Mina Hsiang
‘I Was Just Really Persistent, Listened, and Kept Showing Up’: Mina Hsiang on the Power of Tenacity in Digital Transformation
| Mina Hsiang was the founding Executive Director of the U.S. Digital Service at Health and Human Services, and served at USDS from 2015 through 2017. Prior to USDS, she was the Senior Advisor to the U.S. Chief Technology Officer for Healthcare and Health Data. In January 2021, Mina rejoined USDS, and later became its third Administrator. |
Mina Hsiang was no stranger to public service before joining the US Digital Service: She came from a family of public servants and had held internships at the Office of Management and Budget and the Food and Drug Administration.
Mina’s work at the healthcare company Optum, where she was the VP of New Products in the Analytics Division, coincided with the 2013 HealthCare.gov crisis, during which she helped with the rescue effort. She joined USDS as a staff member about a year later, leading projects at the VA, Department of Defense, Health and Human Services, and other federal agencies.
Below, Mina discusses USDS’s relationship with different federal agencies, responding to the HealthCare.gov crisis, and public service as a calling.
April 3, 2024
Kathy Pham:
Mina, tell us about your journey to USDS.
Mina Hsiang:
I grew up in a family that worked in government. Three out of my four grandparents worked in the federal government, in Taiwan or the U.S. I also had various aunts and uncles who worked in government.
My grandfather was my role model. He was an engineer and had worked in the Department of Commerce, and we spent a lot of time talking about the interplay between government and the private sector as it pertains to technology. My grandmother worked on the Manhattan Project, and my grandfather set up technical training programs at business schools in China through the U.S. government.
My first stint at USDS was actually my third stint in government. I went to MIT for undergrad and did an internship at the Center for Device and Radiological Health (CDRH) in the Food and Drug Administration (FDA). They had never had a technical intern before. They were used to interns carrying the coffee, but when I got there they told me, “Start evaluating medical devices.” It was a really helpful window into how medical devices and drugs are regulated, and the role that government plays in the ecosystem. So much of your life is governed by what the FDA does, and it feels like a black box to most people. But I learned the FDA is made up of normal people with too much work on their desks who are trying to meet deadlines and make good decisions about safety and efficacy. It was a very useful internship and it was definitely a part of my journey.
I was always interested in service work that was quasi-technical. So I joined the Clinton Foundation, where I worked with different governments— including the government of Malawi — to set up health and water and sanitation programs. That provided a different view on a different set of bureaucratic norms and places. In Malawi, I ran a lot of meetings for government workers, and if offered soda and biscuits, people were dramatically more likely to show up. There were lots of interesting bureaucracy hacks and perverse incentives.
Later, I went to Harvard Business School and interned at the Office of Management and Budget (OMB). When I applied, my application ended up who knows where; nobody ever got back to me. So I went online and found an OMB org chart with no names, only phone numbers. And I just started calling. This was in 2009.
Someone answered in the energy branch at OMB, and I talked to him for an hour. They said they’d filled the internship spot, but to send over my materials again. I eventually got an interview in the Tennessee Valley Authority branch, but it was really weird and not for me. Afterwards, I wandered around the building looking for the people I had originally talked to on the phone. I found them and spent another hour there. The next day they called me and said, “We found money for another intern.”
Kathy:
Was there anything else about the OMB experience that planted seeds for later?
Mina:
I learned a lot about scale and financial projections and how government accounting works and affects the policies it needs to enact. Waxman-Markey, a carbon pricing bill at the time, was working its way through Congress when I was there, and one of my jobs was to track and price that legislation. I was also asked to evaluate the loan guarantees for Ford, Fisker, and Tesla – which was fascinating for it’s scale and also for seeing how government interacts with private sector companies in a very different way. Also, OMB has a very prominent and important political-nonpolitical seam, and I saw the way that government works with the career staff and political staff dynamic. All of these things contributed to my understanding of how government works.
Afterward, I was a venture capitalist for a while and did more government-adjacent investing than your average VC associate/principal. Then I went to Optum, a big healthcare company. I was working on data, and eventually HealthCare.gov happened. I started bothering my boss: “We have an exchange business, why don’t we go help?” And they replied, “Well, it’s not going to be profitable.”
I waited a couple of weeks and I saw an executive vice president from my company testifying before Congress. So I returned to my boss: “Hey, me again. Looks like we’re helping. Can you assign me to this project?” And they assigned me to the project.
Because I worked for Optum, I was technically one of the contractors working on HealthCare.gov, rather than one of the fancy people who were brought in to help contractors. But it’s never been clear to me why that should make any difference. We create this magical narrative, but the majority of the people working on the project weren’t feds; they all got hired as subcontractors to other vendors.
Emily:
So first you worked on HealthCare.gov through Optum, and then you joined USDS in 2015.
