA’s objective of establishing stronger
and more online linkages, including programmatic links between
the DOD and DVA disability evaluation systems. DOD uses the
DVA schedule for rating compensable disabilities and a DVA rep-
resentative is a member of the DOD disability council. We work to-
gether to assess the impact of the current compensation programs
that serve our disabled military members.

Improving educational 0] opportunities for military members and
veterans is certainly a goal we share with DVA in that it assists
recruiting, enhances the qualifications of those serving and meets
the needs of veterans. Since the inception of the DVA-managed
Montgomery GI Bill in 1985, over 2.5 million service members have
enrolled in the program. Another 1.1 million National Guardsmen
and Reservists are eligible for the Montgomery GI Bill with the Se-
lected Reserve. We support DVA’s strategic goal and are engaged
with them in their educational assistance, business process re-engi-
neering effort to further increase the value of the Montgomery GI
Bill benefits and to continuously assess the education needs of mili-
tary members and veterans.

The Assistant Secretary of Defense for Health Affairs and the
Under Secretary for Health Veterans’ Affairs are continuing a high-
level program of cooperation and have established a DOD/VA Exec-
utive Council made up of senior DOD and DVA health care execu-
tives. In the spirit of a May 1996 report to the Vice President enti-
tled, Strategies for Jointly Improving VA and DOD Health Sys-
tems, the Executive Council is overseeing a number of joint efforts
to reduce costs and improve health care for veterans, active duty
military personnel, retirees and dependents and to capitalize on the
resources and experience of both departments.

As I have indicated, DOD and DVA have a long history of inter-
action, cooperation, and coordination on our related programs. We
believe that there will be opportunities to further strengthen the
existing alliance between DOD and DVA based on the strategic
planning within both organizations. The result will be greater effi-
ciencies and improved performance for both organizations in the ac-
complishments of our respective missions.

Mr. Chairman, my colleagues and I are prepared to answer your
questions.

[The prepared statement of Mr. Cragin appears on p. 58.]

Mr. EVERETT. Thank you very much, I think we will go to Mr.
Borrego first for his statement and then we will get into questions.


50

What are veterans and other taxpayers getting in return for the money

devoted to veterans’ programs?

VA has made a concerted effort over the past two years to change the way we do
business and to evolve a Strategic Management Process that provides for a “One-
VA" approach to the implementation of GPRA. While we are proud of this
Strategic Plan and the efforts of many VA employees to produce this document, we
believe that the Strategic Pian is a point of departure, not a final destination. We

are enthused about the journey yet mindful that the road is a long one.

VA efforts began soon after the enactment of GPRA in 1993. Early on we sought
and obtained GPRA pilot status for the National Cemetery System, the Loan
Guaranty Program, and the New York VA Regional Benefits Office. These pilot

programs gave us insights into GPRA that strengthened our efforts.

GPRA implementation accelerated in the Fall of 1995 when VA top managers
participated in an intense two and a half day planning conference led by then
Deputy Secretary Gober. Valuable insights on GPRA were provided by then OMB
Deputy Director John Koskinen, which helped us to design a pragmatic approach to
an integrated process. A major outcome of that conference was the formation of
VA's Strategic Management Process. | have enclosed a diagram of the process for
your information. This process uses several internal groups to address strategic
issues critical to VA's future. A Strategic Management Group identifies and
manages strategic issues with a unified approach to problem solving. The Strategic
Management Group is comprised of VA’s top policy level appointees and is chaired
by the Deputy Secretary, This group ensures that we plan as a department and
coordinate strategies as one VA. In addition, the Strategic Management Steering
Committee, composed of both political and career senior executives, is a standing
committee that evaluates and develops strategic issues, provides options to the
Strategic Management Group, and oversees senior staff-level working groups that

work on specific issues or projects.

Using the Strategic Management Process over the past two years, we have
reassessed and reaffirmed the Department's mission, vision, and goals; established
ind developed

the “One-VA” approach to achieving world-class customer servic
the Strategic Plan. We have also made evary effort to set the stage for an effective
planning process by conducting an environmental scan and an organizational
assessment survey of all employees, developing customer service performance

goals, and initiating strategic scans of business lines.


