Wednesday May 29, 2002
MR. LAWRENCE: Welcome to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers, and the co-chair of The Endowment for The Business of Government. We created The Endowment in 1998 to encourage discussion and research into new approaches in improving government effectiveness. Find out more about The Endowment by visiting us on the web at endowment.pwcglobal.com.
The Business of Government Hour features a conversation about management with a government executive who's changing the way government does business. Our conversation this morning is with Ken Nibali, Associate Commissioner for Disability in the
Social Security Administration.
Good morning, Ken.
MR. NIBALI: Good morning.
MR. LAWRENCE: And joining us in our conversation is another PwC partner, John Lainhart.
Good morning, John.
MR. LAINHART: Good morning, Paul.
MR. LAWRENCE: Well, Ken, let's start with let's SSA and the Office of Disability. Could you describe its functions for us, please?
MR. NIBALI: Certainly. I'd be happy to. First of all, I'm very glad for the opportunity to come and talk with you all and appreciate you putting on this kind of information sharing. The Social Security Administration, Social Security programs to, probably, most people tend to be about retirement or survivor's benefits. But what I'm particularly involved in is the disability program.
And many folks don't realize that those FICA taxes that everyone gets taken out of their paycheck each month actually covers the disability program as well. And while most of our benefits go toward retirement and survivors, we really do have a fair portion go to people on disability, overseeing that process in terms of writing all the policies and working with Congress on law and regulation changes.
I also specifically oversee about a $1.6 billion budget. For a major part of the program, interestingly enough, is actually run by the states. We fully fund a portion of state government employees to make a lot of disability decisions when people first file for it. And, then, of course, from there, we're also just involved in maintaining data and information to help run the program in
many different ways.
MR. LAWRENCE: How many people are served by the Office of Disability?
MR. NIBALI: Well, it's not an easy, direct question to answer. The Disability Program really serves everybody in the country. So we're talking several hundred million people. We have a little over 2 million people every year who come in to file for disability claims in this country. And probably about half of them end up on the rolls. Right now, the Disability Program pays out about $80 billion in benefits every year. That's an amount of money that generally catches people's attention. And it probably is doubled when you count the medical coverage that entitlement to disability benefits also covers people for. So you add Medicare and Medicaid kind of coverage
in there, and we're spending well over $100 billion on individuals. There's about 12 million people that are on the disability rolls in the country right now. Just for context, there's probably about 1 of every 20 or 5 percent of the population in this country that would be eligible is on the disability rolls.
MR. LAWRENCE: How many people are employed by the Office of Disability to administer this. I imagine there's hundreds and thousands of people doing all this work.
MR. NIBALI: I wish you would tell Congress so we can budget it like that. The Office of Disability specifically, I only have about 250 employees to write policies, to oversee the operation, to maintain data. A fair number of those employees, we actually run our own claims operations right in Social Security headquarters, which many folks might not realize is in Baltimore, Maryland, versus Washington, D.C., where most agencies are headquartered. So, we have an operation here to actually do some claims to help out.
But, the program, broadly, is really run by, actually, many of the thousands of employees in Social Security that -- most people know the Social Security by the field office, or their local district office, is what we call them. They're in almost every community around this country. And that's where people can either walk in or they can call our 800 number service. And then, the initial part of the process, when you file a claim, as I said, is actually carried out by about 14,000 state employees that we fully fund. And they, you know, follow our directions and our instructions and our regulations. But they're actually state employees that are making those decisions.
And, then, actually, many hundreds, if not thousands of employees, are involved beyond that as individuals can appeal, because some people are denied when they first apply. And, then, there's an appeals process, et cetera. So to put it in context, SSA is about 60- or 70,000 people nationwide. You put another 14,000 state employees on top of that, two-thirds of those resources actually go for running the disability program. Even though the retirement and survivor's programs are much larger, the Disability Program is a tough program to run. It's got a lot of decision-making
data-gathering that has to go on. So it's interesting that people don't realize that actually
two-thirds of the resources, and, probably, management attention and problems, are in the Disability Program.
MR. LAINHART: Ken, as the Associate Commissioner for Disability, what are your specific responsibilities?
