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SSA Disability Redesign: Actions Needed to Enhance Future Progress

HEHS-99-25 Published: Mar 12, 1999. Publicly Released: Mar 12, 1999.
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Highlights

Pursuant to a congressional request, GAO: (1) reviewed the Social Security Administration's (SSA) efforts to redesign its disability claims process; and (2) identified actions that SSA could take to better ensure future progress.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Social Security Administration As SSA proceeds with further exploration and testing of redesign initiatives and considers implementation options, it should further focus resources on those initiatives, such as process unification, quality assurance, and computer support systems, that offer the greatest potential for achieving SSA's most critical redesign objectives.
Closed – Implemented
While SSA continues to manage redesign initiatives not related to process unification, quality assurance (QA), and computer support systems, it has increased its focus in these three areas. In addition to pursuing process unification as part of normal business, SSA is studying enhancement of disability decision explanations as part of its prototype initiative. Also consistent with process unification, SSA has begun efforts to enhance its disability program training for claims representatives, disability examiners and medical consultants (included in its 2002 performance plan). With respect to computer support systems, SSA's 2002 performance plan includes new indicators to track progress regarding electronic processing of disability claims at both the initial and hearing levels. While progress in developing and implementing the information technology initiatives required to support the hearing process improvement effort has been slow, SSA tested the electronic disability system (eDib) in Delaware, and plans to begin testing it in Texas in mid-August 2001. Regarding quality assurance, SSA has formed a work group to consider next steps after the publication of a March 2001 study, in which a contractor recommended that SSA adopt a broad, modern view of quality management and pursue efforts outside of its current QA process.
Social Security Administration As SSA proceeds with further exploration and testing of redesign initiatives and considers implementation options, it should test promising concepts at a few sites in an integrated fashion.
Closed – Implemented
In March 1999, SSA decided to test a number of changes to its disability claims process (single decision maker, expanded rationales, claimant conference, elimination of reconsideration, and hearing office improvements) in a single prototype in 10 states involving up to 20 percent of the workload. In three states, the prototype also includes the disability claims manager position. SSA expects to complete the prototype in December 2001. While this test integrates features heretofore tested in a stand-alone fashion or not at all (which is consistent with GAO's recommendation), it is a large test and involves 10 states in 10 regions (which is inconsistent with the recommendation).
Social Security Administration As SSA proceeds with further exploration and testing redesign initiatives and considers implementation options, it should establish key supports and explore feasible alternatives before committing significant resources toward the testing of specific initiatives, such as the disability claims manager.
Closed – Not Implemented
SSA proceeded with a large-scale test of the DCM in late 1999, without having begun any specific effort to explore feasible alternatives. In addition, SSA had not established key supports (e.g., computer systems) prior to late 1999. As of September 2000, SSA expected to complete phase II of the DCM test on June 30, 2001, without any computer supports originally envisioned.
Social Security Administration As SSA proceeds with further exploration and testing of redesign initiatives and considers implementation options, it should develop a comprehensive set of performance goals and measures to assess and monitor changes in the disability claims process.
Closed – Implemented
In its report, GAO criticized SSA for having separate performance measures (but not an overall measure) for disability claims processing times at the initial and appeal levels. As such, SSA cannot determine whether (1) reducing processing time at the initial level causes an increase in appeals and thus an increase in overall processing time, and (2) increasing processing time at the initial level causes a decrease in appeals and thus decreases overall processing time. In its recently issued Strategic Plan, SSA addressed GAO's recommendation in two ways. First, SSA added a new strategic objective, "Make the right decision in the disability process as early as possible." Second, to support this new objective, SSA added a new outcome measure, "Reduce significantly the time it takes for a disability claimant to receive a final Agency decision." By measuring the time to issue a final Agency decision, SSA is measuring processing time for adjudicating claims that combines the processing times of both the initial and hearing levels.
Social Security Administration As SSA proceeds with further exploration and testing of redesign initiatives and considers implementation options, it should ensure that quality assurance processes are in place that both monitor and promote the quality of disability decisions.
Closed – Implemented
The Social Security Administration (SSA) made significant progress in its ongoing efforts to improve its quality assurance process. For example, SSA created a new office of Quality Management in January 2003, and a workgroup looking at quality assurance as it pertains to disability claims processing in May 2003. The workgroup identified activities to make quality more visible, including initiating a quality site on SSA's intranet. It also took steps to integrate quality into SSA's processes & policies by including one of its members on other workgroups in the agency. The workgroup is currently working on a quantifiable definition for quality, and is identifying systematic changes for incorporating quality into its processes, including into its planned electronic claims folder. SSA also let a contract to Booze-Hamilton to develop additional recommendations for improving SSA's quality assurance system. The contractor's report is expected in October 2003.

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Topics

Best practicesClaims processingDisability benefitsEligibility determinationsManagement reengineeringPerformance measuresSocial security benefitsSupplemental security incomeQuality assuranceAppeals