The private-sector-bred technology mavens at the U.S. Digital Service—the government tech startup launched by President Obama to bring Silicon Valley design sensibility to government programs—appear to have found something unexpected in the Trump era: Opportunity.
Despite considerable turnover at USDS following the presidential transition and fears that the organization’s mission might be usurped by President Trump’s new Office of American Innovation, staffing has stabilized at about 180, down from just over 200 under Obama. About 100 have joined since the 2016 election.
Recruiting at the organization members affectionately call the “Peace Corps of geeks” has remained steady, said Shannon Sartin, executive director of digital service at the Health and Human Services Department. While USDS has morphed from a White House startup into a network of teams working across five major departments and the Small Business Administration, improving the lives of Americans through better technology remains the “unwavering mission,” Sartin said.
The men and women at USDS serve as digital utility players, mostly on break from Silicon Valley, to try their hand at easing agency software headaches in tasks as varied as processing health insurance claims, determining veterans benefits and modernizing immigration records. Besides supporting HHS and SBA, digital service teams are embedded at the Defense, Homeland Security, Veterans Affairs and Education departments.
USDS gives private sector technologists an “opportunity to give back with the skill sets they have in service to their country,” she said.
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Sartin’s team of 13 at HHS is designing digital tools to focus on two main challenges at the department: measuring the quality of medical care and organizing Medicare recipients’ claims to improve the payment process.
For the Center for Medicare and Medicaid Services’ quality measures program, Sartin’s team is using agile project management methodology to build new Web tools for medical personnel. It “focuses on user-impact and is a great place for USDS because of the need for human-centered design for clinicians,” she said. “The premise is value-based care, and for the outcomes to keep populations healthy, we need data to make the determination of how to pay a doctor,” she said.
A second focus is an application programming interface called Blue Button that provides Medicare beneficiaries access to past claims data. Links to third-parties the beneficiary selects also allows access to authorized physicians, pharmacists and researchers.
Her team’s work requires updating an infrastructure for processing claims that’s been around for many years using ancient COBOL software. “One thing we quickly recognized is that the infrastructure would need to shift to [a more] modern, better-aligned format,” she said.
“CMS is the largest healthcare payer in the country, and because HHS is a regulatory agency, its decisions impact more than just the care received,” she said. “So in order to not be the 800-pound gorilla in healthcare, we have to make sure that the ability to process claims is leading the way, and not getting in the way of somebody who wants to make technical advancements.”
What is not on her team’s agenda is improvements to the healthcare.gov site, whose foul-ups for enrolling people in the exchanges under the Affordable Care Act in 2014 led President Obama to create the USDS. “We’re consistently available if any system goes down,” Sartin said, “but in last open enrollment, I was never asked to scrub in on anything, and they have their own team.”
Nor does her fix-it squad get involved in decisions about website content, she said, in reference to recent HHS managers’ controversial removal without fanfare of some content related to Obamacare and certain information on women’s health.
An Unlikely Career Path
Sartin happened on the Digital Service almost by accident. After earning a B.A. in Italian from the University of Arizona, she bounced around Web development startups in sales and marketing and co-founded a food waste disposal company called Scraps on Scraps.
Her first experience of working in government came in 2010, around the time when the Obama team was launching federal IT reforms. She worked at HHS’s Indian Health Service. “The internal momentum in agencies for transformative efforts was not there,” Sartin said, so she returned to the private sector. But she noted that “the vast majority of technology work for the federal government is done by contractors, and if you can get good people to the table, you can solve problems.”
One day she stumbled across the USDS website, she said. “I thought, there’s no way they would ever want me because I don’t come from Google or Facebook,” she recalled. Happily, she was wrong. “USDS is one of the most intellectually challenging jobs and surroundings I’ve ever been in,” she said. “I’ve never worked with a more brilliant group of people, and I’ve felt there is no way I’m as smart as all these humans.”
The atmosphere can be intense, she said. Colleagues are committed “to doing good for the country, and the sense of community is really important.” She values career feds at HHS, some of whom have been at the department for decades and demonstrate “the same level of brilliance and amazingness” as her USDS colleagues, she said. “It’s impossible to be effective as an organization without the support and team building, and they have so much subject-matter expertise.”
But “bureaucracy is really hard,” she cautioned. “In a small- to mid-size company, you don’t face as many people saying no, and there are not as many hoops to jump through to get something done.”
Agency staff often “work in silos, keeping heads down and focusing on their own mission—‘I’m just here to buy things’—and maybe some forget they’re connected to providing health care to 150 million Americans,” Sartin said.
“They’re forgetting to look more broadly at what we’re trying to achieve. They don’t do great team-building in government to work collaboratively,” she added.
Sartin says CMS will always have a need for the kind of work the digital team provides. “The odds of CMS not having projects requiring USDS are pretty slim.”
Sartin herself today is more than 2 1/2 years into a maximum four-year term at USDS, where the average tenure is 18 months. “I recognize I will have to leave. I’m keeping an eye out, but I have yet to find anything with as much impact as my current position,” she said. “I won’t leave until I do.”