95

House Veterans’ Affairs Committee

Department of Veterans’ Affairs Strategic Plan
September 18, 1997
Member: Chairman Everett
Witness: Gary A. Christopherson
Question 1

Question 1, part 1:

It is my understanding that VA and DoD don’t have a standardized medical record, electronic or
paper, which could, for example, greatly improve the handoff between the departments when a
service member is discharged and goes to the VA for treatment and disability compensation. Are
there plans to move beyond the current transfer of hard copy service medical records from the
military services to VA?

Answer:

The Department of Defense is pursuing electronic data record transfer through the Computer-
based Patient Record (CPR) project. The Computer-based Patient Record will contain
information about an individual’s longitudinal health status and health care. Appropriate
portions will be easily accessible to authorized users when and where needed. CPR integrated
computer systems will facilitate the worldwide delivery of health care, assist individuals and
clinicians in making health care decisions, and support leaders in making operational and
resource allocation decisions. One planned component of the CPR is the Service Member Life
Cycle project, which will maintains continuous information about the service member’s health
status beginning with the initial military service entrance physical through the exit physical.
Ultimately, the CPR will completely replace the current system.

‘The Computer-based Patient Record will insure that a complete, accurate and continuous record
of health care is maintained and made available to the Department of Veterans Affairs when
Service members transition from active duty. The Department of Defense is working with the
Department of Veterans Affairs to share information contained in the CPR. Our goal is to begin
implementing both the Computer-based Patient Record and Service Member Life Cycle by the
year 2000.


33
APPENDIX

STATEMENT OF THE HON. JAMES E. CLYBURN

HOUSE COMMITTEE ON VETERANS AFFAIRS
SUBCOMMITTEE ON OVERSIGHT & INVESTIGATIONS

HEARING ON VA’S STRATEGIES FOR GOVERNMENT
PERFORMANCE AND RESULTS ACT (GPRA)
COMPLIANCE

| WOULD LIKE TO COMMEND THE CHAIRMAN
FOR CALLING WHAT MAY LIKELY BE ONE OF THE
MOST IMPORTANT — BUT LEAST SEXY — ISSUES THE
OVERSIGHT SUBCOMMITTEE WILL TRY TO TACKLE

DURING THIS CONGRESS.

WHEN THE CONGRESS PASSED THE
GOVERNMENT PERFORMANCE AND RESULTS ACT
(GPRA) FOUR YEARS AGO, MOST OF US BELIEVED
WE WERE BRINGING MUCH-NEEDED FOCUS TO
STRATEGIC PLANNING AT OUR FEDERAL
AGENCIES. FOUR YEARS LATER, WE ARE FINALLY

BEGINNING TO SEE THE FIRST STAGES OF THE


17

tempting to identify areas of mutual concern, we have not done the
necessary substantive coordination of issues. That remains to be
done and I will tell you that we are fully committed to doing that
with our partners in the Executive Branch.

Mr. EveERETT. Thank you very much. Mr. Mascara.

Mr. Mascara. I note in your statement that you speak to the
outcome-base performance. In Pennsylvania, we have that in edu-
cation, refer to it as the OBE and I was just wondering, is there
some board or commission that will be responsible for analyzing
that information and that performance, and then reporting back to
you or to us?

Mr. Durry. There will be Congressman. I would make a couple
of points on that. First of all, the Results act requires that the De-
partment Provide to you a performance plan that will be submitted
with our fiscal year 1999 budget. In addition, the law requires that
we provide you with an accountability report showing the specific
progress made in achieving the various goals and objectives identi-

ied in our strategic plan. We are committed at the Department
level to do this through our Strategic Management Group, which
isa board composed of our most-senior level officials in the Depart-
ment.

Mr. Mascara. Your testimony indicates the VA conducted an ex-
tensive survey of employee views on strategic planning. Can you
outline how this survey was conducted and provide the subcommit-
tee with a copy of the survey and its results and what other ste
has the VA en to involve managers, outside of the Central Of-
fice and the strategic planning process?

