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Commit: The Nuna Story

Jini Kim

Cofounder and CEO

Nuna is the story of the passionate Jini Kim, propelled by family tragedy to deliver better health care to huge numbers of Americans. Of how she bootstrapped Nuna through years of rejection. And of how she recruited engineers and data scientists to commit to a wildly audacious goal: building a new Medicaid data platform, from scratch.

Alongside focus, commitment is a core element of our first superpower. In implementing OKRs, leaders must publicly commit to their objectives and stay steadfast. At Nuna, a health care data platform and analytics company, the cofounders overcame a false start with OKRs. They went on to clarify priorities for the entire organization. They realized that they needed to show a sustained commitment to reach their own individual OKRs, and to help their team do the same.

Nuna took off in 2014. Four years and one enormous Medicaid contract later, the company is leveraging data to make the health care system work better for millions of people who need it most. Applying the technology and lessons learned from its Medicaid work, Nuna is helping large companies improve the efficiency and quality of care in their private plans. All of this work is supported by the goal-setting prowess of OKRs, which Jini first encountered as a Google product manager.

This story reflects two aspects of our commitment superpower. Once Nuna’s team got the hang of them, OKRs locked in their commitment to their highest-impact goals. At the same time, both leaders and contributors learned to commit to the OKR process itself.

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Jini Kim: The story of Nuna is very personal. When my brother Kimong was two years old, he was diagnosed with severe autism. A few years later, he had his first grand mal seizure at Disneyland. One second he was fine, and the next he was on the floor, barely able to breathe. As Korean immigrants with limited resources and little English, my parents felt helpless. Without a safety net, my family would surely have gone bankrupt. The task of signing us up for Medicaid fell to me, at age nine.

When I joined Google in 2004, my first job out of college, I’d never heard of OKRs. But over time, they became an indispensable compass to help me and my teams navigate through Google and get the most important work done. One of the first products I worked on, Google Health, taught me the importance of data for improving health care. I also learned just how difficult it can be to gain access to health care data, even one’s own. In 2010, that experience led me to found Nuna.

We didn’t use OKRs in the beginning. Nuna had no money and no customers. I was working full time and five others part time (including my grad student cofounder, David Chen), but no one was getting paid. We stitched together a prototype and talked to some large self-insured employers. That first year we got zero orders, and rightfully so. We thought we knew what the market needed, but we didn’t yet understand our customers well enough to effectively advocate for the product.

When we still had no orders in year two, I knew it was time to get an education. What did benefits directors actually care about? What did meaningful innovation look like in the health care market? I put on a suit and crashed some human resources conferences to find out.

In 2012, the things I’d learned helped us sign some Fortune 500 companies as clients. More than two years of rejection, frustration, and more ramen dinners than I could count had finally led Nuna to a product-market fit. But at a start-up, the only constant is change, and Nuna was about to undergo a dramatic one. After I returned to the Bay Area from a six-month stint with Healthcare.gov, we closed $30 million of funding. We’d finally be able to pay our team, and for many years to come.

By that point, I’d learned of a government request-for-proposals to build the first-ever database for all Medicaid members: 74.5 million lives in fifty states, five territories, and the District of Columbia. The effort had already failed multiple times. After seventy-two hours fueled by adrenaline and Red Bull, we submitted our bid just on time to the Centers for Medicare & Medicaid Services (CMS). Two months after that, we found out we had won the contract.

Scaling Nuna was an enormous undertaking, in three dimensions. The first was the business itself, to upgrade compliance, security, and privacy. The second was our data platform infrastructure. The third was our employee base, from fifteen people to seventy-five. We’d have to construct a historic database while still running our existing employer business—and to finish within a year. To deliver, we’d need more focus and commitment than ever before.

In 2015, we made an initial try to implement OKRs. As an ex-Googler, I was sold on the power of objectives and key results. But I underestimated what it took to introduce them, much less to execute them effectively. You need to build your goal muscle gradually, incrementally. As I know too well from my own private wellness OKR to run a marathon: Doing too much too soon will definitely end in pain.

We created quarterly OKRs and annual OKRs, and rolled them out to everybody at Nuna from day one. We were tiny then, around twenty people—not such a big lift, you might think. But the process didn’t take. Some people never set their individual OKRs; others set them, but stuck them in a drawer.

