NAVA PUBLIC BENEFIT REPORT
Five years in, and our mission hasn’t changed. We’re here to improve the simplicity, effectiveness, and accessibility of critical government services.
We started Nava as a public benefit corporation with a lot of urgency—HealthCare.gov needed help, people needed access to care, and the public was losing trust in the government’s ability to work in the digital age.
We also started Nava with a lot of aspirations—that the lessons we’d learned fixing HealthCare.gov could help avoid future disasters entirely, and that taking a human-centered approach would in time change the standards, practices, and culture around delivering public digital services. We started Nava because we want to live in a world where public institutions are able to earn trust by quickly and effectively responding to people’s needs.
But it feels like we’re a long ways away from that right now. The global pandemic we’re living through is unprecedented in our lifetimes. What’s being made painfully clear is that the failure of critical public services causes real harm, both physical and financial. Our healthcare system is being overwhelmed, millions are pouring onto unemployment, and we’re seeing an unprecedented number of people trying to access government programs.
Five years in, our mission hasn’t changed. We’re here to improve the accessibility, effectiveness, and simplicity of critical government services. We’re here to help people who need it most because it’s here where the stakes are often highest, where trust is either created or destroyed en masse—and not just for the people these programs are designed to serve. We’re here to help agencies be more adaptable in a world where the only constant is change. What’s been both humbling and exciting is seeing our aspirations become responsibilities—projects we care deeply about, and roles we’ve taken on that will resonate across lifetimes. Now more than ever, it’s important to remember that this work benefits from, if not requires, taking a profoundly long-term perspective.
In the past year, we’ve won new work, including helping the Commonwealth of Massachusetts build and roll out their new Paid Family and Medical Leave legislation, as well as improving the flexibility, security, and resilience of systems at the Centers for Medicare & Medicaid Services (CMS). In Massachusetts, we’re taking lessons we’ve learned at the federal and state level around eligibility and enrollment systems, and applying them to greenfield work to roll out this groundbreaking legislation. At CMS, we’re listening to developer teams across the agency to update the tools, standards, and practices around building resilient services at scale.
At the same time, we also transitioned off of projects that we’ve loved working on, such as our work on the Quality Payment Program for Medicare. We’ve also gotten to celebrate milestones, such as VA.gov’s launching of the redesigned Pittsburgh Healthcare System website, and Vermont’s successful integration of our Uploader work piloted the year before.
Between the hard fought wins to the bittersweet transitions, we are reminded that structural change is a difficult and continuous process—a process that demands focus, persistence, and growth. And we’ve grown a lot this past year. As a company, Nava is now over 130 people, and growing quickly, with more than 20% of staff working fully remotely. We launched an apprenticeship program, were able to hire all the apprentices, and are excited to expand and launch our 2020 program in the fall. We’re excited to expand and launch our 2020 program in the fall. In 2019, Nava also became majority women across the company, from all staff to management to the executive team. We still have work to do—people of color represent only 35% across the company—but it’s work we’re ready to take on.
We’re only four months into the year and structural failures have cost lives and affected millions. But for millions of people in this country, the challenges they face accessing critical public services didn’t start with COVID-19, nor will they end with an election. Building resilience in the face of systemic challenges like a global pandemic, climate change, and surging nationalism will affect us all, and Nava has a role to play. When quarantine is over, there will still be caseworkers and public servants working their hardest to improve brittle systems, or build better ones. There will still be people needing care, people navigating complex services or life changes.
There will still be work to do, work Nava was founded and exists to support, and work we hope you’ll contribute to as well.
Rohan Bhobe, CEO
Sha Hwang, COO
We’re partnering with Centers for Medicare & Medicaid Services (CMS) to modernize how Medicare pays doctors. Using a human-centered, agile approach, we’re improving the efficiency, flexibility, and reliability of claims processing. In turn, this will raise quality of care, facilitate smarter spending, and support a healthier Medicare population.
Medicare delivers critical health care services to more than 58 million people or 18% of the entire US population. Most are over the age of 65 and/or living with disabilities. Medicare provides more than $2 billion of vital services per day, or $750.2 billion annually, for vulnerable populations. Its value to the country, health care providers, and patients is enormous. The payments for these services provide financial stability to our entire health care system. Health care providers—from big, urban hospitals to small, rural private practices—rely on this cash flow. But inflexibility of payment models and the work required to document and process claims prevent doctors from being able to provide the best possible care to their patients.
We’re working on a project called Medicare Payment System Modernization (MPSM), which will help CMS modernize how Medicare pays doctors. MPSM supports innovative payment models, reduces the time doctors spend managing paperwork, and lets them focus on their patients. The current system processes claims using a 40-year-old legacy system, built on the mainframe, using the out-dated programming language COBOL. It’s inflexible and can’t easily adapt to support things like alternative payment models. During our research, one doctor at a major health care provider lamented being unable to try in-home services for elderly patients with mobility difficulties because they weren’t confident that they would be reimbursed for it. Others told us that billing processes and mandatory data entry are a cause of burnout so severe that physicians are leaving smaller practices.
