Public Benefit Report
Looking back on 2020
We're not new to challenges. Nava formed as a public benefit corporation when we worked with the Centers for Medicare & Medicaid Services (CMS) to help rebuild HealthCare.gov after its troubled launch: a time of urgency, legislative pressure, and massive infrastructural undertakings. But the scale of tragedies since 2020—an ongoing global pandemic that’s taken more than 4 million lives, a US unemployment rate that peaked at 14.8 percent, wildfires that roamed the American West, and violent nationalism that shook the entire country—was unprecedented. Unprecedented and unsurprising.
This last year brought to the fore what we've known all along: Our public institutions, their programs, and the people they serve are interconnected, but these connections are incredibly fragile. Brittle systems and infrastructures hinder our government's ability to provide timely, transparent, and equitable access to critical services when they're needed the most.
Structural change requires resilience
We also know that through catastrophe, our understanding of what's possible changes and opportunities to create a better future emerge. Across the country, we've seen both grassroots groups and large institutions mobilize to address the structural failures that have affected millions of people in this country and build a more equitable, inclusive, and just system. But this type of change isn't linear. It's messy, measured by both setbacks and gains that eventually, over time, move us forward. This type of change is a continuous process that takes enduring commitment and extraordinary effort. What’s required from us today, and for decades to come, is resilience.
Every day we work alongside public servants who share our hope of rebuilding trust in public institutions by providing digital services that are simple, effective, and accessible to all. These are people who are fighting for program outcomes that benefit vulnerable communities, who are leading efforts to make their agencies more adaptable to a world of continuous change—both tall orders. But the values that have informed our work since the beginning—to think long-term, to pursue the root cause, to build together—are vital for us to support agencies so that they may be resilient to the challenges they will face.
Resilience in the services we build
Below you can read about what we've been working on during this unprecedented past year to support agencies as they adapted and delivered critical public services amidst crisis. In 2020 our projects included: helping Veterans get their benefits during the pandemic with the Department of Veterans Affairs; meeting urgent unemployment needs in an economic crisis with the state of California; providing a more personal healthcare coverage experience for Medicare beneficiaries; and building human-centered cloud infrastructure with CMS. Our work for Medicare and Veterans Affairs was recognized with 2021 FedHealthIT innovation awards. We're also proud of our progress with the commonwealth of Massachusetts as it implements its paid family and medical leave program.
Outside of those projects, we’ve tried to engage our community more broadly and share what we’ve learned: in our perspective on implementing the American Families Plan, ideas to support unemployment benefits challenges, and in our endorsement of legislation with the potential to dramatically improve state government’s capacity to build internal digital services teams. And it’s been an honor to see our work recognized as an example to build on in publications like Tara Dawson McGuinness and Hana Schank’s book Power to the Public, New America’s playbook to improve unemployment insurance delivery, the Brookings Institution’s report on digital transformation in labor and education systems, and Aspen Institute’s report on building a tech-enabled safety net.
Resilience in ourselves
We’ve also spent 2020 reflecting on our own company culture. Nava doubled in size during the pandemic, with people distributed across the country. Internally, we say that “Nava is what we do together.” And while we’re far apart, impossibly scattered during this time, we are a team, and a team takes care of each other.
And so this past year has also meant honest conversations about ways we can become a more sustainable and inclusive organization and take action to do so. We published our first diversity, equity, and inclusion report—which holds us accountable to our goal of becoming majority BIPOC by 2025, from about 49 percent now—and have begun mapping out the work ahead of us. Our growth as an organization has also meant the growth of new ERGs for Navacados to build community: In 2020 our existing earthtones and Gender Equity ERGs were joined by Juntos and Kaleidoscope.
2020 was not only an unforgiving year, but also an inflection point for the next decade. The urgency we and our government partners have felt is now a visible and legible historic moment. New perspectives, long overdue, are entering the conversation. New people are rolling up their sleeves for the work ahead. And so we remember from Progress Takes Work: “We believe the future belongs to the people who are willing to make change happen, and we are grateful to play our part.” We hope you’ll join us as well.
