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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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.

GAO noted that: (1) even with its scaled-back plan, SSA has been unable to keep its redesign activities on schedule and to demonstrate that its proposed changes will significantly improve the claims process; (2) the inability to keep on schedule was caused, in part, by SSA's overly ambitious plan and its strategy for testing proposed changes; (3) other problems with the design of its tests weakened SSA's ability to predict how the initiatives would operate if implemented; (4) the problems that led to SSA's redesign effort persist, and as SSA continues its efforts to improve the disability claims process the agency has an opportunity to learn from its experience and the best practices of other organizations with reengineering experience; (5) SSA could improve its chances of making future progress by further scaling back its near-term efforts to include only initiatives that are critical to improving the disability claims process; (6) in addition, by testing related process changes together, rather than on a stand-alone basis, and at a smaller number of sites, SSA could free up resources while still obtaining valuable data; (7) SSA should also explore feasible alternatives before committing significant resources toward the testing of specific initiatives; (8) because a process change might function differently under actual operational conditions than it did in a test environment, SSA will need to revise its performance measures to better monitor and more fully assess the impact of changes on the process; and (9) moreover, SSA will need to ensure that an adequate quality assurance process is in place so that any changes SSA makes to the process do not compromise the quality of decisions.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Not Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: 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).

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: 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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