MR. NIBALI: Well, pretty much, it's to oversee all the things I was just speaking of in terms of staying on top of policy and making sure that that's up to date, managing that rather large budget over the state agencies. When you think about how the program is run and all the different people that are involved in it, the management challenge is really one of coordination and communication. When two-thirds of the agency's resources are involved in running the program, you can't just hold one person accountable over here and lots of other high-level people, you know, say that they don't have anything to do with the program.
The fact is that almost every high-level executive in SSA has something to do with disability. And, so, communications within the organization is a major, major challenge. You have to try to help everybody keep going in the same direction. And, then, you throw that federal/state relationship in, which is a pretty unique kind of thing to run a program. I do a lot of traveling, put it that way, to states and regions.
MR. LAINHART: Well, tell us something about your career at SSA; where and when you started, and then how you got to join the Office of Disability.
MR. NIBALI: Well, probably many of us at points in our career sit back and wonder just how we got to where we are now. But I started with the Social Security Administration back in
the early �70s. I was actually in private industry for several years, right out of college. My father actually worked with the Social Security Administration. The organization sort of has a family culture in many ways.
And I will tell you, being a child of the '60s, the last place I wanted to work was a place my father worked. And so I went in private industry a couple of years. But then, interestingly enough, I got an offer from the Social Security Administration to come in, in those days, what was called a Management Intern Program, where you literally could come into an organization and you had 2 years to move around from job to job, try things out, see if you liked the organization, where you liked it. And, then, you would settle down into a job. So, I figured I'd try it. And if I didn't like it, I'd be gone. And if I liked it, then that's a good way to get introduced. So, here 31 years later, I sit.
But I actually started in the field of, more or less, human resources, personnel. It was actually the Equal Employment Opportunity Staff. That was just something that was very interesting to me at the time, and I spent probably a good close to a third of my first part of my career really learning all about that, and hopefully contributing. SSA has a strong emphasis on diversity. We serve everybody in the country. We need to be, as an organization, capable of serving them that way. So equal opportunity was a very big factor. I guess the second third of my career, I moved into workforce analysis. It was an analytic kind of work about how SSA gets its jobs done and where we put our resources and, you know, what's the most effective use of things. And that got me very
interested in what SSA is really all about.
And, then, roughly, the last third, since about '94 or so, is when I moved into the disability arena. And it's a challenge. It's one of the most difficult programs I've seen. It's generally acknowledged that retirement or survivors questions are pretty straightforward. You work a certain number of years, you're of certain age. As long as you can tell us that, we calculate your benefits.
But disability is a little tougher. It's, you know, are you able to work anymore? I mean, not just what job you have right now, but really, any other job that exists in the economy. And the challenges of that just attracted me for some reason. So I've spent the last 8 or 9 years there. And along the way, I went to law school and became a lawyer, which was very, very helpful, particularly in the disability field, because we deal with an awful lot of lawyers. And that
was very helpful to me as well. So, that's more or less a thumbnail sketch of how I got here.
MR. LAWRENCE: You describe the program as large and complex. I'm curious, what of your jobs or experience best prepared you for your present position?
MR. NIBALI: Certainly, going to law school helped a great deal. But also, I think the analysis that I was involved in was very, very helpful. When you get to the level of running a program like the Disability Program and trying to understand what works and what doesn't work and convince other people in the organization about what needs to be done and how to go about certain things, a good analytical approach absolutely is essential. And, SSA, as an organization, is a very caring organization and people really want to do their very best for the folks that we serve.
So, I also have to say my early days in the more personnel-related kinds of areas was very important to me. I have to say I specifically sought that out. That was probably
one of the bigger challenges to me. I was a math and economics major in high school and went to law school. And the analysis stuff came a little easier than really learning how to work with people and understand them as individuals, and all the things that a manager has to do when they eventually really are dealing with a number of very good and talented people. But also, as you know, they're also every one of them is unique. They each bring something different to a job. And the more skills you can bring in that area really make a difference.
MR. LAWRENCE: That's a good stopping point. Rejoin us after the break, as we continue our conversation about management with Ken Nibali of the Social Security
How is technology changing SSA? We'll ask Ken when The Business of Government Hour returns.
MR. LAWRENCE: Welcome back to The Business of Government Hour. I'm Paul Lawrence, a partner of PricewaterhouseCoopers. And today's conversation is with Ken Nibali,
Associate Commissioner for Disability in the Social SecurityAdministration.