Supporting Veterans with virtual tele-hearings
Nava worked with the U.S. Department of Veterans Affairs Board of Veterans’ Appeals and other partners to increase VA’s capacity to serve Veterans during the pandemic by offering secure, confidential, and convenient virtual tele-hearings for benefits appeals.
At a glance
benefits hearings can now be held per week by VA
more hearings per week than before virtual tele-hearings
of hearings have had a virtual component during the pandemic
Making an effective service even better
Veterans and their families can obtain benefits they’re entitled to by filing claims to the Department of Veterans Affairs (VA). If a Veteran is unsatisfied with the outcome of their claim, they can request a decision review. Nava works with the U.S. Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board) and other vendor partners to help make that decision review process more efficient and user-friendly with a new suite of digital services called Caseflow.
As part of Caseflow, VA wanted to make it possible for Veterans to attend benefit appeals hearings without traveling to a VA office. The urgency of this project increased when the COVID-19 pandemic suspended in-person hearings. To move quickly and minimize risk while building virtual tele-hearing capacity, a new feature to generate video conference links when scheduling hearings was added to Caseflow to ensure a seamless, unified experience and efficient adoption of remote hearings. Scheduling and rescheduling hearings could all happen within the workflow they were already using. Making it easier for VA staff to use the new system would ultimately make it easier for them to better serve Veterans.
Building a secure and convenient service
In March 2020, one week after shelter-in-place orders were issued, the team rolled out the new scheduling feature, enabling a small group of VA staff to test the virtual tele-hearings system within Caseflow. The new feature allowed coordinators to convert 25 percent of previously scheduled hearings to virtual tele-hearings by June; this number rose to 33 percent in July. During current COVID-19 operations, roughly 95 percent of all hearings have had a virtual component. The new virtual tele-hearings scheduling system puts scheduling and email functions all in one place—what used to be a multi-step process now has been reduced to a two-step process.
VA is now poised to hold over 1,000 hearings per week in 2021, about 50 percent more than before virtual tele-hearings. Before virtual tele-hearings, hardware constraints required Veterans to travel either to a Regional Office, the Central Office in DC, or approved alternate locations. With virtual tele-hearings, Veterans and their representatives can participate in a hearing from any location with an internet connection and appropriate hardware. This allows VA to schedule and hold many more hearings, since VA staff is no longer constrained by the number of rooms available at a Regional Office. Moreover, virtual tele-hearings can run alongside other hearing types, increasing overall hearing capacity.
Adapting to new challenges, during the pandemic and beyond
While VA already knew it needed to—and could—increase its capacity to serve Veterans remotely with virtual tele-hearings, the onset of the COVID-19 pandemic demanded that changes happen quickly. At the same time, the pandemic could have derailed the project: Teams across the country had to adapt to things like new workflows, additional responsibilities, and different means of communication.
The Board and Nava launched quickly, got real-time feedback, and rapidly responded to it so we could ultimately deliver better services for Veterans amidst the crisis. Learn more about this work in our case study.
Delivering unemployment benefits during the pandemic
At the beginning of the COVID-19 pandemic, Nava worked with California’s Employment Development Department to build a web application that let Californians confirm their status for unemployment benefits they received. In six weeks, we launched an easy-to-use and secure application that helped meet unprecedented economic need for 1.1 million people.
At a glance
unemployment rate in CA, in April 2020
to build and launch an unemployment benefits certification app
people used the app to keep their unemployment benefits
Rapidly responding to a crisis
In April of 2020, the unemployment rate in California reached 16.3 percent. In that month alone, 2,415,000 jobs were lost in the state. At this time of urgent economic need, Nava worked with California’s Employment Development Department (EDD) to build a web application that let Californians confirm their status for unemployment benefits, after already filing their claim.
As state unemployment agencies across the country struggled to handle the rise in unemployment claims, EDD moved quickly to meet the demand and get unemployment benefits into the hands of as many eligible people as possible. This fast action helped more than one million people receive benefits immediately, but required retroactive certification to verify their employment status.
In response, Nava partnered with EDD to build a system to collect certifications for the benefits paid. In six weeks, the system was launched with an easy-to-use and secure application, on new cloud infrastructure. Ninety-three percent of people who logged in—1.1 million in total—completed the multi-page unemployment certification to keep their benefits.
