Serving & Returning: Lucas Merrill Brown
When USDS was founded in 2014, private sector technologists began taking a one-to-four year breaks from their careers to serve in the federal government to improve critical services. After nearly six and a half years, some USDSers have returned for round two. In this series, we will highlight those “boomerang” USDSers on their experiences serving and returning.
Lucas Merrill Brown (he/him), Engineer @ USDS HQ. Previously Myst AI. First served at USDS from January 2016 to March 2018.
I joined USDS in January 2016 and stayed for about two years. Although I was moonlighting on a couple different projects, I mostly worked on the Quality Payment Program (QPP), one of the largest (I think it is the largest?) payment reform efforts in Medicare history. The program shifts Medicare from a pure fee-for-service model (if a doctor runs ten tests, they’ll get paid ten times) to value-based care, where we incentivize quality care at efficient costs. I was eventually the program’s Chief Technology Officer.
Those years were a wild ride. The healthcare.gov fiasco was still fresh, and I have clippings of about 30 different articles asking if the compliance burden from the new program would end Medicare as we know it. We had a short timeline to set up a system that scores billions of claims from every Medicare provider in America, intuitively explains these scores, and awards approximately $180 billion in financial incentives. It was stressful and fraught. People were working long hours and were exhausted.
I was trying my best and I had no idea what I was doing! This was all orders of magnitude more complicated, more constrained, and more important than anything I’d ever worked on before.
Luckily there was a truly tremendous team of people involved from USDS, many different divisions of Medicare, and several private contractors. I have particular praise and thanks to colleagues from the Center for Clinical Standards and Quality (CCSQ), Office of Enterprise Data and Analytics (OEDA), Office of Information Technology (OIT), and Office of Administration (OA). (Yes, we swim many laps in the alphabet soup.)
I remain in awe of how skillfully and passionately many civil servants can advance their public service mission in spite of endless challenges such as funding limitations, hiring challenges, restrictive compliance burden, and outdated tools for their daily work. I felt honored every day to work with people who cared so much and brought their best selves to the work.
And while not without hiccups or strain, it generally went well! We built the service using open-source components, launched the platform before our required start date, maintained 100% uptime, exceeded our very high participation goals, and supported hundreds of vendors who submitted millions of API requests. Back-of-the-envelope calculations indicate that our novel approach saved at least $100 million compared to the projected cost of implementing the program.
Most importantly, we continued the process of moving Medicare towards providing higher-quality care that’s patient-centered, and we encouraged and financed experimental alternative payment models for healthcare reform that deliver better outcomes for Medicare beneficiaries. And we reduced the expected reporting burden so that healthcare providers can continue seeing Medicare patients across the country.
According to one healthcare analytics firm, the QPP platform represented “a quantum leap forward compared to what Center for Medicare and Medicaid Services (CMS) has done before.” One user called the help desk because she had reached the end of her data submission process but was sure she couldn’t be finished. She’d never completed a Medicare reporting program nearly that fast before. She told us, “This is almost too easy–it’s scary!”
After leaving USDS, what did you decide to do next? How did your experience at USDS shape that decision?
Well, I needed a break! So I walked from Mexico to Canada on the Continental Divide Trail. I spent five months alone with the person who’s meanest to me on planet earth — me — and became good friends with him again. It was roughly equal parts achy processing, wondrous joy, and boredom. I loved almost every mile of it — although screw you still, New Mexico roadwalks.
After that I joined Myst AI, a small startup that uses machine learning to help clean energy companies better predict the future, increase renewable energy adoption, and reduce carbon emissions. Shayle Kann talks about how clean energy technologies are contributing to “grid weirding” — we helped reduce the weirding by making the grid more predictable. I loved being part of a very tight-knit team of people with big brains and big hearts.
What made you decide to come back to USDS?
I worked with the Presidential transition team on the Justice40 initiative, a plan to “deliver justice for communities who have been subjected to environmental harm”. Specifically, Justice40 directs 40% of the benefits from federal spending related to climate and the environment to historically overburdened and underserved communities. Our federal government, through redlining and other policy choices, has repeatedly and intentionally contributed to the unjust distribution of pollution burden and health hazards into communities of color and low-income communities. We are long overdue to redress that, especially as the climate crisis magnifies these inequities.
I loved everyone I met working on these topics, and I wanted to keep working with them. As the federal government ramps up its response to the urgent climate crisis, we’re trying to contribute to a just transition.
How has your experience been rejoining USDS? What has changed and what’s the same?
It’s been really good to be back. USDS is its usual quirky, unpredictable, social self. People are always laughing through the messiness and stress of the work we do.
Early on at USDS, we learned the importance of getting input from people who will be most directly impacted by a program — and from people who will implement the program — as far upstream in the policymaking process as possible. Otherwise, the policy that comes out may look great on paper but either not serve the community it’s trying to serve or be impossible to implement. It’s new that we’re now working so closely with our policy friends at the White House to bring that community and operator’s perspective into planning at the very beginning of an administration.
What are you working on right now?
As I mentioned, I’m working on the Justice40 project to direct 40% of relevant environmental spending to overburdened and underserved communities. And I’m working with awe-inspiring civil servants again — like Dr. Cecilia Martinez, an inspiring life-long environmental justice advocate, and Charles Lee, one of the founders of the environmental justice movement.
One of the most consistent themes from everyone working on this project is that the needs and goals of environmental justice advocates and residents of communities affected by environmental injustice should be driving the policy and implementation roadmap (see the Jemez principles and USDS’s value #6). We’re working on building out that engagement now.
What are you most excited about for the rest of your tour?
I really care about the mission of our team’s work. President Biden has focused on four historic crises: the global pandemic, an economic catastrophe, a continued crisis of racial injustice, and the climate crisis. Environmental justice intersects all four of those. I’m going to try my very damnedest every day to honor that mission.
And I’m very excited about the team we’re building around Justice40, within USDS and across agencies and with external stakeholders. So far it’s been joyous and productive and focused. And we need more people to join! Come help, please!
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