And joining us in our conversation is another PwC partner, John Lainhart.
Well, Ken, you said something very interesting in the first segment when you described that
approximately 5 percent of our population is on disability. And, I'm curious, is that a large number or a small number? And how do we fare with, say, the rest of the world?
MR. NIBALI: Sure. Whether you consider it small or large obviously depends on where you're coming from. One of the interesting aspects of the job is to deal with lots of advocate organizations, people who really look for people with disabilities, et cetera. And as you can imagine, their pressures are generally are there that there are a lot more people who should be on the rolls in disability. The truth is the standard in this country is really a very tough one. It's, as I said earlier, not that you just can't do your past job, but really you are unable to do any job that exists in the our economy. That is not a standard that many other countries use.
And, therefore, you find, when you look around, that this country's program compares pretty favorably if you're doing it in terms of the percentage of people on the rolls. There are a number of European countries that are closer to 10 or even 15 percent of eligible population on disability benefits, because their definition is a little easier. Maybe it's just that you can't do your past job or whatever.
And, of course, they have different programs anyway, with sort of national health insurance and they all roll together. But I suspect many of you also know that there's higher taxes in many of those countries to support those kinds of programs. So this country, from the word go, when Social Security started, it did not include disability. When it started in the mid-�30s, it wasn't until 1954 that really started a disability program. And it was for the very reason of being concerned about what percentage is it. Is it 5 percent? You know, maybe, you live with that. But people were very concerned about it getting much higher.
Every once in a while, Congress will come along and, you know, do something with the regulations and laws to maybe tighten up here or add benefits there. But it's been pretty much in that range for a couple of years now. The concern, of course, is we're now facing the major part of this country's population, the baby boomers, hitting the what we know are the disability prone years, which is around age 50. That's when people really start applying for disability. So keep an eye on that, and you'll see Congress starting to probably deal with issues in relation to disability.
MR. LAINHART: Ken, the SSA has expressed a commitment to continually improving service to our nation's citizens. How are you using innovative solutions in the Office of Disability to achieve this goal?
MR. NIBALI: Well, we take advantage of absolutely anything we can find along the way. Running the program is a challenge. We deal with 50 states running much of it. It's kind of a constant challenge to do it. One of the things I'd like the audience and the American public to know is we are jealous about the fact that when we put people on the disability rolls, we like to make sure that they still belong there and that we periodically review them. They are called continuing disability reviews. And depending of the nature of your impairment, and some other factors, we may review you every year, every 3 years or every 7 years; something like that.
So, the issue is, that's a pretty expensive process. We have to go out and write to people, call them back into the office, get updated medical information and make sure that their medical condition still exists and that they are still unable to work. In fact, it's so time-consuming and expensive that back in the early '90s, we got totally away from doing it, and we built up a tremendous backlog., because we felt the right thing to do was to put what were some stretches of our resources at the time on deciding new people. There were still several million people a year coming through the door. And it was important to find out if they belonged on the rolls or not. And we simply didn't have the resources to keep up with looking at the folks on the rolls.
Several things happened. Congress got very helpful for us with the Office of Management and Budget with Congress, actually gave us exceptions to some of the caps on federal spending. And what they said is, we will give you dollars to do these reviews, because we believe that when you do them, some people will come off the rolls. And the amounts that we save in those benefits will at least offset what's spent. Has absolutely happened. Something like a 10 to 1 ratio. Okay? And for the American taxpayer, I think that's very important in the stewardship of the program.
The second thing we did is say, you know, we've doing a lot of reviews on people over the years and we've learned something. And we can learn something from experience to say if we look at the types of people who are on the rolls, how long they've been there, whether they've had a prior review or not, we ought to be able to predict whether or not they are going to come off the rolls if we reviewed them again. And so we did that. And we called it profiling. And we looked at the characteristics, as I said, of a number of people, and we came up with a pretty good predictive model about a number a years, go back in the mid-90s or so, that would tell us that this group of people, really, we should call them in and do a full medical review of them, et cetera.
