Database Architect’s Design Revolutionizes Healthcare Access and Reduces Costs

In a significant advancement for healthcare access, Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum, has developed a modular database architecture that streamlines healthcare enrollment processes across multiple states. This innovative design not only enhances service delivery but also saves states millions in federal fees. Notably, Colorado has benefitted from this architecture, achieving greater independence from the federal platform and avoiding substantial annual costs.

The journey began in 2012, when the Affordable Care Act mandated that states establish digital marketplaces for healthcare enrollment. Many exchanges struggled to meet the high demand, but Colorado’s system, underpinned by Jaiswal’s design, effectively processed applications for over 220,000 users in 2023, the highest enrollment since the exchange’s inception. Jaiswal’s system maintains remarkable efficiency, ensuring sub-second response times even during peak periods when hundreds of thousands of individuals seek coverage.

Transforming Database Architecture for Enhanced Performance

Jaiswal’s database architecture proved adaptable, allowing states to modify affordability rules and Medicaid eligibility without overhauling the core system. For instance, in Massachusetts, the same architecture supports a unified enrollment process for private insurance and MassHealth, demonstrating its versatility. Advanced encryption and role-based access controls ensure patient data security while maintaining rapid response times.

In 2025, Colorado’s exchange set a new record by enrolling over 282,000 individuals. This achievement highlights an 80% success rate in automated renewals during Medicaid unwinding, effectively preventing coverage gaps that plagued other state platforms. These outcomes illustrate how robust technical design translates into tangible benefits for families seeking healthcare.

The independence afforded by Jaiswal’s architecture allows state-based marketplaces to avoid federal user fees, which were 2.75% in 2023 and projected at 2.2% in 2024. Colorado’s exchange has completely sidestepped these costs, enabling more funds to be allocated towards outreach and service stability. In Massachusetts, real-time transaction capabilities have replaced lengthy batch processes, significantly reducing staff workloads and improving customer service response times.

A National Blueprint for Healthcare Access

The impact of Jaiswal’s design extends beyond individual states. As marketplaces across the U.S. vary between fully state-run sites and those operated through HealthCare.gov, the architectural choices made by each state influence overall costs, performance, and enrollment outcomes. This modular approach allows states to pivot between models seamlessly, ensuring uninterrupted coverage for their residents.

Since 2021, Jaiswal has led a transition from traditional monolithic database designs to a cloud-based microservices architecture. This evolution increases scalability, reduces maintenance needs, and minimizes data inconsistencies by 97%. Utilizing real-time monitoring tools, the system can proactively address potential issues, enhancing user experience during peak traffic.

Jaiswal has also prioritized training for over 100 database professionals, dedicating more than 2,000 hours to develop their skills in managing healthcare-specific challenges. His innovative designs, including a patented data lake and consent management systems, have set new standards for data handling in healthcare.

By enabling state-based marketplaces, Jaiswal’s architectural contributions have become integral to the implementation of U.S. healthcare policies. As regulations continue to evolve, his work empowers states to maintain control over costs and operational efficiency. This not only lowers fees but also enhances reliability, allowing states to focus on improving healthcare coverage options for their residents.

The current systems serve millions of Americans, with Massachusetts recently enrolling nearly 390,000 individuals during open enrollment. These figures reflect the real-world impact of Jaiswal’s infrastructure, which supports families in securing medical care.

In conclusion, Jaiswal emphasizes that a robust, flexible, and secure database foundation is more than just a technical success; it serves as a national blueprint for states. By providing the tools necessary to manage costs, streamline operations, and ensure healthcare accessibility, his work stands to benefit millions of people across the United States.