AWS Public Sector Blog

Covered California provides affordable healthcare access, powered by AWS

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Before the Affordable Care Act (ACA) was implemented, purchasing insurance in the individual market proved challenging for those without employer-sponsored health benefits. This was particularly true in California, where more than 39 million people live. In 2013, more than 17 percent of Californians did not have health insurance. Through the work of Covered California, the state’s health insurance marketplace, the percentage of uninsured Californians now sits at a record-low 6.5 percent, which represents the largest percentage point drop of uninsured in the US. The dramatic gains in insurance coverage in the state were achieved by Covered California’s dedicated staff and their innovative use of Amazon Web Services (AWS).

Delivery of healthcare solutions in the cloud

When the ACA was signed into law, many states raced to help their residents find and enroll in health insurance. California swiftly embraced the ACA and became the first state in the nation to enact legislation to set up a health insurance exchange and soon after, in partnership with the state’s Medicaid agency, established the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS). CalHEERS is the portal through which eligible Californians can enroll in high-quality, affordable health insurance coverage. CalHEERS allows individuals to easily shop for and compare health insurance plans and enroll in coverage that brings them the best value. Through CalHEERS, applicants can determine their eligibility for financial assistance that lowers the cost of their coverage, find a certified insurance agent or community-based organization for enrollment support, or complete their enrollment on their own within a short period of time.

CalHEERS was initially deployed on-premises, in two in-state data centers. In its first year, CalHEERS helped nearly a million Californians enroll for healthcare. Since inception, the number of Californians using Covered California each year has increased, with more than 1.7 million users annually enrolling in healthcare and an additional 12 million people using CalHEERS to confirm their eligibility for Medi-Cal (California’s Medicaid program) and the Children’s Health Insurance Program (CHIP). During the annual peak period from October to January, Covered California serves more than 300,000 daily users. The entire system handles more than 450 terabytes of information every year.

Save costs and improve operations, efficiency, and resiliency

CalHEERS is a complex solution. There are more than nine million active accounts. It connects with multiple health insurers’ enrollment systems. It can go from a few hundred users one day to 300,000 the next. To leverage the power of the cloud, Covered California partnered with Deloitte as a systems integrator.

In the first year after transitioning to the AWS Cloud, performance of the CalHEERS portal improved by 200 percent over the previous year while servicing a 20 percent increase in enrollments. The system processed 112 million transactions in a single day and there were zero critical or serious issues.

The original on-premises system was designed for peak usage, which meant that for most of the year, it ate up unnecessary operational costs. Leveraging the scalable nature of the cloud, Covered California is no longer paying for unnecessary computing capacity. They can scale up operations during open enrollment and then scale them back down the rest of the year. By moving to the cloud, the organization has been able to reduce IT costs, including hardware and software expenses, maintenance, and energy costs.

“The opportunity to scale up or down quickly—without the hassle of investing in physical servers or hardware and freeing up the IT team to focus on more critical tasks—has been a game changer,” said Karen Johnson, chief deputy executive director for Covered California.

“After that first successful open enrollment, we weren’t done—we had only just started,” said Kevin Cornish, CIO of Covered California. “The next question we asked was, how do we modernize? The objectives were to reduce complexity, gain improved performance, increase resiliency, and decrease cost.”

Every year, the team has improved operations, simplified the system, and enhanced the user experience.

“The cloud lets us scale up and down, saving on costs. It also provides increased resiliency. For example, the failover is almost instant. With an on-premises system, it took 30-40 minutes,” said Cornish.

The impact to constituents

Covered California’s mission is to increase the number of insured Californians, improve healthcare quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.

“Through Covered California and CalHEERS, many previously uninsured individuals and families were able to access affordable healthcare for the first time. This not only improved their overall well-being but also provided them with peace of mind knowing that they were covered in case of any medical emergencies,” said Johnson.

Covered California is not done yet. Their journey with AWS has gone from a traditional cloud migration to focusing on a more complete cloud modernization. This means they are actively building and refining a digital infrastructure that’s more capable and prepared for what’s next—whatever ‘next’ might be.

“Overall, Covered California has meant a lot to the people of California. It has been a game changer that has increased access to healthcare and improved the well-being of Californians. And through its work on CalHEERS, Covered California has demonstrated the role technology plays in creating access to coverage and care, and reduced the rate of the uninsured,” said Cornish.

If you’re attending re:Invent 2023 in-person or tuning in virtually, join the session “Empowering citizens through digital innovation” to learn more about Covered California’s work. Discover how government agencies across the country use AWS to better serve constituents at the AWS Cloud for State and Local Governments hub.

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