In-Depth: A peek inside the United States Digital Service at HHS

By Laura Lovett
04:40 pm

The US government has never been known for its easy-to-use web platforms. At one point getting Medicare or Medicaid information could turn into hours of navigating an antiquated platform. But some of these websites are getting a facelift and becoming faster, simpler, and easier to use. In part, that’s thanks to the brain power of the US Digital Service (USDS), a team of technologists that come to Washington to tackle some of the most difficult tech issues in government. Traces of their work are on everything from the latest version of CMS’ Blue Button to the Quality Payment Program platform. 
Who’s enrolling in the USDS?
President Barack Obama launched the program in 2014 with the goal of using technology to better deliver government services to the people of the US. The team is spread across six agencies including Health and Human Services, Department of Defense, Department of Homeland Security, Veterans Affairs, Small Business Administration, and the General Service Administration. 
“[USDS] is essentially a startup based at the White House that is geared at doing a couple things,” ShannonSartin, executive director of the USDS at HHS, told MobiHealthNews.“One is bringing high technical talent into the government to help solve this consistent failing that the government has when it comes to technology. … We are trying to solve it by bringing in super smart people and giving them the air cover and license to work on complicated problems and … rethink how we are delivering digital services to the American people.”
The idea is to bring experts into the government for a “tour of duty” and find new tech-enabled ways to provide services to the American people. 
The program likens itself to a Peace Corps or AmeriCorps organization. However, there are some key differences between the USDS and these service programs. First off, there is no set-in-stone time commitment. Participants can decide to stay as little as three months and up to four years, though the average length of stay is one year. 
As opposed to many of the national service programs, which recruit young people early in their careers, the Digital Service is looking for experienced professionals with upwards of five years in the field. Currently there are 180 members of the service. Between 60 and 70 percent of these members come from the private sector, with the remaining 30 to 40 percent coming from the public sector like the Foreign Service or the Peace Corps, according to a USDS representative. 
Diversity has also been key in developing the program, according to a representative. In fact, 60 percent of leadership roles in the service are held by women. 
Positions range from software developer to user experience designer, and communications representative to technical recruiting roles. Officially all of the members of the service are called "digital service experts." 
Some members joined as a way to contribute their talents to the public. 
“Everyone should do a tour of duty and they should define that however they want,” Lexa Pope, a digital service expert working in HHS, told MobiHealthNews. “It is just an unbelievable way to be able to learn and contribute and give back to your country.”
Like many in the USDS, Pope comes from the private sector. Notably she worked with Facebook when it was still a relatively new startup with 150 employees. After working in the startup space for more than 15 years she started looking for her next steps. She said she knew she wanted to do something impactful. That was when she came to digital health and eventually the USDS. 
Like Pope, digital service experts who work in the HHS arm of the program come from a myriad of backgrounds. Some folks have worked in hospitals for years, while others have never set foot in a hospital as an employee, Sartin said. Although it’s not required, it’s helpful to have a health or hospital background, she said. 
“I’ve been trying to recruit a little bit more people who have healthcare experience,” Sartin said. “You don’t come to USDS and get a ramp-up period. You come in and you get thrown in the middle of a really deep ocean and it is sink or swim. … But someone who has some healthcare background is really helpful, especially when it comes to understanding all the various players and spaces and niche markets.”
USDS’s Health Efforts
The HHS arm has a heavy focus on Medicare and Medicaid, a space which poses many challenges but also has a wide reach. 
“Our team at HHS has this interesting space because for the most part [HHS] is really driving a lot of the policy that shifts the way any of us get care. But they are not actually doing the delivery of care,” Sartin said. “So the work that we do, and one of the reasons we are based at CMS, is because CMS as the largest payer has the ability to move the market and the ability to make or break technology in the market, and obviously they serve some of the most vulnerable populations.”
Recently, the service teamed up with the CMS to develop Blue Button 2.0, an API that lets Medicare patients give third parties access to their claims data. Blue Button 2.0was officially launched at HIMSS 2018 in Las Vegas. Currently the team is in the process of handing this program back to CMS. 
The technologists in the service have to navigate legislation as well as reach out to stakeholders. 
For example, USDS also worked on the creation of a platform for the Quality Payment Program. The project evolved from legislation called Medicare Access and CHIP Reauthorization Act that seeks to focus on quality care measures. But when the legislation first came out there was a lot of confusion and stress around what it meant for doctors. Some of those difficulties could be solved with technology and design. 
“The physician community became very vocal that they were concerned about the potential burden that this was going to place on them,” Sartin said. “This was at a time when physicians were deciding they didn’t want to continue participating in Medicare. And I think we all recognized if physicians entirely stop participating in Medicare, then who is going to provide care for Medicare beneficiaries? So making sure that this Quality Payment Program product was designed to minimally burden [doctors] was really important. That team did a lot of work from inception and delivery with how to work with the provider community to understand what does burden mean and how do we avoid creating more. We did a lot of user-centered design. Stuff that is very typical for technical people but not typical for government.”
Culture shock
But there are some major differences the digital service experts face when coming from the private sector to the public. For one, government systems don’t always have the newest tech.
Sartin recalls one day when she was locked out of her email and lost almost an entire day of work because of it. 
Coming into the space with a new perspective can also mean shaking up old systems. 
“When you go into bureaucracy that has been around for 30 years, being the disruptor is … really hard,” Sartin said. “Like, you basically have to sit there and tell people ‘No you are doing the wrong thing’ and make a room of 20 people feel bad. Then [you have to] figure out how to bring it back around so they are going to do the right thing when you tell them what it is.”
But one person’s struggle is another person’s challenge, Sartin said.
“Some people are there because they love complicated hairy problems,” she said. “Let me tell you, there is nothing more complicated and hairy then the 60-year-old systems that control four percent of the economy which is Medicare. People like that who are looking for that technical adrenaline rush are going to be drawn to those kinds of things — especially when you know the outcome of it is improving care for your kids or family, and this really is.”
But working with people from different industries and background to solve complex problems has also brought teams together. 
“It is easy to get frustrated and throw your hands up and think ‘I’ve hit a wall,’” Pope said. “But I think what is great about this team is we serve as a great counterbalance, [we don’t take] no for an answer. There is always a way around and listening to the various stakeholders at the table keeps the ball moving forward.”
Because everyone comes from different industries, there isn’t one uniform perspective. 
“It’s been really fun to watch folks who don’t have a background in healthcare come in and get overwhelmed and then get super passionate about untangling those webs that healthcare is, and ensuring those ecosystems between payers and providers and patients,” Natalie Kates, another digital service expert told MobiHealthNews. “That has been the most meaningful part. But it’s been great because you have fresh ideas.”
While it can be frustrating working within the government, at the end of the day the service also gives technologists a peek into why things operate they way they do. 
“CMS is like a black box,” Sartin said. “So people on the outside don’t really understand how CMS makes decisions, like how is policy written, how do these products get built. This is like front row seat to all of that. So my pitch to companies who are considering sending people is always like, ‘Your person gets to come in and gets to see how all these decisions are made and by who. There is this leg up that people get by coming in and getting to do this work.”

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