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How Nava PBC helped government make Medicare’s largest change ever

Senior Product Manager Ivana Ng and Senior Engineering Lead Mari Miyachi explain how Nava PBC is building an API to reinvent how doctors care for 34 million Medicare recipients.

Senior Engineering Lead Mari Miyachi chats with a coworker at Nava PBC's New York City office. (Photo by Nina Sparling)

Nava is a Technically Talent client and reviewed this article before publication.

When “Navacados” aren’t flipping through thousands of pages of policy or coordinating between a dizzying array of stakeholders, they focus on making Nava Public Benefit Corporation (PBC) a more inclusive, diverse and supportive place to work.

“We’re not here just to build cool tech,” said Ivana Ng, a senior product manager working out of the D.C. office of the civic-tech startup. “We’re here because we want to change how people interact with the government.”

At Nava, user-centric technology improves the relationship between government and people. The company is building an API that will transform how doctors get paid to care for the country’s 34 million Medicare recipients, ushering in the largest change in Medicare history. This award-winning API has broken new ground in software development at the Centers for Medicare and Medicaid Services (CMS) as the first public transactional API in the history of agency, and the first to be developed in the open.

We sat down with Ng and her colleague Mari Miyachi to talk about what it’s like to work alongside policymakers, mastering communication and the supportive workplace culture at Nava.


Technically Talent: What are some of the key parts of an average day in terms of how you interact with the Centers for Medicaid and Medicare Services? What stands out about working so closely with government agencies?

Mari Miyachi: Our government partners are lifelong civil servants who have really good intentions about wanting to improve this system for Medicare patients and Medicare doctors. Every day we have to dig deep into understanding why a policy is written a certain way, and I have to be able to explain technical concepts and technical reasoning to folks who may not have a tech background. It’s truly a two-way street: as the implementers, we give our government partners feedback on what the policy should look like and how they can get to the outcomes they want through different means. We are building a lot from scratch, and sometimes our government partners might not know what the path is to make technological improvements, but they are extremely open minded.

Ivana Ng: We’re at the forefront of policy and service delivery here at Nava. It’s exciting — there are a lot of cooks in the kitchen. When we’re functioning as one team and thinking through technical and product solutions with policy in mind, that becomes a feedback loop where ultimately, long term, we can drive policy and implementation to be centered around the user — in this case doctors and the ecosystem that supports them. Our government is in turn serving our people in a more effective and respectful way.

TT: What are some of the more interesting technical challenges that you’ve encountered on the job? What tools do you use? What skills have you learned?

IN: As a product manager, I work to make sure stakeholders have the same overarching goal, also known as a product vision. Medicare’s Quality Payment Program (QPP) aims to deliver real-time, actionable feedback to doctors so that they are incentivized to deliver high-quality, cost-effective patient care. To do this, our product strategy is to get as many vendors and parties who are involved in reporting to QPP as possible to use our APIs to ease the reporting burden for doctors and deliver feedback in real time. That clear, common goal is so important in government, where the stakes are incredibly high, but it’s often overlooked in the world of contracting. A contract gives you a sense of what you want to build, but it doesn’t always explain the how and why — we’re trying to ask the why and understand the intention behind the problems we’re working to solve. So it’s an interesting challenge to be a product manager in government service delivery. I’m not always brought in to ask the why — but I ask anyway, because it’s in my blood as a PM and because it results in government services that better serve people.

MM: We work with more than 300 public servants and other contractors like us — it isn’t always intuitive how to integrate products in an environment like that. One of the biggest things that I’ve encountered is around system design: where do you draw the boundaries between two systems? We’ve developed a core API and were involved in the core architecture decisions, but there are a lot of products that are equally important. We’ve made use of libraries to manage certain static datasets, which has been really powerful in allowing the third party integrators to access important information about QPP.

TT: Tell me about a time when you shifted your process following a conversation with stakeholders?

MM: When we were writing the data model for what we would accept in the API, the original specifications that we received were just about collecting the same data as always. We felt it was a lot — excessive almost — but we were able to have conversations with policymakers about what data is required for analysis and what data just falls in this category of “we’ve collected it in the past.”

TT: How is working at Nava is different than working at other startups you’ve been with?

MM: We’re all here to help others. It’s refreshing and makes for a healthy and warm working environment where people are supportive and aligned around a common goal. When things are tough, having something meaningful that drives everyone’s work helps get through those harder times.

IN: We’re not here just to build cool tech; we’re here because we want to change how people interact with the government. We want people to feel like they can trust the government to do right by them.

And Nava is really committed to diversity and inclusion — I see that every day here. We all understand that we each bring different skills and talents to the table, and that they all allow us to work more efficiently towards the same goal. To me, that means that I feel respected at work, and I don’t feel like I have to earn it. Instead, I can focus on what I do best — work with government partners to develop a compelling product vision, and build products that improves how government serves people.

TT: What are the team dynamics and culture like at the company? What do you look forward to about coming into the office?

MM: There is a ton of trust in our team. I know that if I make a mistake the rest of my team is there to help me fix it and support me. I understand that if mistakes happen, we’re not here to pick that apart. We’re here to move forward and make things better. Everyone is really supportive and encouraging — they help motivate me and make me a better person.

IN: People here are empathetic and collaborative. I’ve gotten frustrated working through the tangles of policy, but Nava is a hearth. Coming back to a place like Nava where everyone cares about the mission and is respectful about what everyone brings to the table makes it easy to weather those kinds of challenges. And we’re constantly improving internally. It’s not just about making an impact on the government side but also improving Nava so that we can continue to be the sort of place where we attract people who want to make an impact both inside and outside government.

Companies: Nava
Series: Brooklyn

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