But, another group of people, the likelihood of them coming off the rolls is so low that all we're going to do is send them what we call a mailer. We send them about a six- or eight-page -- six or eight questions, really, one page, form. And they answer questions like, are you back to work, has your doctor told you you can go back to work? You know, have you medically improved? And as long as they answer no to those questions, you know, under penalty of signature, and our data tells us that with their impairment and history they don't really have much of a likelihood of coming back on the rolls, that counts as doing one of our reviews. And we're now up to doing about half of the reviews that we have to do every year that way.
Now, where Pricewaterhouse has really come in to help us is, we knew that we had to update and improve that profiling. And they came in and were extremely helpful in taking more current data than we had taken many years ago and not only updated what we had done, but also greatly improved by the way you compare things and the kind of characteristics that are included. And, now, we're reaching out to some other agencies, like, CMS. For some of you, that will be HCFA, the Health Care Finance Administration. And we're sharing some data with them. We're really finding that we're really improving that process. So, not only is it more efficient and enables us to keep up and to keep just the people on the rolls who belong there, but it's also a lot more humane for the people involved.
You know, if you're somebody who is obviously disabled and aren't going to improve -- let me use the example of the quadriplegic. They almost always, obviously, meet our definition of disability, and that's not likely something that you will improve from. So, therefore, why would we have you come in every 3 or 7 years to prove you're in the same position. If we know that, we'll let you just certify to that's the way you are. And you don't have to come in and be exposed to another doctor's review, et cetera. We're very pleased with that, and really very pleased with the sort of government/private sector partnership that we've had; not just with PricewaterhouseCoopers, although you're one of our shining examples, I will say that, but with a number of others who have come and helped work on issues like this.
MR. LAWRENCE: The Office of Disability has been working on a number of initiatives to streamline the process of applying for and getting disability benefits. Could you describe some of these efforts for us?
MR. NIBALI: Yes, I can. And this will be a lesson learned kind of description here. Back in the early '90s, the agency engaged in what probably a number of organizations were doing. And that was re-engineering. And, you know, automation was really hitting its stride. And people were saying, gee, where are we going to be able to improve our processes and change them? And we came up with some pretty, for us in the program, bold and innovative kinds of changes. In some ways, they were perhaps a bit more dreams and hopes than reality, but we wanted to really try to improve the process for the public as well as the taxpayers.
The truth is that over really many more years than we would like, we've kind of piloted and tested and prototyped many different angles of these things. The Commissioner who came in, JoAnne Barnhardt, our current Commissioner, made some very good decisions about let's stop, you know, testing and piloting and let's move on with what we've learned here. So, we are doing some things.
For example, one of the things we tried to do, which quite honestly, we are not going to end up doing, is we tried to drop a step in the process. I've mentioned several times that when you first file, you get an initial decision by individuals from the state agency. Well, the second step is if you don't like that decision, which generally means you weren't allowed, you can appeal. And that state agency makes a second decision, called a reconsideration. Then if you're still denied, you can appeal to an administrative law judge. If you're still denied, you can appeal to our Appeals Counsel. And if you're still denied, you can go into district court and on up the line. A lot of steps. We talked about streamlining that. So we tried it in 10 states in this country, with about 25 percent of the people covered by those 10 states. We dropped that second step. If you got denied by that state agency initially, you didn't go to a reconsideration if you appealed. You went right into the administrative law judge step.
What our test showed us is that moved people along faster. It gave pretty good service. What we did is we told the state agencies instead of taking your resources and making two decisions, an initial and a reconsideration, put them into one really good initial decision. And that turned out pretty well. They did a better job of developing information, and more people were properly allowed early in the process great service. What we couldn't live with is by not having that second step in there, it meant a significantly greater number of people had to appeal on to the administrative law judge step, which is a much more time-consuming, much more expensive step and simply wasn't good service to people. So, the commissioners kind of called a stop to that. But, we're going to continue the pilots in a few states until we came up with an alternative. But, now, we're looking for an alternative to that process.
My point is, we are kind of constantly testing things. But the Disability Program has grown, very large, number 1. But, also, very much through a lot of tensions between, you know, the administration, the Congresses, the courts, the advocates. And there's a lot of reasons why the process is as it is. And making changes to any of it is kind of one of those things where you push in here and it pops out over here. So, we're making some changes and improvements, but it's probably slower than any of us would like.
