Database Architect’s Innovations Revolutionize Healthcare Access

In Ashburn, Virginia, thousands of database transactions occur each second, facilitating healthcare enrollment decisions that directly affect working families’ access to medical coverage. At the heart of this critical infrastructure is Vishal Kumar Jaiswal, Senior Manager of Software Engineering at Optum. His innovative modular database design supports multiple state marketplaces, demonstrating how strategic engineering can enhance healthcare access and save states millions.

The narrative of this achievement traces back to 2012, when the Affordable Care Act mandated that states develop digital marketplaces capable of accommodating significant enrollment volumes while ensuring strict privacy standards. Many exchanges faced challenges under this demand. However, Colorado’s system excelled, largely due to Jaiswal’s database design, which efficiently managed millions of concurrent transactions without system failures.

Transforming Healthcare Enrollment with Advanced Database Architecture

Jaiswal’s database architecture has shown remarkable adaptability across various state implementations, particularly in Colorado, which achieved record enrollment numbers. In 2023, the state surpassed 220,000 users, the highest since the exchange’s inception. The system consistently maintains sub-second response times, even during peak enrollment, when hundreds of thousands of individuals seek coverage. “This system secures sensitive personal information while keeping response times under one second, even at peak load,” Jaiswal stated.

The modular nature of the architecture allows states to tailor affordability rules and Medicaid eligibility requirements without needing to overhaul core components. For instance, in Massachusetts, the identical platform facilitates State Wrap premium assistance and integrates enrollment for both private insurance and MassHealth. Enhanced encryption and strict access controls help protect patient data while ensuring quick, reliable service.

In 2025, Colorado’s exchange enrolled over 282,000 individuals, achieving an 80% success rate in automated renewals during the Medicaid unwinding period. This success prevented coverage gaps that other state platforms struggled to manage. Such results underscore how robust technical design can translate into improved healthcare access for families.

Cost Savings and Technical Independence

By establishing independent state-based marketplaces, Colorado successfully avoids federal platform user fees, which were 2.75% in 2023 and are projected to be 2.2% in 2024. This financial freedom allows states to allocate more resources towards outreach, customer support, and operational stability. Jaiswal’s database optimizations have significantly reduced processing times from days to mere minutes. In contrast, the federal platform’s fees on premium dollars have been completely sidestepped by Colorado’s independent exchange.

Massachusetts has similarly benefitted by transitioning from time-consuming batch processes to real-time transactions, reducing staff workload and call center wait times. This has enabled quicker resolutions for families reliant on subsidies to access coverage.

The unified platform connects consumers, insurance providers, state agencies, and navigators, optimizing billing, eligibility verification, and regulatory reporting. States adopting this integrated model can reallocate administrative costs towards enhancing consumer assistance and support.

Jaiswal’s design serves as a national blueprint for states, showcasing how architectural decisions in marketplace platforms can significantly affect costs, performance, and enrollment outcomes. With national marketplace sign-ups reaching 24.2 million for 2025, and Colorado achieving notable enrollment numbers, the impact of these systems is substantial.

Modernizing Healthcare Systems through Innovative Design

Since 2021, Jaiswal has spearheaded a transition from a monolithic database structure to a cloud-based microservices architecture. This shift has increased scalability, reduced maintenance needs, and minimized data inconsistencies by 97%. Real-time monitoring tools help identify issues before they affect users.

“I led the migration to microservices, automating deployments and performance tuning, so we could handle sudden traffic spikes without manual intervention,” he noted. This transition also allows for quicker updates to policies, such as new subsidy regulations or expanded Medicaid eligibility, while ensuring compliance with evolving standards.

Jaiswal has invested over 2,000 hours in technical training, mentoring more than 100 database professionals. His instruction emphasizes the unique challenges of healthcare, including patient privacy management and regulatory compliance. “Training others on secure, scalable database practices is as important as writing the code itself,” he remarked.

His patented data lake design and consent management systems have been recognized as groundbreaking contributions to healthcare data management. Jaiswal’s influence extends beyond his immediate work, as he participates as a reviewer for international conferences focused on artificial intelligence, data science, and healthcare technologies, helping to set standards for database design in regulated environments.

By facilitating the establishment of ACA marketplaces in multiple states, Jaiswal’s database design has become integral to the implementation of U.S. healthcare policy. As regulations continue to evolve, his work empowers states to manage costs and operations effectively. The system currently supports millions of Americans accessing healthcare through state exchanges, with Massachusetts alone enrolling nearly 390,000 individuals during recent open enrollment periods.

“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.