Innovative Database Design Transforms Healthcare Access and Saves Millions

In a significant advancement for healthcare access, Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum, has developed a modular database architecture that is reshaping state marketplaces across the United States. This innovative design not only enhances the efficiency of healthcare enrollment processes but also saves states millions in operational costs.

The journey began in 2012 when the Affordable Care Act mandated states to create digital marketplaces capable of handling extensive enrollment while adhering to strict privacy regulations. Many exchanges struggled to meet these demands, but Colorado’s system excelled, thanks to Jaiswal’s strategic database design. This initiative allowed Colorado to operate independently of the federal platform, thus avoiding significant annual fees that could have burdened its budget.

Revolutionizing Enrollment Efficiency

Jaiswal’s database architecture has proven to be versatile and effective, particularly for Colorado, which achieved record enrollment figures surpassing 220,000 users in 2023. The system consistently maintains sub-second response times, ensuring that even during peak enrollment periods, when hundreds of thousands seek coverage simultaneously, sensitive personal information remains secure. “This system secures sensitive personal information while keeping response times under one second, even at peak load,” Jaiswal stated.

This modular design allows states to customize their affordability rules and Medicaid eligibility without the need to overhaul the entire system. In Massachusetts, the same platform supports State Wrap premium assistance and unifies enrollment processes for private insurance and MassHealth. Advanced encryption and role-based access controls further enhance the protection of patient data while ensuring reliability.

In 2025, Colorado’s exchange enrolled more than 282,000 individuals, setting a new record. The system achieved an 80% success rate in automated renewals during the Medicaid unwinding process, effectively preventing coverage gaps that plagued other state platforms during policy transitions.

Cost Savings and Technical Independence

State-run marketplaces that utilize Jaiswal’s database can avoid federal platform user fees, which were 2.75% in 2023 and are projected to decrease to 2.2% in 2024. This independence allows states to allocate more funding towards outreach and services. Colorado’s independent exchange, for instance, completely bypasses these costs, which has resulted in reduced processing times from days to mere minutes.

Massachusetts saw similar improvements after transitioning from batch processing that took two hours to real-time transactions. As a result, staff workloads decreased, and call center wait times were significantly reduced, enabling quicker resolutions for families relying on subsidies.

The integrated platform connects consumers, insurance carriers, state agencies, and navigators into a single system, streamlining billing, eligibility verification, and regulatory reporting. By adopting this model, states can redirect administrative overhead towards enhancing customer support rather than maintaining extensive infrastructure.

The implications of this database architecture extend beyond individual states. As the national marketplace sign-ups reached 24.2 million in 2025, the architecture serves as a successful model for states to improve their healthcare exchanges. This adaptable design enables rapid policy updates and smoother operations, whether a state operates its own site or relies on the federal platform.

Since 2021, Jaiswal has overseen a transition from traditional database structures to a modern cloud-based microservices architecture. This shift enhances scalability, reduces maintenance needs, and decreases data inconsistencies by 97%. Real-time monitoring tools effectively identify issues before they impact users.

“I led the migration to microservices, automating deployments and performance tuning, so we could handle sudden traffic spikes without manual intervention,” Jaiswal explained, highlighting the architecture’s capacity to support swift policy changes while ensuring compliance.

Jaiswal’s commitment to training has also made a substantial impact on the healthcare technology landscape. He has conducted over 2,000 hours of technical training and mentored more than 100 database professionals, focusing on challenges specific to healthcare, such as patient privacy and regulatory compliance. His patented data lake design and innovative consent management systems have gained recognition in healthcare data management.

As healthcare regulations continue to evolve, Jaiswal’s database design empowers states to maintain control over their operational costs and improve coverage options. The system currently serves millions of Americans accessing healthcare coverage through state exchanges. Notably, Massachusetts enrolled nearly 390,000 individuals during recent open enrollment periods, exemplifying the real-world impact of Jaiswal’s work.

“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. This innovative approach is setting new standards for healthcare access across the United States.