Injecting Human-Centered Design into Government Policymaking

How do you get meaningful feedback from doctors all across America on 2,200 pages of legalese? That’s the challenge faced by the policy team at the Centers for Medicare and Medicaid Services every time they change how Medicare works.

United States Digital Service
4 min readAug 2, 2018

By Natalie Kates

Government agencies have a process for making changes to their programs: you write a draft of the change, post it publicly, wait 90 days for any public comments, modify your draft based on those comments, and then publicly post the final document. Sounds good, right?

Not so much.

What doctor wants to read a 2,000-page PDF to try to find the one or two changes that impact them? And how can the government get meaningful feedback on their proposals if only a few people manage to read the draft? The process feels broken for almost every stakeholder group.

Typically, policymakers mainly get feedback from special interest groups and lobbying organizations with the resources and financial incentives to synthesize these complex documents. A conversation is happening, but only within the community that knows how to participate.

The U.S. Digital Service started working with the Centers for Medicare and Medicaid Services (CMS) three years ago. It was clear their policy team wanted to make it easier for more people to join this discussion so their services could meet the needs of more Americans. The question was, how?

What we did

Over the last three years, USDS and CMS partnered to introduce product management and human-centered design into the CMS policymaking process. We journey-mapped how proposed changes will impact users, we identified the problems we needed to solve instead of starting with theoretical technical solutions, and we focused teams of more than 200 — from policymakers to software engineers — on a single, user-centered goal.

These new practices allow CMS to write less complicated policies that carry more impact. While many changes have been internal, one of the most significant is now public. On July 27, 2018, the Federal Register — the official public record of the government’s day-to-day business — will link to a website visualizing policy options using design examples. Pictures are worth a thousand words, but you’d be hard pressed to find them describing policy in the Federal Register’s pages.

At you’ll see design examples for two of CMS’s most important proposed changes to Medicare’s Quality Patment Program: how data is submitted and how program participation works. Through these drawings, we aim to facilitate quick and easy understanding of how policy will look if implemented in 2020 — without actually having to wait until 2020.

Why it matters

Using design examples to visualize and illustrate different policy opinions has two key benefits.

First, it allows the team to interact with draft policies more quickly. Traditionally, it takes a long time to implement a policy idea. Now, the policy team can visualize a concept in a matter of days. This facilitates rapid iteration. Only the best policy options make it into an official proposal.

Second, using design examples makes it easier for readers to understand and interact with policy proposals. Instead of thousands of pages locked in PDFs, if a user can browse a design example or even a prototype, we enable a broader group of Americans to weigh-in on proposals that impact them.

This is just the beginning, and there’s lots of room for improvement, but the door is open for CMS and other government agencies to iterate and improve upon interactive, human-centered policymaking. And if more agencies incorporate these tools at scale, then we could usher in a new era of public policy; one in which it’s fundamentally easier to change how doctors interact with their patients. And for citizens to interact with their government.

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