Building a system for people
State unemployment benefits systems are often complex and outdated. California is raising the bar by prioritizing human-centered design practices like user research and usability testing.
User research is often skipped because of tight timelines. But EDD and Nava knew incorporating feedback from people who’d use the service would ensure that our limited time was well-spent. We were able to launch the application quickly and ensure that it met people’s needs.
Using a tool called Ethnio, we quickly screened, recruited, and scheduled a diverse group of eight research participants from 225 volunteers. Interviewing eight people would generate enough user data to build out the application, while still adhering to the tight timeline.
We employed task-based usability testing to directly observe and learn from how people responded to the application prototype. In task-based usability testing, participants are given common task scenarios and asked to use the prototype to complete them. During this testing, we learned that 88 percent of research participants didn’t understand what one of the three required pieces of information—a unique customer number called the EDDCAN—was or where to find it. So, we asked for a date of birth instead. This small adjustment made the application sign-in process significantly easier to complete while staying compliant.
A user experience to emulate
Removing the requirement of a unique customer number is just one example of leveraging user research to quickly create a simple and easy-to-use user experience. Alongside the application for retroactive certification, we also built a guide—written in plain language—to help people applying for unemployment benefits understand the application process and what benefits they could be eligible to receive. Google Analytics data showed that people who read the plain language guide had 2-4 times the rate of success filing a claim than others.
The guide succinctly lets people know what they need before they apply, how to apply, and what to expect after they apply.
The EDD Strike Team described our solution:
This tool allows a positive user experience for claimants while meeting an unexpected rule requirement from DOL. The creative and functional mechanism for tying data back to the database, and focus on user experience should be emulated in future improvements.
Learn more about this work in our case study.
Designing a more personal healthcare experience
Nava is working with Centers for Medicare & Medicaid Services and the prime contractor, Oddball, to design a more seamless, personal, and integrated experience for Medicare beneficiaries. To start, we’ll unify seven websites into one, so people can easily access self-service options about their health plans, payments, and other services.
At a glance
people use Medicare
people have online Medicare accounts
websites unified into one online experience
Helping people make informed healthcare decisions
As of 2020, more than 62 million people, or about 19 percent of the entire US population, rely on Medicare for healthcare coverage. Most are over the age of 65 and/or living with disabilities.
Chances are, you know one of those people. About 19 percent of Medicare beneficiaries, more than 12 million people, have online Medicare accounts.
People using online Medicare accounts increasingly expect to find information that’s current, personalized, and relevant to them. These expectations will only continue to grow as internet-savvy people age into the program.
Our goal with the Medicare Authenticated Experience (MAX) is to help people make informed decisions about their healthcare through a secure, seamless, and personal digital experience.
Making quick, incremental improvements
Previously, Medicare beneficiaries had to navigate more than seven websites, each with their own structure, to find information—like pricing for prescriptions, how to schedule a doctor’s appointment, or make a copay—about their healthcare. Alongside Oddball, we're working to unify these disparate websites into a single Medicare experience. Beneficiaries will be able to sign in to one place and find all of their healthcare details. It's a massive task that involves multiple teams, both inside and outside of government. It can't—and shouldn’t—be done all at once.
To prioritize a quick pace over perfection, we work iteratively. This means we make small improvements, test them, track their performance, and improve upon them. As a first step on this project, we designed a new header with a navigation that accommodates all of the information from Medicare’s previous websites. The new header gives beneficiaries a more consistent experience and helps them understand where, exactly, they are on a Medicare website.
With the new header, beneficiaries signed into their Medicare account can find information on their claims, premiums, plans, providers, and more—all in one place.
After rolling out the new header, we tested and measured its efficacy in the MyMedicare (account management) site. Once we knew that beneficiaries could find the info they needed, in partnership with Oddball, we supported incorporating this header into all eMedicare properties. Now whether beneficiaries are finding a care provider, browsing Medicare plans, or paying their premiums, they have a consistent navigation experience to find where they need to go next. One beneficiary described the new experience:
Please note...the web site has changed greatly for the better since the last time I was here (probably to pay my last premium). In the past it has been extremely challenging to find how/where to pay my premium. I almost didn't want to visit. Today was a fabulous experience!
