Updating veteran customer experiences in healthcare

ARTICLE | December 12, 2023

On the front lines of customer service in government

From siloed and clunky websites to a streamlined portal with a robust mobile app, the VA became an agency that helps more veterans

By Melanie Warner, Workflow contributor


The first time John Boerstler filed a medical claim as a veteran, he spent several hours at a Veterans Administration (VA) regional office in Houston filling out forms and talking with a service rep. The rep said she would need to send medical records requests to the military and to Boerstler’s previous health insurer. This would take time, she warned.

She wasn’t kidding. Boerstler, a former Marine, didn’t hear back about his claim for almost a year after he filed it in 2009. It was the kind of slow, complicated, paper-based experience many Americans have come to view as a frustratingly normal part of dealing with government services.

Today, Boerstler, who is now the VA’s chief veterans experience officer, has a very different story to tell. Earlier this year, he says he spent less than 15 minutes on VA.gov filing a claim for his chronic sinusitis and rhinitis, caused by the use of burn pits on the base where he was stationed in Iraq. “I was able to push a button and send the PDF forms to the healthcare system, where my claim automatically showed up in the queue for the veteran service representative,” he says. This time, the whole process took a couple months. “Nobody knew who I was. I’m just another veteran applying for sinusitis and rhinitis.”

Boerstler’s experiences offer a glimpse into how the VA’s interactions with the 9 million veterans it serves have changed in recent years. In 2014, a scandal involving medical appointment wait times rocked the VA. Investigations found that veterans were enduring long waits to see doctors, some dying in the process and leading to the resignation of Eric Shinseki, the VA chief at the time. A few years later, when the agency asked veterans about the overall experience it was providing, the results were not encouraging. In 2016, only 55% said they trusted the VA, according to Boerstler. Now, that trust score sits at 79%, putting it in company with leading consumer brands like Starbucks, USAA, and Warby Parker. The proportion of vets who report positive experiences specifically with VA healthcare is even higher: 90%.

How did things change so dramatically for an immense organization of 9 million “customers” and 400,000 employees? Following the wait-time scandal, the Government Accountability Office took the VA to task for failing to provide timely care to patients and for its lumbering, inefficient processes like the ones Boerstler experienced. Taken as a mandate, the agency vowed to modernize systems, simplify operations, and rebuild trust among veterans—in other words, become “the No. 1 customer-service agency in government,” as VA head Robert McDonald put it to Congress in 2016.

Achieving it hasn’t been easy. Boerstler, who joined the VA in early 2021, credits previous leaders with taking the long view. “Early on, they realized customer experience wasn’t going to be a quick fix. It was something that had to be hard-wired into an organization,” he says. He attributes the VA’s success to a combination of a human-centered design and “massive investments” in training, organizational change, new technologies, digital transformation, and systems for continuous feedback.

 

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Credit the VA’s public sector win to private sector leadership. To figure out how exactly the VA needed to be improved, McDonald, the former Procter & Gamble CEO whom President Barack Obama chose to run the agency in 2014, used skills honed during his three decades in the consumer goods industry—including a zeal for market research and customer feedback. He visited dozens of medical facilities across the country to talk to thousands of employees, providers, and veterans in small group sessions, asking what was getting in the way of a great veteran experience.

Some of the answers were surprisingly simple. For instance, McDonald and his teams heard there was often nowhere to park at VA facilities, and no one to help veterans out of their cars if needed or to guide them through old, circuitous buildings that are often difficult to navigate. This feedback prompted the development of the Red Coat Ambassador program, now an immensely popular concierge service that greets veterans at all VA healthcare facilities and helps them find whatever they need.

The effort has put the VA ahead of other federal agencies, where initiatives are underway to slough off old stereotypes about bureaucratic inefficiencies.

“An executive director or chief of staff at a VA Medical Center would have never gotten this kind of insight from an operational dashboard. That’s why the one-on-one interviews with veterans are so important,” says Boerstler.

McDonald’s listening tours helped establish human-centered design as the foundation for great customer experience. Today, Boerstler says the VA “measures everything under the sun” and has a direct line to veterans through open-ended text-based surveys. These messages not only provide customer experience data, but also identify when a vet may be at risk of suicide, homelessness, or food insecurity. By zeroing in on certain words and topic clusters, AI-based programs identify responses to send for review by VA staff, who then forward actionable cases to the Veterans Crisis Line and National Call Center for Homeless Veterans. These services reach out to the veteran within 24 hours.