(The information follows:)

DEPARTMENT OF VETERANS AFFAIRS,

UNDER SECRETARY FOR HEALTH,
Washington, DC, September 26, 1997.
Hon. FRANK MASCARA,
Subcommittee on Oversight and Investigations, Committee on Veterans’ Affairs,

House of Representatives, Washington,

DEAR CONGRESSMAN Mascara: Thank you for the opportunity to discuss our stra-
tegic in process with you and the other mem! of the Subcommittee on
Oversight and Investigations’ Your comments will help us to continue to improve
the Department of Veterans Affairs’ strategic plan.

As Promised, Tam enclosing a copy of 1997 “One VA” Employee Survey Re-
port, The survey instrument is contained in Appendix A.

‘We are in the process of analyzing data, both at the Departmental level and for
each independent facility to determine priority areas upon which to focus. It is our
intention to link the employee survey results with some of our key GPRA perform-
ance outcome measures, such as customer satisfaction. Overall, we will be able to
use employee data as part of our strategic data base to enhance our ability to im-
prove service to the Nation’s veterans.

We plan to re-administer the survey in late FY 1999 or early FY 2000. Data from
this future survey will help us measure th and | re-examine how well we are

loing in comparison to other Federal agencies private sector organizations.

If you or your staff have questions or need any additional information on the sur-
vey results, please let me know. I look forward to further discussions of how we can
work together in making sure the GPRA process works for the veterans and the

yer.
Sincerely,
DENNIS M. DUFFY.

Mr. DurFy. We would be pleased to provide you with a copy of
the Organizational Assessment Survey instrument and the results


61

between DVA and DoD requires joint planning and implementation of joint procedures for using
the VA medical system as a primary backup to DoD in such emergency situations. Additionally,
DoD and DVA have formed a partnership to perform our respective roles in the National Disaster
Medical System, along with the Public Health Service and the Federal Emergency Management
Agency.

In the immediate future, we hope to be able to expand collaborative medical research
efforts in order to maximize research opportunities and to enhance the research dollars available
to both agencies. Our Defense Manpower Data Center already provides extensive data support to
DVA scientists and analysts working on special projects. Notable in the past year has been the
provision of significant data on personnel who served in the Persian Gulf, in support of
epidemiological studies. Other ad hoc data reports provided to DVA include profiles on women
veterans in support of the National Registry of Women Veterans, and assistance in the
determination of the eligibility and use of education benefits.

In planning for the maintenance of a high-performance workforce, DVA's strategic plan
‘emphasizes that employees are VA’s most valuable asset. DoD shares this emphasis with its
workforce-- full-time, part-time, military and civilian. Both organizations rely heavily in certain
areas on volunteers who dedicate their time and service. A substantial number of our reserve
component healthcare providers and specialists, essential to meeting DoD's wartime medical
requirements, support DVA’s medical care services in their civilian capacity. We believe both

‘agencies benefit from the sharing of these valuable medical personnel. While work with the

DVA ensures that these reserve members have current, well-honed medical skills, their reserve
assignments with DoD expose them to the military system and to the exigencies of wartime or
simulated wartime conditions.

‘Au example of interagency cooperation is the Comprehensive Clinical Evaluation
Program and Persian Gulf Registry to assess the illnesses and health consequences of military
service in the Southwest Asia theater of operations during the Persian Gulf War. Veterans of
active duty service during the period of the war--both active and reserve members--with
undiagnosed illnesses can, depending upon their status and preference, be referred to a DoD or
DVA medical treatment facility for an in-depth, medical examination. Our combined efforts are

intended to ensure that none of the veterans who may be suffering as a direct result of service in

the Persian Gulf will fall through the cracks of our medical support systems.

45-927 98-3


114

threatened to include things in the plans that were contrary to the goals of BPR and detrimental to
the rights of veterans, DAV’s strong objections were heeded, and the draft plans were changed.

The DAV is represented on each of the Management Assistance Councils (MACs) in the 22
Veterans Integrated Service Networks (VISNS) of the Veterans Health Administration (VHA).
The MAC mission is to:

‘facilitate open dialogue and communication among VA Network officials, individual
stakeholders, and stakeholder groups regarding planning efforts and operational
activities of the network

© provide opportunities for stakeholders and stakeholder groups to be involved in
network planning efforis

A survey by the MAC Review Work Group generally received positive responses on questions
related to opportunities for input and VA responsiveness.