We’ll continue tracking how people use the header and the rest of the website so we can continue to find opportunities for improvement.
Using data to provide more relevant information
Centers for Medicare & Medicaid Services (CMS) knows they can use the data they have to give beneficiaries a more personal experience. So, we’re building a new message center that provides beneficiaries information about their health and their Medicare accounts. For example, in the new message center we crafted a series of messages that provide feedback to beneficiaries that use Medicare Easy Pay, a service for automatically paying their premiums. With the new experience, when a change is made to a beneficiary’s Easy Pay, they get a message and email informing them of the change and letting them know if there are any additional things for them to do. We’ll use data to both deliver new messages and track how effective they are.
To accomplish this, we've designed a new message center, built an API to manage the data, and created the strategy and content for personalized messages. In return, beneficiaries will get timely, personal, and secure messaging that helps them manage their healthcare and Medicare coverage.
Responding to people’s needs efficiently and effectively
While much of our work improves the experience for Medicare beneficiaries, we’re also helping to improve CMS’s ability to adapt and respond to beneficiaries’ needs. As one example: With the new message center, CMS will be able to issue both personally and broadly relevant messages across their ecosystem of webpages—from one place.
When major events—global (say, a pandemic) or personal (emergency surgery)—happen, CMS can act quickly and ensure their beneficiaries have the information they need, when they need it. Global messages can be shared via prominent banners across all Medicare pages. And personal messages can be sent directly to beneficiaries.
Importantly, when those messages are shared, Medicare can track clicks and other measures of effectiveness so they can adjust course and continue to improve beneficiaries’ experiences as needed.
After launching the message center, in partnership with Oddball, a product manager at CMS told us, "I love the new Message Center, it's light years better than what we had before."
We were thrilled to hear the feedback, but we also hope this is just the beginning of increasingly better services and outcomes for both CMS staff and Medicare beneficiaries.
Building human-centered cloud infrastructure
Nava has partnered with the Centers for Medicare & Medicaid Services (CMS) as the agency optimizes its cloud platform—CMS Cloud—for new application development and migrates hundreds of applications away from traditional data centers. This work will allow CMS to rapidly design, build, and launch modern services for their teams and 149 million beneficiaries—nearly quadrupling the number of applications CMS can run and saving millions of taxpayer dollars along the way.
At a glance
people rely on CMS for healthcare services
applications can be run via CMS’s new self-service cloud ecosystem
per year saved by updating just one logging tool
Helping CMS better serve millions of people
Nava is building an intelligent, self-service cloud ecosystem that provides CMS teams with everything they need to design, build, and launch modern services. At the same time, we’re also effectively operating their existing cloud infrastructure—which supports CMS’s websites and applications, including HealthCare.gov and Medicare.gov—to serve the more than 149 million people who rely on those services.
CMS is ahead of the curve with cloud modernization in the federal government: according to a report from the Government Accountability Office, as of April 2019, only 11 percent of federal IT systems were running in the cloud. As CMS migrates out of traditional data centers, the hundreds of engineers, managers, and other stakeholders at CMS will reap the benefits of having their applications in the cloud, which offers secure, compliant, flexible, and cost-effective ways of managing applications and data. Teams will be able to work in the cloud how, when, and where they want, get support if and when they need it, and see what they're spending in real time. And in turn, the people who rely on CMS for healthcare payment coverage will also benefit as CMS is able to more rapidly evolve and adapt to people's needs in a changing world.
To ensure that CMS Cloud is accessible to everyone who may need it, we applied a human-centered approach across all of our engineering and design work, beginning with documentation and onboarding.
Starting with small, simple pieces
Cloud.cms.gov provides CMS Cloud customers—Business and System Owners, Contracting Officers, and Application Delivery Organizations (ADOs)—with all of the information, tools, and support they need to successfully migrate an application, build a new application, or operate in the cloud.