MR. LAWRENCE: Well, it's a good stopping point because it's time for a break. Come back with us after the break as we continue our conversation with Ken Nibali of the Social Security Administration.
SSA consistently receives high marks for customer service. How have they done this? We'll ask Ken when The Business of Government Hour returns. (Intermission)
MR. LAWRENCE: Welcome back to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers. And today's conversation is with Ken Nibali, Associate Commissioner for Disability with the Social Security Administration.
And joining us in our conversation is another PwC partner, John Lainhart.
MR. LAINHART: Ken, SSA consistently ranks very high among federal agencies for its customer service. What do you think has been SSA's major success factor for this?
MR. NIBALI: I think the reasons are fairly straightforward. First and foremost, we're simply a service-oriented organization. We're there to help people, pay benefits and help them in what are pretty vulnerable times in their lives. And that obviously engenders, rightfully so, I think, a good reaction to what we're about.
Secondly, we're located in every community in this country. I think to many, many people, we are the federal government. And the Post Office is probably out there a little more than we are, in terms of actually dealings and services being provided, where people would look to the government. I think, generally, SSA is very much or organization that comes first and foremost to people's minds.
And another reason is, very simply, it's our culture. And, you know, that's a word that's often used and probably misused in many ways, but I think it's extremely true for our organization. We just have the type of people, we attract the type of people that want to give service and want to get the kind of reactions that the public gives us. We have kind of a mantra, or you could even call it a vision nowadays, of what we're all about. And that's pay the right person the right check at the right time. It's pretty simple, pretty straightforward. But when we keep on that track, you know, we find we do very, very well.
And, finally, I will tell you we measure an awful lot in our agency. We do an awful lot of measuring about what people understand, how we're servicing, how long they wait, whether they're satisfied with our service. We have a fairly significant number of people who do go out and do follow-up interviews with people and really find out what they thought of our service. And when you measure things, as you know, people tend to pay much more attention to that, and it also helps management deal with individuals if there's any questions about what kind of service is being provided. So it's just all through our culture and, like I say, we take a lot of pride and we always enjoy hearing favorable comments back.
MR. LAWRENCE: As you indicated, SSA, and the Office of Disability, its mission is service. I'm curious. You have to give service to everybody. How do you deal with so many languages and disability barriers when you interact with customers?
MR. NIBALI: It is a challenge, as I'm sure it is for any organization, but again, our strength is that we are throughout the entire community, and therefore, we do much of our hiring throughout the entire country. And our field offices, our servicing offices out there in every community, we make explicit efforts to make sure that we hire individuals with language abilities. Obviously, Spanish is the next major language in this country, and in many parts of the South, Southwest, West, major portions of the individuals we hire will have Spanish-speaking capability. The challenges now are the many, many Asian languages that are coming to the front that we really need to make sure are in our offices and available.
One of the challenges there is that to hire individuals in the federal government, you need to be a citizen. And citizenship takes a certain number of years, and as a certain population starts coming in, you don't have a sufficient number right away to be able to actually hire, but as time goes on, we've caught up with many of those as well. And, we're also, I think, justifiably proud of our 800 number service. It is an 800 number. It's 800-SSA-1213, for anyone who's interested. And you call that number, and you can get any information about SSA you need. And we in fact recently won awards for our multi-language facilities there, Gateways, that when you call in, you actually get a selection of choices to hit on the menus, if you will, of what language you would like to be serviced in. And then we can route those calls to different segments of the country where we have those kinds of skills.
MR. LAINHART: SSA has expressed a deep concern about the double impact of workforce retirements and the increasing workloads from the aging population with the baby boom. What are the agency's top human resources concerns, and what steps are being taken to address them?
MR. NIBALI: Well, our biggest one, I suspect, is shared by many agencies. And that is we absolutely have a retirement wave that not only is coming, we're in the middle of it now. And we did much of our hiring back in the early �70s. For anyone who follows the Social Security program, you know, there is the sort of Social Security program proper that everyone thinks of. But then there's also the supplemental security income program that came from the states and to be run by the federal government back in the early to mid �70s.