‘The DAV participates in the rulemaking process. We pay particular attention to proposed rules
relating to the compensation program. While we believe the VA has become more receptive to
‘our comments on proposed rules, we still believe some of our suggestions are rejected without
adequate justification or even explanation, Also, historically, VA has followed the notice and
comment procedure for most of its rulemaking. More recently, we have seen a disturbing trend
toward invoking exceptions to the notice and comment procedure on matters of importance to
veterans and VSOs. VA now more frequently issues final rules without affording us an
‘opportunity for comment. We would certainly like this recent trend reversed.

Beyond all the formal channels for stakeholder input, the DAV-and various VA officials have

many informal conversations regarding performance and the administration of VA's various
programs. Overall, we would rate the dialogue as good and meaningful.

(e)


ISBN 0-16-056384-4

| ll

9°780160"563843


4

In VA, over one-half of its $40 billion budget is mandatory spend-
ing for entitlements, and the VA im contains objectives for in-
creasing efficiency of its benefits a ministration, and for improving
its outreach to veterans and their families. Program evaluations
could provide a basis for VA to recommend legislative changes, but
in the absence of such changes, VA will proceed on the assumption
that appropriate objectives are satisfied when it complies with the
law as written. For example, evaluations could lead VA to conclude
that the basis for compensation ratings is inadequate to the goal
of linking appropriate compensation to service-connected condi-
tions, but it will continue to rate and compensate service-disabled
veterans under current rules until Congress tells it otherwise.

On the other hand, developing strategic goals for discretionary
programs could require balancing competing objectives. While two
competing objectives may be necessary and defensible, the empha-
sis on one may mean less success on meeting the other.

Substantial time and effort has been expended in the preparation
of the strategic plan, an investment in staff resources partially
shared by your Committee and by your support agencies. I am sure
all of us who participated in the consultative process came away
with a renewed sense, not only of the broad range of functions
within VA, but with the difficulty of creating a unified explanation
of those functions.

Now I turn to my counterparts from GAO for their more specific
evaluation. Thank you.

[The prepared statement of Mr. Snook appears on p. 38.]

Mr. EVERETT. Ms. Fagnoni, if you will continue, thank you.

STATEMENT OF CYNTHIA M. FAGNONI

Ms. FaGNon!. Thank you. Good morning Mr. Chairman and
members of the subcommittee. We are pleased to be here today to
provide our views on VA’s draft strategic plan which is required
under the Government Performance and Results Act of 1993. As
you know, the Results Act was one of the major steps the Congress
has taken in recent years to fundamentally change the way Federal
agencies go about their work. The Results Act requires agencies to
clearly define their missions, set goals, measure performance, and
report on their accomplishments. One of the act’s major milestones,
that Federal agencies submit their strategic plans to the Congress,
is September 30, less than 2 weeks away.

With fiscal year 1996 spending of over $38 billion, VA is respon-
sible for administering laws that provide numerous types of bene-
fits to many of this Nation’s 26 million veterans and their families.
The information I am presenting today will address VA’s progress
in implementing the Results Act. My observations are based on our
review of VA’s June 1997 draft strategic plan and have been up
dated to reflect revisions VA made between June and its latest ver-
sion, dated August 15.

In summary, VA has made significant progress in its strategic
planning, based in part on consultations with the Congress. This
is reflected in the progress VA has made in improving its strategic
plan. VA’s June draft was confusing, because there were numerous
layers of goals, objectives and strategies. Also, it contained signifi-
cant gaps where goals were missing and lacked a clear focus on re-


93

September 18, 1997

Honorable Terry Everett, Chairman
House Veterans’ Affairs Subcommittee on Oversight and Investigations
335 Cannon House Office Building

Washington D.C. 20515

Dear Mr. Chairman:

At your request, we are pleased to submit the following comments for inclusion in the record of
your hearing on the VA Draft Strategic Plan for FY 1998-2008, Our comments are focused on
the Strategic Goals for the Veterans Health Administration with particular emphasis on programs
providing care for spinal cord dysfunction.

