Database Architect Revolutionizes Healthcare Access and Saves Millions

In a groundbreaking move, Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum, has developed a modular database blueprint that significantly enhances healthcare access while saving state governments millions of dollars. His innovative design is already operational in several state marketplaces, notably helping Colorado gain independence from the federal platform and avoid substantial annual fees.

The journey began in 2012 with the implementation of the Affordable Care Act, which mandated states create digital marketplaces to manage healthcare enrollment. Many exchanges faced challenges under the weight of high enrollment volumes and strict privacy requirements. However, thanks to Jaiswal’s database architecture, Colorado has successfully processed applications, achieving record enrollment figures while maintaining stringent security protocols.

Transforming State Marketplaces

Jaiswal’s database architecture has shown remarkable versatility across different state implementations. Colorado reported enrollment numbers exceeding 282,000 in 2025, marking its highest tally since the exchange’s inception. Notably, the system consistently maintains sub-second response times during peak periods, allowing hundreds of thousands of Americans to search for coverage simultaneously.

“This system secures sensitive personal information while keeping response times under one second, even at peak load,” Jaiswal stated. The modular design enables various states to customize their affordability rules and Medicaid eligibility without the need to overhaul core components. For instance, Massachusetts utilizes the same platform for its State Wrap premium assistance and unified enrollment for private insurance and MassHealth.

The database optimizations implemented by Jaiswal have drastically reduced processing times, cutting them from days to mere minutes. This efficiency is vital as states like Colorado avoid user fees associated with the federal platform, which stood at 2.75% in 2023 and 2.2% in 2024. Consequently, more funds remain within the states for outreach and stability.

National Implications and Future Developments

The implications of Jaiswal’s work extend beyond individual states. As national enrollment numbers reached 24.2 million in 2025, the architecture he developed serves as a model for other states, allowing them to transition between fully state-run exchanges and those using HealthCare.gov without disrupting coverage. This capability is crucial for ensuring that families maintain access to healthcare services during policy shifts.

Since 2021, Jaiswal has also spearheaded a transition from a monolithic database design to a cloud-based microservices architecture, which enhances scalability and reduces maintenance challenges. The new system operates with an impressive 97% reduction in data inconsistencies, providing real-time monitoring to preempt service interruptions.

“I led the migration to microservices, automating deployments and performance tuning, so we could handle sudden traffic spikes without manual intervention,” he explained. This transition allows for rapid policy updates, including new subsidy rules and expanded Medicaid eligibility, further enhancing the reliability of state exchanges.

Jaiswal’s contributions extend to training and mentorship, with over 2,000 hours dedicated to educating more than 100 database professionals. His focus on healthcare-specific challenges ensures that the next generation is equipped to manage patient privacy and regulatory compliance effectively.

As the landscape of U.S. healthcare continues to evolve, Jaiswal’s work provides states with the tools needed to control costs and streamline operations. Lower fees and higher reliability enable states to focus on improving coverage options rather than grappling with technical issues.

Counting millions of Americans who rely on these state exchanges for healthcare, Jaiswal’s innovative database design stands as a testament to the impact of strategic engineering in the healthcare sector. “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,” he concluded.