And, at that time, when Social Security took that program on, we hired an awful lot of people. Well, guess what? Those people are now approaching the retirement age. And you know, our projections are very high for what's going to be happening. So, obviously, the challenges in front of us are projecting who's leaving and what the needs are; to continue to hire the kind of individuals with the diversity that I spoke of before, make sure the training and tools are there, the work environment. You know, all the kinds of things that companies are doing, SSA is in the middle of that.
I would just observe that given our culture and our very much family atmosphere of what's going on, I don't think it's a bad thing that we're going to have a fair amount of turnover as well. You never like that. You know, you always have a new group of people coming in that have to be sort of trained and gotten used to how things go on. But, I think as an organization, SSA will benefit for that as any new organization does with some new blood as we go along. So, I hope we also view that as a positive as we move forward, as well as the issues that we'll have to deal with.
MR. LAWRENCE: Just to set context, you talk about the number of employees that SSA may need to be, perhaps, hiring in the near term. What type skills does SSA employ? You describe yourself as an economist, kind of an amateur statistician, you know, a lawyer. And, I'm trying to understand. That's not what I would have thought. I would have thought there would have been a lot of actuaries and accountant-type things.
MR. NIBALI: First and foremost, the kinds of folks we have in Social Security are claims representatives. The people on the front line who deal with individuals when they come in, as I said, often, at very vulnerable times of their lives, to file claims. And they need, you know, they need help. They need some handholding. They need information, and basically they need the job done to make sure that if they have benefits coming, that they will get those.
So that's kind of first and foremost the type of people that we have, the front line individuals. Perhaps, what you're thinking is more when you go into our central office of our headquarters in Baltimore, we have an incredible array of occupations. Probably the largest single most there are systems. You know, we run one of the biggest systems, certainly, outside the Department of Defense, anywhere in the world. And we're very heavily automated. And all of our information is run through mainframe computers and is on direct access storage devices, because as we deal on the front line with individuals, we literally have a claim rep get online and call up people's records about what earnings they've reported over 30, 40 years of working and what our records say about their age, et cetera, et cetera. So the system we use is very, very large.
Then, of course, you need people, I'll say, like me, who have to kind of know what the programs are, write the policies. And those individuals can be from a variety of backgrounds. Yes, we have many lawyers, because we have lots of people who appeal, some who even sue us, as any government agency knows. So we have a number of lawyers. We have actuaries, you know, who report right to the Commissioner, because they make the projections and set the actuarial tables,
et cetera, for just how much money we plan on spending, and therefore, how much taxes we have to collect and those types of things. So, it's a pretty endless supply. And it's one of things I hope people would keep in mind about SSA in particular and even the government in general. There's going to be a lot of opportunities for a lot of young people, I think, in the coming years throughout the government, because so many agencies are in a similar position to ours.
MR. LAWRENCE: You talked about SSA working with state level organizations and even other federal level organizations. What are the challenges and managing efforts that involve multiple organizations?
MR. NIBALI: Well, the disability program is, again, a bit unique, certainly for SSA, in terms of the federal/state relationships that I spoke about. We, of course, deal with many other federal agencies, including what used to be the Health Care Financing Administration, Department of Labor, and, of course, Health and Human Services. And, I know, my boss, Mark Gary, who's come in very recently, is very interested in a lot more government interaction and coordination about serving, many times, the same people.
You know, Department of Labor is out there with their offices about coming in for help on various issues. So he is being very aggressive about trying to bring more of that kind of activity together.
But I would like to mention, just for a few minutes, the particular challenges of running a federal program through a state structure. And, first and foremost, the state employees and agencies that we deal with are a good group of people. In fact, they're a great group of people. They perform very well. I think we get very efficient operations out of them. And, quite frankly, they're very, very willing to work closely with us. And we've worked hard at establishing a partnership there.
The reality is, though, that they are still state employees. They do not work for our commissioner or the President. They work for their governor. And even though I'm sitting there with my budget saying I'm willing to support, you know, 2- or 300 state employees in state X, Y and Z, and that's what you need to run the program, if their governor believes for his or her particular timing and political reasons that he or she wants to downsize the state workforce, by gosh, they'll do that. And that makes it awfully hard for us to run a situation. So, there's a lot of negotiation and a lot of discussion back and forth that go on there.
MR. LAWRENCE: That's a good stopping point. Come back with us in a few minutes as we continue our conversation about management with Ken Nibali of SSA.