Our vision for MPSM is to apply human-centered design to make claims processing painless, establish and promote API-first development, and support a larger transition from a Fee-for-Service to a Supporting first-class care 7 Value-based Purchasing Program model. All of these things will support better quality of care, smarter spending, and a healthier Medicare population. For example, API-first development practices power tools like a service-pricing calculator app. As a result, providers are able to get quick and accurate pricing information, relieving some of the burden they’re currently facing. We’re proud to support CMS’s ability, now and in the future, to deliver health care services with modern digital infrastructure, tools, and practices.
Nava worked with the Department of Veterans Affairs (VA) and several partners to make it easier for Veterans to find, understand, and use information about health care and benefits on VA’s websites. In a nine-month pilot, we built a new website and streamlined existing ones. Our work will guide VA’s multi-year product roadmap, ultimately improving the experience of VA’s 144 medical facilities’ websites.
More than 10 million Veterans and their caregivers visit 144 VA’s medical facilities’ websites every month. They come to make appointments, refill prescriptions, order hearing aid batteries, and more. But many can’t find what they need because information is organized according to VA’s internal structure, not Veterans’ needs. It should be easier for Veterans to access their health care and benefits. We partnered with the VA Office of Information Technology’s Digital Experience Product Office (DEPO), Veterans Health Administration (VHA) Digital Media, CivicActions, and Agile 6 on a nine-month pilot. We consolidated top VA health services under just one website (va. gov), retired websites that had competing or outdated information, streamlined 300+ webpages, and developed a new website for one of VA’s largest facilities, VA Pittsburgh Healthcare System.
This foundational work, which launched on January 29, 2020 at va.gov/pittsburgh-health-care, will guide the VA’s multi-year product roadmap to help deliver a better experience for Veterans, family members, and caregivers across the VA’s medical facilities’ websites and 1,200 health care facilities. The new site is responsive, faster, more reliable, and flexible. It employs a modern tech stack and a custom Drupal content management system (CMS). The CMS supports a new information architecture (IA) that reflects the way Veterans search for information so they can find what they need more quickly.
As with any human-centered design project, we put users at the center of our work and began with research to understand their needs. DEPO surveyed more than 800 Veterans, asking them to complete 10 key tasks using the newly proposed IA. We used their results to organize content and make design prototypes. As an example, one significant finding was that Veterans identify with VA through their local or 10 regional medical or office site. So we used that as a key principle to guide our organization.
We regularly iterated on and improved the content and design by observing and listening to 76 Veterans, family members, caregivers, and patient advocates as they used the prototypes and described their experiences:
“I’d be shocked if this were a VA page. It looks like a modern website. I’m no designer, but the whitespace here helps me find things quicker,” said one Veteran.
Prioritizing Veterans and considering their needs helped us deliver tools and systems to support VA content editors too. The CMS we built also provides guidelines for creating and publishing content so that it’s more clear and consistent across VA websites.
“Serving Veterans is our priority. We want to sort out the distinctions on our end to get basic information intuitively on the websites so that VA personnel can use their time to support Veterans on more pressing health concerns,” said a Pittsburgh staff member.
When we began rewriting and redesigning content, we prioritized updates that would address the most significant pain points identified during our research. For example, navigation challenges caused stress and frustration, so we decluttered the design and reorganized content according to what Veterans need most. During research, one veteran offered this organization of site content.
“Think about how people are accessing this information when they’re on their mobile devices and are in waiting rooms, trying to find information quickly–and it could be an emergency. This version is good for that. I’m not squinting and having to zoom in and out for everything, especially if I’m stressed,” said one Veteran using a prototype with reorganized content.
As we got further into content auditing, consolidation, and rewriting for the VA Pittsburgh site, we doubled down on plain language practices. We wanted to make all of the information we published more consistent, conversational, clear, helpful, and empathetic. We conducted three rounds of paraphrase testing with 28 Veterans. The ultimate goal was to draft content that would better prepare Veterans for their medical visits. Overall, we reduced the total word count and site pages by 87 percent.
“I like that it’s pretty simple. I can find things by scrolling rather than clicking on a million tabs,” said one Veteran.
As we cut words in some places, we added words in others. We learned that to help Veterans find information quickly, we needed to write in the second person. So, instead of, “The VA provides suicide prevention services,” we used “If you are a Veteran in crisis or concerned about one, connect with qualified responders for confidential help.”
“I like that it’s very straight to the point—and I like that I can see all health services,” said one Veteran.
With help from our partners at VA Office of Information Technology’s Digital Experience Product Office (DEPO), Veterans Health Administration (VHA) Digital Media, CivicActions, and Agile 6, we were able to better understand the people we were designing for. By focusing on the experience of Veterans, we helped make it easier—as it should be—for them to access health care and benefits through va.gov
At the end of every weekly all-staff meeting, it’s Nava tradition to show appreciation by “shouting out” particularly special things Navanauts did that week. It’s a privilege to close our week with gratitude for the work and each other. It’s with great appreciation that we shout out the communities that support us, teach us, and cheer us on. Thank you Nava staff, alums, partners, the Navatots who were born this past year, and last but not least, Navapets for making the work in this report possible. See below for our complete list of shoutouts.