“From early on, we were looking at it from a customer perspective: from outside in, instead of inside out. That was a key piece,” says Lee Becker, the former chief of staff for the Veterans Experience Office from 2016 to 2020 and now a senior vice president at Medallia. Prior to the 2014 wait-time crisis, 95% of what the VA measured focused on aspects of operations and finance that had nothing to do with customers

In the mid-2010s, it wasn’t hard to see why veterans found so many of their interactions with the VA exasperating. If they needed to access healthcare services, they had to go to one website. There was a different one for disability benefits. Yet another website helped them apply for education benefits. The VA’s digital platforms were spread across multiple sites, with a total of hundreds of portals and pages across the agency, many of them disconnected. Employees who worked in one business line had limited tools for sharing data with those in other areas, requiring veterans to submit the same information to different areas of the VA to accomplish seemingly simple tasks like updating their mailing address when they moved.

“You don’t want your customer to have to learn your org chart, especially in a 400,000-person organization,” says Charles Worthington, who joined the VA as its CTO in 2017. “The magic trick with technology is to try and make that invisible to the customer.”
 

Tech leaders didn’t have the resources to rebuild everything all at once, so they worked to knit together legacy software systems and to integrate more than 200 databases. “You can almost think of it as Kaiser merged with State Farm merged with B of A in one giant entity. Making all those systems, all with built-up legacy software, talk to each other was quite complex,” recalls Worthington. Tech teams are now focusing on replacing those old systems with cloud-based software and a model of continuous improvement.

 

The updated VA.gov portal resulted in a 221% jump in monthly users.

Many of the processes VA staffers use in their work had to be digitized and automated—from medical notes and records scribbled on paper to the claims appeal process, which included hearings captured on cassette tapes.

On the front end, the VA launched its first unified and cohesive portal, VA.gov, in 2016, giving veterans one place to go to access digital government services and information. A redesign in 2018 helped make the site even more customer-centric, resulting in a significant bump to its customer satisfaction score and a more than doubling of monthly total users. Similar positive user responses have also been logged for the VA’s mobile app, the one Boerstler used to file his burn pit claim. Launched last year, it has 2 million active users.

Reaching these milestones required extraordinary efforts. Customer experience staffers fanned out across the country and online, talking to roughly 500 veterans and asking what they wanted to be able to do on VA.gov. Hiring for roles like customer experience designers and data scientists took years because these job classifications didn’t exist at the VA. In the interim, tech leaders found talent by partnering with innovation labs and programs across the government. IT teams also had to learn to adopt a new mindset. Instead of working on finite projects with a beginning, middle, and end, they were now responsible for products that would be continuously improved and updated.

Even after nearly a decade of careful listening and the implementation of hundreds, if not thousands, of changes, the VA still has a list of customer experience to-dos. “Customer acquisition,” for instance, is still a pain point. One woman in Virginia, for example, cared for her disabled husband for years without realizing he had VA benefits. After learning of them through a virtual one-on-one meeting with a VA rep, the caregiver called the interaction “life-changing,” since she was able to significantly cut back on the two jobs she’d been working to pay for their family’s health insurance. But such efforts to reach veterans, their families, and members of the military who are transitioning to civilian life haven’t gone far enough, Boerstler says. Currently, only half of new veterans access VA services. “We’ve been waiting for veterans to come to us rather than going to meet them where they are,” he says.


Overall, the effort has put the VA ahead of other federal agencies, where initiatives are underway to slough off old stereotypes about bureaucratic inefficiencies and improve public trust. An executive order issued by President Joe Biden in 2021 forced nearly 35 federal agencies to reevaluate how they interact with citizens. Aimed at rebuilding trust in government, the order mandates a reduction in administrative hurdles and paperwork, the enhancement of transparency, and a boost to efficiency. “Federal services have not always been designed with the public’s needs and priorities in mind, nor have these services always kept up with these needs,” notes the government website devoted to the effort. “Poorly designed, out of date, and inequitable government services are a cost to our Nation.”

“The magic trick with technology is to try and make it invisible to the customer.”

Perhaps no one is waxing poetic about interacting with the IRS, Health and Human Services, or a passport office today. But thinking back to his 2009 experience filing a VA claim, Boerstler concludes that if one of the federal government’s largest and fastest-growing agencies can turn itself around, anything is possible.

Why building trust counts

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Author

mark yeow headshot

Mark Yeow's first foray into the world of journalism and content was in high school, writing articles about antique furniture that he patched together between studying and video games. Since then he's written about everything from environmental science to wireless technology to trends in global trade, alongside citizen video journalism for social impact causes around Southeast Asia. Raised in Australia, he currently resides in his birthplace of Singapore but struggles to say which is truly home.

Melanie Warner is a writer and editor based in Boulder, CO. A former staffer at Fortune and the New York Times, she is the author of Pandora's Lunchbox: How Processed Food Took over the American Meal, and The Magic Feather Effect: The Science of Alternative Medicine and the Surprising Power of Belief

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