What might the future hold for SSA? We'll ask Ken for his thoughts when the Business of Government Hour returns. (Intermission)
MR. LAWRENCE: Welcome back to The Business of Government Hour. I'm Paul Lawrence, a partner at PricewaterhouseCoopers, and today's conversation is with Ken Nibali, Associate Commissioner for Disability in the Social Security Administration.
Joining us in our conversation is another PwC partner, John Lainhart.
MR. LAINHART: Ken, how do you measure success in the Office of Disability?
MR. NIBALI: Well, as I hope our discussion so far has shown, this is a pretty far-reaching and complicated program. And, as I mentioned, many other countries struggle with it. But, I've given you some ideas of the kinds of things that we think why we're running a pretty good program.
I will tell you, we get much feedback. The Commissioner gets more feedback on the Disability Program, and unfortunately, more negative feedback, simply because it's a very difficult thing to run. And, pretty much, when you file for retirement or survivor's benefits, most people get them. They know they've worked, they know they had their earnings and they get them. Something roughly like 50 percent of the people who come in for disability benefits end up getting them, and 50 percent don't end up getting them. So right there, you have a pretty good chunk of people who have some reason to raise questions.
But, given all of that, and given all the different interests that we're trying to balance with advocates and lawyers and taxpayers and the public themselves filing for claims, I sometimes jokingly say that if everyone is yelling at us equally, then we must be doing it right. And that probably isn't as true with the Disability Program as just about any that I can think of.
But, beyond that observation, you know, I think there's some fairly obvious things that we look at. We certainly try to keep current with policy. That's something we'd slipped on. A lot of decisions are very medically based, and medicine changes as far as, you know, what incapacitates people, or what kind of improvements are out there to help people. So, we have to keep our policies current with that. We got to keep cases moving in a reasonable time frame. And that is always a number one thing.
Probably, more complaints go to local Congressmen's offices about disability claims than anything else. That's probably their number one complaint that Congressmen receive. So we obviously hear back a lot from that if that time frame gets too big. We're very interested in measuring that the right people are on the rolls. And we talked about reviewing and making sure folks come off if they no longer belong there. But, we do want the right people on the rolls. And one area that we just haven't mentioned much is we're also increasingly interested because of the people with disabilities community is increasingly interested in opportunities for returning to work.
While it's very important for most people who file for disability to have a benefit to help them through rough times, or even until they retire, we are getting an increasing number of younger individuals on the rolls with very serious problems. But, even with those problems, with the right support services, et cetera, they could return to a job. And many of them, for self worth, dignity reasons, are very interested in doing that. And we would like our programs to be a help to that as opposed to a disincentive, if you will.
Unfortunately, right now, less than 1 percent of the individuals on our rolls ever return to work. Okay? It's like one half of 1 percent. So, you know, even if we could double or triple that, it would be a big improvement. But, still, you know, recognize that most people do need and want the benefits. But that is an area that we'd like to see a lot more progress in.
MR. LAWRENCE: How is technology changing the way the employees of the Office of Disability perform their jobs?
MR. NIBALI: Well, within the agency, obviously, we're facing a lot of the same things any organization is: e-mail and access to information is very, very different as time has gone on. Within the broader range of doing all the claims that I've talked about, a major effort in the agency, and one the Commissioner's putting the highest priority on is something we call electronic disability, or e-dib. But, electronic disability is the whole idea of, we need to move from what is right now a very paper-bound process. That's no surprise in government to anyone.
But, we need to move to a process where, essentially, you can file over the telephone, you can file over the Internet, you can come into our office, and we will input the information directly into a system, and then we don't have paper after that. One of our biggest challenges in running the disability program is getting information about you from your doctor or from employers or from whoever else would help us understand what your condition is. And the faster that those parts of the population move towards being able to give us information electronically, if doctors and hospitals can send us records electronically, we want to get, literally, in the next couple of years, as close to electronic processing, an electronic folder on you. And that will mean that we can move that case along from one step of the process to another much easier. And, it can be worked on by multiple people. Some of the benefits are incredible. It's much faster; it means we get better information because it's easier to give it to us.