(On the whole, the plan spends more time quantifying what care will be provided and where,
rather than setting measurable goals insuring the quality of those health care services and the
applicability of that health care to the needs of the veteran population. The plan sets dollar-
driven goals for cost and patient utilization, citing contemporary managed care techniques, but
sets no other standards for consumer protections (such as those currently being implemented in
Medicare managed care programs) to make certain that veterans get the appropriate care in the
appropriate venue. The managed care formula described in the plan, with its reliance on low-cost
outpatient, primary care services, shunning inpatient and specialty services, seems completely at
odds with VHA’s otherwise stated mission to provide specialized services, such as spinal cord
dysfunction care, as well. The VHA “Vision for Change and Prescription for Change” as well as
Eligibility Reform Legislation, P.L. 104-262 approved by this Committee last year, stated that
meeting these specialized needs of the veteran population was one of the core missions of the VA
health care system, and yet these programs scem little more than an afterthought in the draft plan
in its drive for low cost “white bread” medicine.

The plan references quality assurance measures such as increasing the number of patients who
achieve maximum functional potential, expanding clinical practice guideline production, and

increasing chronic disease index scores and prevention indices, but sets up no process, (none

currently exist, whereby these measures and guidelines would be implemented or monitored

either at the national headquarters level or in the field.

801 Eighteenth Street, NW, Washington, DC 20006-3517
(202} 872-1300 (202) 416-7622 TTY (202) 785-4452 fax www.pva.org


38

The Strategic Plan of the Department of Veterans Affairs as
Required by the Government Performance and Results Act

Presentation Before the Subcommittee on Oversight and Investigations, of the
House Committee on Veterans Affairs

Dennis W. Snook
Specialist, Social Legislation
Education and Public Welfare Division
Congressional Research Service

September 18, 1997

Good morning, Mr. Chairman and Members of the Committee. We at the
Congressional Research Service (CRS) appreciate the invitation to appear before you, as you
consider the strategic plan prepared by the Department of Veterans Affairs (VA). Much of
my understanding of Government Performance and Results Act (GPRA) and its requirements
T owe to CRS colleagues with special knowledge of the Act’s provisions, specifically the
work of Frederick M. Kaiser, and Virginia A. McMurtry, of CRS’s Government Division,
and Genevieve J. Knezo, of our Science Policy Division.’ My brief remarks provide
additional introduction to the concepts and terms that GPRA instructs agencies to use in
responding to the Act’s requirements, and to how those concepts and terms relate to the VA
effort to develop a strategic plan. As required by GPRA, the General Accounting Office
(GAO) has prepared a formal evaluation of the VA plan, and my counterpart from GAO will
present that evaluation.

The Government Performance and Results Act and the Ideal of a Fully
Rational Federal Government

Mr. Chairman, GPRA envisions a rational government with measured effects. In order
to achieve such an ideal, the Act requires that the Executive Branch describe itself in terms
of the effectiveness of its efforts as well as provide a detailed account of what it does.
Through this coherent and comprehensive look at the interrelated aspects of federal
functions, GPRA encourages more efficient operations “...by providing [Congress] more
objective information on achieving statutory objectives, and on the relative effectiveness and
efficiency of Federal programs and spending” (107 Stat. 285).

‘The responsibilities of the national government and the problems and challenges it faces
are many and diverse, and such a government-wide plan responds to the difficulties inherent
in efforts by congressional overseers to understand the practices and applications of federal
authority across the spectrum of government operations. GPRA set in motion a process by
which such a plan could be produced: the Act established a series of steps and a timetable
to produce an accounting of government functions from the bottom up, and it requires that

* Of special note are CRS Reports, Government Performance and Results Act: Implications for
Congressional Oversight, 97-382 GOV, by Frederick M. Kaiser and Virginia A. McMurtry, May
12, 1997; and Government Performance and Results Act, P.L. 103-62 Implementation Through Fall
1996 and Issues for the 105% Congress, 97-382 SPR, by Genevieve J. Knezo, December 24, 1996.