Mina:
Yep. After I was assigned to HealthCare.gov, my boss asked me to build and stand up a scheduling system so people could sign up for slots on HealthCare.gov. So I talked with relevant people at Optum and also with Deputy U.S. Chief Technology Officer (CTO) Ryan Panchadsaram (also known as RyPan). RyPan, Mikey Dickerson, and Paul Smith had just arrived and had started a standup.
I started going to the standup, working on this prototype, and reading all the notes. I was making mock-ups and asked, “What information do we need from people to ask them to apply for health insurance?” But nobody could answer that question for me. So I phoned the call center and said, “I would like to sign up for health insurance.” I wrote down every question they asked me. And then I typed it up and said, “Here’s all the questions we ask people.” It was the first of 100 times that I signed up for health insurance.
When I arrived at the project, I was asked to focus on and evaluate core metrics. At some point, the team was trying to figure out how to debug the latency, and during a standup Mikey listed all the applications that we were running. He said, “We’re going to turn all this off if no one can say what they’re using it for.” One of the things he wanted to turn off was Splunk. I said, “I don’t think you want to turn off Splunk.” Mikey replied, “Who are you? You now own Splunk — make it useful or we’re turning it off.”
So I’m helping them get organized, and Ryan and I start standing up the front end, and I’m also part of all these Optum teams. I’m moving between all the different vendors, keeping track of all of their tickets. And I still have to brief my Optum leadership every day. It was very USDS, having to wear multiple hats.
Emily:
So even though you worked for Optum, you were not necessarily representing Optum in a traditional way. Instead, you were focused on, “How do we solve this problem effectively?”
Mina:
That’s right. I moved anywhere I wanted and had whatever conversations I wanted, and so a lot of things shifted early on. At one point I connected with two guys from the insurance companies. They said, “All of us insurers are getting gobbledygook forms, but no one will listen to us.” They started explaining the process and the problem, and I realized it was a goldmine. So I started reading the ticket boards for every single vendor and figured out, “Oh, actually this problem that the insurers are experiencing comes from these four different issues.” It was about understanding how it all fits together.
Nowadays, during more recent crises, people assert that I can get certain results or access because of my position as the administrator. But during HealthCare.gov, I had no status. I was just really persistent and kept showing up. And this is the thing I now tell teams.
Kathy:
Mina, can you discuss how you went from HealthCare.gov to USDS?
Mina:
When I was working on HealthCare.gov, there were whispers of creating a U.S. Digital Service. After HealthCare.gov, I went back to Optum and ended up running new products and strategy for the analytics division. But I was still talking to my friends in and around government, and they were kicking around ideas.
Later, when I was trying to get hired at USDS, I applied for the Digital Service team at the Veterans Affairs (VA) as well as USDS Headquarters, testing out the new hiring process. I didn’t tell everyone that I applied, because I wanted to see what would happen since I have a weird resume; my resume was rejected from the new hiring process at the Digital Service at the VA.I don’t recall how much I cared, but I sent my rejection email to Matthew Weaver, who was leading the Digital Service team at the VA, who immediately texted me freaking out: “Whoa, whoa, whoa, we’re going to work on it.” They figured out the issue, and I was eventually hired. At the same time, I was accepted to USDS Headquarters. Later, during a USDS meeting, Mikey put me on speaker after I was accepted. He said, “We realized that none of us have sent you a general offer. We all assumed somebody else was doing it.” In the end, I got an offer, and we fixed that process too.
Kathy:
Tell us about your first day.
Mina:
My first day at USDS was in 2015, and it was a snow day. My first project was focused on synchronizing across VISTA instances. I ended up doing a big research project and coming up with a recommendation. And then I worked on the Department of Defense (DOD) sprint, which was so many things wrapped into one. This is around the time Ben Mauer was kicked out of the Pentagon meeting for wearing jeans. And I’m the person who then said, “You can’t kick out my guy.”
Kathy:
I want to get into your work standing up a USDS team within Health and Human Services (HHS), because every agency team is so different.
Mina:
I had a very clear vision on what I wanted to do at HHS. I had helped set up a precision medicine initiative at the National Institutes of Health (NIH). I had worked on HealthCare.gov. I had worked at the Centers for Medicare & Medicaid Services (CMS). Others at USDS said, “It can’t be done,” but I told Mikey, “I can set up an HHS team.” Mikey was skeptical. I explained that while it was too hard to put a central team within HHS, we could get CMS to pay for it and then send people and have an agreement with HHS.
Kathy:
That’s such a great story for understanding the bureaucracy of every place we go into. You really understood the model that could work. Related to that: What are some of the things you’ve done at USDS that you are really proud of?
Mina:
I’m proud of the work we did at CMS and HHS in general. We really did change the agencies’ perspective, capitalize on momentum from HealthCare.gov, and pioneer a new way to do things. We built a really great team and team culture, and I had not done that before. All of USDS and HealthCare.gov was a growth experience.
Kathy:
Thanks Mina!