Shaping Healthcare
Part 2 of Mission-Driven Work
How does one actually shape healthcare?
Slowly.
But seriously, a small group can, but it takes a strong, cross-functional team to make things happen because there are so many layers from inception to execution.
My team at CMS took on the task to help implement the Quality Payment Program (QPP) which is a massive, multi-year project whose aim is to shift the current payment system from a fee-for-service to a quality-based one. QPP received overwhelming bipartisan support in congress and is generally the common sense approach to both controlling Medicare costs while increasing patient outcomes.
Shaping Healthcare
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It is not enough that a project is big with a large budget to shape healthcare, it requires them to operate in an environment that can actually make waves in healthcare. CMS provides this scale and impact. When CMS moves, the rest of the industry follows. This allows for shaping. That is impact.
Implementing a project of this scale requires taking law and applying regulations, design, communication and outreach, project/program/product management, and development. Each of which has the possibility of derailing the project as a whole. USDS’ team consisted of a single person providing the proper guardrails to policy making. A tag-team of designers to make sure the policy that was coming out of the work groups was actually possible to design against and easy enough for users to understand. Experienced product managers to define a roadmap and prioritize ruthlessly, and finally a few engineers to ensure proper infrastructure, redundancy (the system can’t go down under heavy load), security, and APIs were built by contractors to support the industry participating in QPP.
When you have these conditions for a project and a cross-functional team working on them, you are in a position to actually shape healthcare — like really shape it.
As an engineer on this project, I had challenges that were not only unique to the rest of the team but also to the typical engineering space. The regulations of the healthcare industry are a bit stricter than your typical startup space (though coming from FinTech, regulations might be even more constraining there!). When you add that on top of government imposed development guidelines, things are hard to get done!
As with any engineering project, victory is accomplished with a million little wins. This is even more so when doing work within the government. There were many times when I questioned what I actually accomplished other than writing decision papers or papers justifying technology implementations. APIs that in a past life could have been implemented in a matter of months are taking the better half of a year in government, setting up industry standard infrastructure required coalition building, and frontend development required looping in a communication department that delayed daily deployments to weekly ones.
These struggles are real and often enough of a roadblock that when combined together grind progress to a halt while the rest of the technology world moves on. That is why it is so important to push extra hard to get these APIs out. Our team was able introduce the first read/write API at CMS and this in turn forces the rest of the healthcare industry to step up its game to interface with CMS. That is shaping healthcare.
Why Shape Healthcare In The First Place?
I’m hesitant to say that this work is larger than any of the individuals that are working on it, but this much I do know: shaping healthcare in this way encourages better patient outcomes — better patient outcomes means a healthier population and possibly a longer life. This means I get to spend more time with my parents, grandparents, and loved ones. My children get to go to the park, concerts, baseball games, movies more with my parents. And isn’t that what it is all about? We are all but travelers through this small blip in history and the most meaningful things we have to take us through life are our relationships with each other. That is a project that is impactful. This is shaping healthcare.