100

CRS Congressional Research Service + Library of Congress + Washington, D.C. 20540

Memorandum November 4, 1997

TO House Committee on Veterans Affairs;
Honorable Lane Evans, Ranking Democratic Member
Attention: Debbie Smith

FROM __ : Dennis Snook
Specialist, Social Legislati
Education and Public Welfare Division

SUBJECT : Responses to Questions Submitted for the Record

‘You have asked for responses to four questions regarding the topic covered by a hearing
before the Subcommittee on Oversight and Investigations of the House Committee on
Veterans Affairs on September 18, 1997. The topic of the hearing was the strategic plan that
the Department of Veterans Affairs (VA) submitted in compliance with the Government
Performance and Results Act (GPRA). This memorandum was prepared in response to your
request

Question 1. Ona scale of 1 t0 10, how would you assess the VA's strategic planning efforts
to date? Please explain the basis for your answer, and summarize the areas where
significant improvements are needed. if any, in the short term.

‘The Act requires the General Accounting Office (GAO) and the Office of Management
and Budget (OMB), to provide formal evaluations of agency strategic plans, and those
agencies have assessed the VA plan. GAO found that the VA plan was incomplete, especially
with respect to identifying goals and objectives, and measurements of the efforts to achieve
them. OMB agreed with GAO's assessment, and identified specific improvements that were
needed. Because the Act assigned evaluative tasking to these other agencies, the
Congressional Research Service (CRS) did not develop a method for grading and comparing
various plans on merit, and thus we have not assigned a relative score to the VA strategic
plan

Further, given the size and complexity of VA, and the requirement to produce, within
4 specified period of time, a comprehensive strategic plan covering the range of VA
‘operations, it would be surprising if any plan could match a criteria of success developed from
an abstract ideal. A coherent plan requires coordinating goals and objectives understood from
different vantage points. In VA, assimilating these different vantage points required that the
planning staff gain additional familiarity with ongoing practices of all VA divisions and their
diverse responsibilities. Vertical communication problems abound in such situations, and
attempts at defining broad goals that could guide the formulation of measurable objectives



41

CRS-4

Conclusion

Achieving the GPRA objective of rational, results-linked government program
operations will take time, and VA’s difficulty in bringing about a complete and balanced plan
at this time is not surprising. In part, this difficulty resides within GPRA, which does not
fully distinguish between performance linked to mandatory program operations, and
performance in which the agency is permitted considerable discretion in the pursuit of goals
outlined and authorized by Congress.

In VA, over one-half of its $40 billion budget is mandatory spending for entitlements,
and the VA plan contains objectives for increasing efficiency of its benefits administration,
and for improving its outreach to veterans and their families. In addition, regularly scheduled
program evaluations could provide a basis for VA to recommend legislative changes, but in
the absence of such changes VA will proceed on the assumption that appropriate objectives
are satisfied when it complies with the law as written. For example, evaluations could lead
VA to conclude that the basis for compensation ratings is inadequate to the goal of linking
appropriate compensation to service-connected conditions, but it will continue to rate and
compensate service-disabled veterans under current rules until Congress tells it otherwise.

On the other hand, developing strategic goals for discretionary programs could require
balancing competing objectives. While two competing objectives may be necessary and
defensible, the emphasis on one may mean less success in meeting the other. For instance,
the primary VA discretionary program is medical care, and an ongoing issue concems
whether localized special programs can be made more effective; but would that objective
interfere with the long-term goal of equitable access to basic medical care for all eligible
veterans? Strategic plans could identify where these tradeoffs may be required; VA's plan
does not.

‘Substantial time and effort has been expended in the preparation of VA’s strategic plan,
an investment in staff resources partially shared by your Committee and by your support
agencies. | am sure that all of us who participated in the consultative sessions came away
with a renewed sense, not only of the broad range of functions within VA, but with the
difficulty of creating a unified explanation of those functions, together with an outline for
examining their results. And of course, all participants also understood that we were not
simply assisting in an explanation of the details of VA programs to scholars of public
administration, but in an evolving document by which this important federal responsibility
could be more efficiently managed as it shifts to meet the changing needs of the nation’s
veterans.

Thank you.