Photo courtesy of Vishal Jaiswal.
Opinions expressed by contributors are their own.
In a server room in Ashburn, Virginia, thousands of database transactions execute every second, processing healthcare enrollment decisions that determine whether working families can afford medical coverage. Behind this infrastructure stands Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum, whose modular database blueprint underpins multiple state marketplaces and demonstrates how engineering choices can shift costs and outcomes at national scale. His technical work contributed to Colorado’s independence from the federal platform, helping the state avoid substantial annual fees paid to Washington.
The story begins in 2012, when the Affordable Care Act required states to build digital marketplaces capable of handling massive enrollment volumes while maintaining strict privacy standards. Most exchanges struggled under the pressure. Colorado’s system processed applications efficiently, thanks in part to Jaiswal’s database design that could handle millions of concurrent transactions without breaking down.
Database architecture for healthcare access
Jaiswal’s database architecture demonstrated versatility across multiple state implementations, with Colorado achieving remarkable results. The state reached recordbreaking enrollment numbers, surpassing 220,000 users in 2023, the highest since the exchange’s launch. The system maintains subsecond response times even during peak enrollment periods when hundreds of 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 explained.
The modular design allows each state to customize affordability rules and Medicaid eligibility requirements without rebuilding core components. In Massachusetts, the same platform supports State Wrap premium assistance and unified enrollment for private insurance and MassHealth. Advanced encryption and rolebased access controls protect patient data while maintaining speed and reliability.
Colorado’s exchange enrolled more than 282,000 people in 2025, setting a record high. The system achieved an 80% success rate in automated renewals during Medicaid unwinding, preventing coverage gaps when policy changes overwhelmed other state platforms. These results demonstrate how solid technical design translates into healthcare access for real families.
Technical independence and cost savings
Independent, statebased marketplaces can avoid federal platform user fees—2.75% in 2023 and 2.2% in 2024—keeping more funds instate for outreach, service, and stability. Colorado’s independent exchange avoids these costs entirely. Jaiswal’s database optimizations reduced processing time from days to minutes. When the federal platform charged fees on every premium dollar, Colorado’s independent exchange avoided those costs entirely.
Massachusetts experienced similar gains after replacing batch processes that took two hours with realtime transactions. Staff workload decreased and call center wait times fell, enabling quicker issue resolution for families who depend on subsidies to afford coverage.
The unified platform connects consumers, insurance carriers, state agencies, and navigators onto a single system. This integration streamlines billing, eligibility verification, and regulatory reporting. States that adopt this model redirect administrative overhead toward outreach and customer support rather than infrastructure maintenance.
National impact: A blueprint for states
With marketplaces split between fully staterun sites and those on HealthCare.gov, platform architecture influences costs, performance, and enrollment outcomes across the country, not just in a single state. By avoiding federal platform user fees—which were 2.75% in 2023 and 2.2% in 2024—statebased exchanges can redirect resources toward consumer assistance and stability during peak enrollment. As national marketplace signups reached 24.2 million for 2025 and Colorado hit 282,000 enrollments, these systems demonstrate significant scale and impact.
This architecture functions as a blueprint for states by decoupling core components from statespecific rules, enabling rapid policy updates and smoother operations whether a state runs its own site or uses the federal platform. Because dozens of states still enroll through HealthCare.gov while others run their own sites, reusable designs help states move between models without disrupting coverage.
Modernizing through microservices architecture
Since 2021, Jaiswal has guided a transition from monolithic database design to cloudbased microservices. The new architecture scales ten times larger, reduces maintenance requirements, and operates with 97% fewer data inconsistencies. Realtime monitoring tools identify problems before users experience service interruptions.
“I led the migration to microservices, automating deployments and performance tuning, so we could handle sudden traffic spikes without manual intervention,” Jaiswal explained. This shift accelerates policy updates, such as new subsidy rules or expanded Medicaid eligibility, and reduces compliance audit timeframes.
Cloudnative services provide automated failover capabilities, ensuring continuous operation during hardware failures. The system can deploy policy changes without downtime, keeping exchanges compliant and operational when federal or state regulations shift.
Training database professionals for healthcare systems
Jaiswal has conducted more than 2,000 hours of technical training and mentored over 100 database professionals. His teaching focuses on healthcarespecific challenges: managing patient privacy, ensuring regulatory compliance, and maintaining performance under variable demand. “Training others on secure, scalable database practices is as important as writing the code itself,” he said.
His patented data lake design and innovative consent management systems are recognized as groundbreaking in healthcare data handling. Conference presentations and peer review work extend his influence across the broader technology community. Jaiswal serves as a reviewer for international conferences on artificial intelligence, data science, and healthcare technology, helping set standards for database design in regulated industries.
Supporting healthcare policy implementation
By enabling ACA marketplaces in multiple states, Jaiswal’s database design became part of U.S. healthcare policy implementation. Healthcare regulations continue evolving, but this database design gives states control over costs and operations. Lower fees and higher reliability allow states to focus on improving coverage options rather than managing technical problems.
The system currently serves millions of Americans who access healthcare coverage through state exchanges. Massachusetts alone enrolled nearly 390,000 people during recent open enrollment periods. These numbers represent families who gained access to medical care through the technical infrastructure Jaiswal designed.
“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.
