Innovative Database Blueprint Transforms Healthcare Access Nationwide

In a significant advancement for healthcare access, Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum, has developed a modular database blueprint that has revolutionized enrollment processes across multiple state marketplaces in the United States. This innovative design not only enhances accessibility for working families seeking medical coverage but also saves states millions of dollars in fees, particularly for Colorado, which has gained independence from the federal platform.

The journey began with the implementation of the Affordable Care Act in 2012, which mandated states to create digital marketplaces capable of managing high volumes of healthcare enrollments while adhering to stringent privacy standards. Many exchanges struggled to meet these requirements, but Colorado emerged as a leader, achieving remarkable efficiency thanks in large part to Jaiswal’s database architecture. This system successfully managed millions of concurrent transactions, ensuring that enrollment processes remained smooth even under peak loads.

Database Architecture Enhances Performance

Jaiswal’s architecture has proven its effectiveness across various state implementations. In 2023, Colorado achieved a record-breaking enrollment figure, surpassing 220,000 users, the highest since the marketplace’s inception. The system maintains response times of under one second, crucial during peak enrollment periods when demand surges. As Jaiswal noted, “This system secures sensitive personal information while keeping response times under one second, even at peak load.”

The modular nature of the design allows states to customize rules related to affordability and Medicaid eligibility without significant rework. In Massachusetts, for instance, the same platform supports State Wrap premium assistance alongside unified enrollment for private insurance and MassHealth. Advanced encryption and role-based access controls ensure patient data remains secure while maintaining system reliability.

Colorado’s marketplace further demonstrated its capabilities by enrolling over 282,000 people in 2025, setting a new record. This system also achieved an impressive 80% success rate in automated renewals during Medicaid unwinding, effectively preventing coverage gaps that plagued other state platforms during policy changes. Such results highlight how robust technical design translates into improved healthcare access for families.

Cost Savings and Technical Independence

By establishing independent state-based marketplaces, states can avoid federal platform user fees, which were 2.75% in 2023 and 2.2% in 2024. Colorado’s independent exchange has managed to completely sidestep these costs, allowing for more funds to be allocated toward outreach and services. Jaiswal’s database optimizations have drastically reduced processing times from days to minutes, allowing Colorado to avoid costs associated with the federal platform.

Massachusetts also experienced significant improvements after transitioning from batch processes that took up to two hours to real-time transactions. This change led to a reduction in staff workload and shorter call center wait times, facilitating faster issue resolution for families reliant on subsidies for coverage.

The unified platform connects consumers, insurance carriers, state agencies, and navigators, streamlining billing, eligibility checks, and regulatory reporting. States adopting this model can redirect administrative overhead toward outreach and customer support, enhancing overall service delivery.

The impact of Jaiswal’s architecture extends beyond state lines. As national marketplace sign-ups reached 24.2 million for 2025, the importance of efficient platform architecture on costs, performance, and enrollment outcomes becomes increasingly evident. The design serves as a blueprint for states, enabling rapid policy updates and smoother operations, regardless of whether they operate their own sites or utilize the federal platform.

Advancements Through Microservices Architecture

Since 2021, Jaiswal has led a transition from traditional monolithic database designs to a cloud-based microservices architecture. This modern approach allows for scalability up to ten times greater than before, with a significant reduction in maintenance requirements and 97% fewer data inconsistencies. Real-time monitoring tools now identify issues proactively, preventing service interruptions for users.

“I led the migration to microservices, automating deployments and performance tuning, so we could handle sudden traffic spikes without manual intervention,” Jaiswal shared. This transition accelerates policy updates, such as new subsidy rules or expanded Medicaid eligibility, while also reducing compliance audit timeframes.

The cloud-native services provide automated failover capabilities, ensuring continuous operation during hardware failures. This infrastructure allows for policy changes to be implemented with no downtime, supporting compliance with shifting federal or state regulations.

Training Future Database Professionals

Jaiswal’s contributions extend to education, having conducted over 2,000 hours of technical training and mentored more than 100 database professionals. His training focuses on healthcare-specific challenges, such as managing patient privacy and ensuring regulatory compliance under varying demands. “Training others on secure, scalable database practices is as important as writing the code itself,” he emphasized.

His patented data lake design and innovative consent management systems are recognized as groundbreaking advancements in healthcare data handling. Jaiswal’s influence in the technology community is further solidified through his role as a reviewer for international conferences on artificial intelligence, data science, and healthcare technology, where he helps set standards for database design in regulated industries.

By enabling ACA marketplaces across multiple states, Jaiswal’s database design has become integral to U.S. healthcare policy implementation. As healthcare regulations continue to evolve, this architecture empowers states to manage costs and operations effectively. With lower fees and increased reliability, states can focus on enhancing coverage options rather than grappling with technical challenges.

Currently, millions of Americans access healthcare coverage through state exchanges, with Massachusetts enrolling nearly 390,000 people during recent open enrollment periods. These figures represent families who now have access to essential medical care, thanks in large part to the technical infrastructure developed by Jaiswal.

“A flexible, secure, and efficient database foundation is not only a technical achievement—it is a national blueprint that helps states control costs, streamline operations, and keep coverage within reach for millions,” Jaiswal concluded.