Database Architect’s Design Enhances Healthcare Access, Saves Millions

A transformative database architecture developed by Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum, is significantly enhancing healthcare access across multiple states while saving millions in costs. This innovative design has allowed states like Colorado and Massachusetts to operate independently from the federal platform, thereby avoiding substantial user fees and improving efficiency in processing healthcare enrollments.

The journey began in 2012 when the Affordable Care Act mandated states to create digital marketplaces capable of managing high enrollment volumes while adhering to strict privacy requirements. Many states struggled to meet these demands, but Colorado excelled, largely due to Jaiswal’s modular database design. This system efficiently processed millions of concurrent transactions without faltering, a crucial capability during peak enrollment periods.

Revolutionizing Database Architecture for Healthcare

Jaiswal’s architecture has proven versatile across various state implementations. In 2023, Colorado achieved record enrollment numbers, surpassing 220,000 users, the highest since the launch of its exchange. The system maintains sub-second response times, even when thousands of Americans simultaneously search for coverage. “This system secures sensitive personal information while keeping response times under one second, even at peak load,” Jaiswal noted.

The modular nature of the design allows states to customize their affordability rules and Medicaid eligibility requirements without the need to overhaul core components. For example, in Massachusetts, the same platform facilitates 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 high performance.

In 2025, Colorado’s exchange set a new record by enrolling over 282,000 individuals, achieving an impressive 80% success rate in automated renewals during Medicaid unwinding. This efficiency helped prevent coverage gaps, an issue that has plagued other state platforms during times of policy change.

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 are projected to be 2.2% in 2024. Colorado’s independent exchange completely sidesteps these costs, allowing more funds to remain in-state for outreach and service initiatives. Jaiswal’s optimizations have reduced processing times from days to mere minutes, significantly enhancing operational efficiency.

Massachusetts has experienced similar improvements after transitioning from lengthy batch processes to real-time transactions, ultimately decreasing staff workload and reducing call center wait times. This shift enables faster issue resolution for families depending on subsidies to afford healthcare coverage.

The integration of a unified platform allows consumers, insurance carriers, state agencies, and navigators to operate within a single system. This streamlining of processes improves billing, eligibility verification, and regulatory reporting, redirecting administrative overhead towards customer support rather than infrastructure maintenance.

The impact of this architecture extends beyond individual states; it serves as a national blueprint for optimizing healthcare marketplaces. By decoupling core components from state-specific regulations, the design allows for rapid policy updates and smoother operations, whether a state operates its own site or utilizes the federal platform.

Modernization and Training for Future Challenges

Since 2021, Jaiswal has led the transition from a monolithic database design to a cloud-based microservices architecture. This new system is ten times larger, reduces maintenance requirements, and operates with 97% fewer data inconsistencies. Real-time monitoring tools help identify issues before they affect users, enhancing reliability and performance.

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

Jaiswal emphasizes the importance of training for the next generation of database professionals. Having conducted over 2,000 hours of technical training and mentored more than 100 database professionals, he focuses on healthcare-specific challenges, including patient privacy and regulatory compliance. His patented data lake design and consent management systems have gained recognition for their innovation in healthcare data handling.

Through his work, Jaiswal has become a vital contributor to U.S. healthcare policy implementation. The database design he created enables states to exert control over costs and operations, with lower fees and higher reliability allowing them to focus on improving healthcare coverage options.

Currently, millions of Americans access healthcare coverage through state exchanges, with Massachusetts alone enrolling nearly 390,000 individuals during recent open enrollment periods. These numbers reflect families who have gained access to essential medical care through the infrastructure designed by Jaiswal.

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