To move quickly and safely on a large project like this, we work iteratively by launching small pieces and then improving on them. We launched the first version of cloud.cms.gov as a text-based website that provided a high-level overview of CMS Cloud. The simple structure was easy to update so we could continue to make improvements while also saving engineering resources until we really needed them—when the platform became more robust and interactive.
Over the next year we enhanced the website, creating more than 100 pages of technical documentation and contextual information. The increasing amount of relevant, accurate information helped CMS staff see the website as their go-to source for everything about working in CMS Cloud. As more people used it, we iterated on the design, structure, and navigation to make it easier to use and understand. As one example: Readers can filter articles—by the content type (article, overview, training, video) or by the stage they’re at in using CMS Cloud (learning about, onboarding, or operating)—to quickly find information that’s most relevant and useful to them.
Katherine Brewer of CMS describes it:
We now have an efficient, distributed content publishing model, a higher-quality build and more scalable operations, as well as a more visually engaging site...As a result, customer experiences drastically improved.
Removing obstacles to support faster adoption
To ensure moving to the cloud is as easy as possible, we audited and redesigned the onboarding experience of CMS Cloud customers. This was a first step toward automating the process. We started by documenting the existing process and all of the places customers were asked to provide information. Then we determined which were relevant and redesigned information-gathering across the touchpoints.
We minimized redundant information, centralized important information, and proactively captured and verified necessary information to reduce cognitive load for CMS Cloud customers. While this effort has already helped customers start using the cloud more quickly and easily, it’s only the beginning of our efforts.
Our engineers are now in the process of automating the onboarding process, as well as other service provisioning. This will allow CMS Cloud customers to start working even more quickly—sometimes in a matter of days—or adopt new tools and services when they’re ready. More efficient onboarding and service provisioning means that CMS can spend more time focusing on their mission, and less time on administrative burdens.
Fostering innovation over the long term
Teams at CMS have long recognized that migrating to the cloud isn’t just a technical undertaking—it’s also a cultural change that requires new working norms. To help foster efficient working practices, we’re building a centralized authenticated workspace within cloud.cms.gov. This means that CMS Cloud customers can sign in and access shared services, tools, and real-time information about the systems and applications they’re working on.
As we did when first designing and building cloud.cms.gov, we’re using an iterative approach to create the authenticated workspace. In its first iteration, the workspace consists of a dashboard that aggregates links that take customers to the tools and services they’re using and provides cost information to Business Owners. As customers use the workspace, we can collect data about how they interact with the links to inform our improvements. In the future, the dashboard will also provide high-level information about their systems’ health, functionality to manage teams and access, and the ability to manage current services and adopt new ones.
CMS Cloud continues to expand the shared services offered, providing tooling that enables a modern DevSecOps approach. Providing easy-to-adopt tools for logging, monitoring, automated testing, and security scanning enables CMS to scale modern development practices, which also eases the burden of compliance and saves teams time and money. Once we set up a service or tool, every CMS Cloud customer can simply use it—they don’t have to spend time and resources to find, set up, and manage it on their own. For example, previously, customers who needed a logging tool would find, implement, and maintain one on their own. Now everyone can simply use an industry-leading logging tool to schedule regular maintenance and reports. This upgrade alone will save CMS more than $12 million annually.
CMS currently runs approximately 160 applications in the cloud. By iteratively rolling out shared tools and workspaces, we hope to help them dramatically scale the work they can do and triple the number of applications CMS is running in the cloud. Helping CMS use the cloud more efficiently for secure, compliant, flexible, and cost-effective ways of managing data will help them better serve the millions of people that rely on them for healthcare payment coverage.
Everything in this report wouldn’t have been possible without the entire Nava staff, alums, our government and teaming partners, Navatots, and last but not least, Navapets. Over the past year we’ve been through a lot together, from schools closing and childcare interruptions, to becoming new parents or new homeowners, to cross-country moves and other big life changes. It’s a true privilege to work alongside such incredibly smart, thoughtful, and dedicated people. Thank you for bringing your skills, energy, and hearts to help make government services more simple, effective, and accessible for all, every day.
If you’d also like to dedicate your skills to improving critical public services, browse our open roles. We’d love to have you join us.