With hindsight, I would have started with our leadership team of five. For structured goal setting to prosper, as our company learned the hard way, executives need to commit to the process. It may take a quarter or two to overcome your managers’ resistance and get them acclimated to OKRs—to view them not as a necessary evil, or some perfunctory exercise, but as a practical tool to fulfill your organization’s top priorities.

Until your executives are fully on board, you can’t expect contributors to follow suit—especially when a company’s OKRs are aspirational. The more challenging an objective, the more tempting it may be to abandon it. People naturally look to their bosses in setting goals and following through. If the officers jump ship in the middle of a stormy voyage, you can’t expect the sailors to bring it into port.

In mid-2016, we tried again, with a renewed level of OKR commitment. But even as I saw our executive team buy in, I knew I couldn’t be complacent. As the leader, it was my job to keep after people. I would email our contributors to commit to creating individual OKRs. If they didn’t respond, I would reach out to them via Slack, the team messaging app. If they still didn’t hear me, I would text them. And if they still didn’t listen, I would grab them and say, “Please do your OKRs!”

To inspire true commitment, leaders must practice what they teach. They must model the behavior they expect of others. After sharing my individual OKRs at an all-hands meeting, I was surprised by just how much it helped the company rally around the process. It showed everyone that I, too, was accountable. Our contributors feel free to evaluate my OKRs and tell me how to improve them, which has made all the difference. Here’s one example, with my grades (on the Google scale of 0.0 to 1.0) in brackets. I can tell you that I received a lot of constructive input in formulating this deceptively simple and make-or-break hiring OKR:

We also added two key results to measure our commitment to professional development:

At Nuna, our commitment to OKRs is very public and visible. But there are times when the system is more useful in a private mode. In the fourth quarter of 2016, I set my sights on hiring a VP for our employer business, a critical step to accelerate the growth of that business unit. It was a new position for the company, and I was unsure how it would be perceived internally. Establishing a private OKR, for which only David and I were accountable, deepened my commitment to get the hiring process moving. It pushed me to speak one-on-one to key stakeholders in the company, find potential recruits, and finally set into motion a more formal recruitment process.

By definition, start-ups wrestle with ambiguity. As Nuna’s terrain has expanded, from self-insured employers to the massive Medicaid database to a suite of new health plan products, we’ve come to rely on OKRs more than ever. Our whole team needs sharper focus and clearer priorities, the prerequisites for deeper commitment. OKRs have forced a bunch of conversations in the company that otherwise would not have happened. We’re getting more alignment. Instead of reacting to external events on the fly, we’re acting purposefully on our plans for each quarter. Our deadlines are stricter, yet they also feel more attainable. We’re committed to doing what we’ve said we will do.

What’s the moral of our OKR story? As David says, “You’re not going to get the system just right the first time around. It’s not going to be perfect the second or third time, either. But don’t get discouraged. Persevere. You need to adapt it and make it your own.” Commitment feeds on itself. Stay the course with OKRs, as I know firsthand, and you will reap amazing benefits.

Today, with the invaluable support of our CMS partners, Nuna has built a secure, flexible data platform to store private health information for more than 74 million Americans. But we aspire to do so much more. We want our platform to inform policy makers as they grapple with governing a costly and complex health care system. We want it to drive analytics, to help predict and prevent future ailments. Most of all, we want it to play a big role in improving the nation’s health care. It’s a daunting commitment. But as I learned at Google: The hairier the mission, the more important your OKRs.

All these years later, my little brother Kimong speaks only three words: uhma, appa, and nuna—Korean for mom, dad, and big sister. Kimong gave our company both its name and its mission. Now it’s up to us, backed by our commitment to OKRs, to help improve health care for everyone.

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In January 2017, Nuna peeled back the curtain on its Medicaid work. Interviewed by The New York Times, Andrew M. Slavitt, acting director of the Centers for Medicare & Medicaid Services, described Nuna’s cloud database as “near historic,” a leap from state-level computing silos to the first “systemwide view across the program.”

In just a few short years, Nuna’s team has made a lasting impact on the U.S. health care system. But anyone who knows Jini and David—and the strength of their commitment to OKRs—will tell you they are just getting started.