It will also mean savings in -- when I talked about continuing disability reviews, one of our problems 3, 4, 5 years down the road, when we want to go back and review someone is, we might not be able to find that folder. Hopefully, that doesn't happen an awful lot. But even if it happens in a couple of percentage points of cases, that's a lot of cases in our world, since we deal with millions. And the ability to find that information very easily electronically means we can in fact do a good review on that person, and if some people don't belong on the rolls any more. So, there could be a lot of good benefits out of that.
The other thing I mentioned, just for my people in particular, is just writing policies. One of our biggest challenges in updating policies about how to run the program is you need input from a lot of people. You're not just writing it because you're a doctor and something in medicine's changed. But, you have adjudicators. You know, the people out on the front line who have to decide if someone is disabled or not. You need their input as to whether this is going to work or not, and what difference it makes to them.
And with the kind of online creation of documents and sharing of documents that you can do with real-time, you can get people all over the country involved in putting something together and get a major, major help. And the last thing I'd mention, which, again, John, I'm sure is familiar with because of the work he's been doing, is, we're also moving very much towards much more of a data warehousing kind of information gathering storage; instead of having management information shops that decide what reports to run and give the people, they put a lot of data into an automated format and then the users can go in and pick out what they need. Undoubtedly, you took advantage of that as you did some of the things that you did for us on those continuing disability review profiling.
MR. LAINHART: Well, you've seen a lot of changes at SSA during your career. What do you think lies ahead in the next 5 years for your office and, then, also for SSA as a whole?
MR. NIBALI: As I said, the personnel changeover is going to be a big, big driver. We again pride ourselves on knowing our programs and making good decisions about what to improve and change. And, it's going to be very interesting to see how that works as a lot of new people come into the organization. Undoubtedly, there will probably be some mistakes made. But, also, undoubtedly, we're going to make some real advances in terms of new ideas and fresh approaches and all of that.
I will say, in relation to some of the things you've been hearing on homeland security and the aftermath of 9/11, enumeration has become absolutely a hot topic in our agency, and rightfully so countrywide. Because, you know, stories were about how do people get into flight schools and how do they get social security numbers and establish identities in this country.
And the whole areas of fraud and the security risk of individuals creating records that can be used for wrongful purposes has become a very, very hot topic. And we're working very closely with out inspector generals and law enforcement agencies to help make the proper use of social security numbers as much as of a help for those kinds of things that it can be.
And, lastly, I'd say, without a doubt, the whole automation area is going to change. Our agency, dramatically -- what I talked about with the electronic disability and paperless processes that we're moving to, are going to make a big difference. And I hope the American public will see, in a very favorable way, you know, faster and better service as a result of it.
MR. LAWRENCE: What advice would you give to a young person considering a career in public service, and perhaps even at SSA?
MR. NIBALI: Well, thank you for mentioning SSA. I will say this. Please take a look at federal service, and particularly at SSA. Please consider it seriously. I would say give it a try, at least for a year or 2. For one thing, we don't have the same retirement program we used to have that when you got into the federal service, you felt like if you ever left, you were doing the wrong thing until you retired. We now have much of a portable retirement system where if you get in and find out you simply don't like it, and some of you will, then move on. And I think that's an understood part of the process nowadays.
But, I will say this, if you find a job that matches your skills, if you hit upon that, I do sincerely believe you will love it. And I think you could have a very, very interesting career with the government. But the opportunities are unlimited, and with the turnover that we talked about, there are just going to be many, many opportunities in government.
MR. LAWRENCE: Well, that's a good stopping point. Ken, I'm afraid we're out of time. John and I want to thank you very much for being with us today.
MR. NIBALI: Well, again, thank you very much for doing this program and this kind of service for helping people understand the government. And, I will say, if anyone is interested in further information about the Social Security Administration or disability, we do have a web site very easy to remember. It's ssa.gov. And you can get on that, and it will have send you to portals to many interesting aspects about both working for our agency and the programs that we run.
MR. LAWRENCE: Thanks again. This has been The Business of Government Hour, featuring a conversation with Ken Nibali, Associate Commissioner for Disability in the Social Security Administration.
Be sure and visit us on the web at endowment.pwcglobal.com. There, you can learn more about our programs and research into new approaches to improving government effectiveness. And you can also get a transcript of today's very interesting conversation. Once again, it's endowment.pwcglobal.com.
This is Paul Lawrence. See you next week.