California Healthcare, Eligibility, Enrollment and Retention System (CalHEERS) is the enrollment platform of the largest state-based health insurance marketplace in the U.S. It needed a robust, secure digital platform to help 39 million Californians compare, select, and apply for free or low-cost, name-brand health insurance plans.
Meeting 39 million Californians’ health insurance needs
The Patient Protection and Affordable Care Act in 2010 led to the creation of Covered California—a new state agency committed to providing Californians access to affordable health insurance. Providing access to Medi-Cal and private insurance payers, nearly a third of all California residents have since come to rely on Covered California’s CalHEERS platform to meet their health insurance needs.
CalHEERS’ legacy infrastructure became increasingly difficult to maintain around 8 years after implementation. It was becoming more expensive to run—particularly as demand accelerated during the COVID-19 pandemic— and more difficult to upgrade. CalHEERS needed a new, scalable solution that would simplify its operations.
“CalHEERS needed to increase capacity for existing operations and support competing priorities within an existing budget,” said Lorna Eby, Deputy Director/Project Director, CalHEERS. “Migration to open source products allowed us to realize cost efficiency in both the short and long term for both software and hardware.”
In June 2023, the team behind CalHEERS, which includes the Office of Technology Solutions Integration (OTSI), and project sponsors the Department of Health Care Services (DHCS) and Covered CA, completed a multiyear journey to redesign and redeploy its platform as microservices in the cloud. The open source technology used in this deployment provided the flexibility to rapidly adapt to health care, regulatory, and legislative changes.
“Our teams migrated 72 interfaces to a more secure, containerized platform—Red Hat OpenShift with Red Hat 3Scale API Management, DROOLS, and Red Hat Fuse— in just 7 weeks, with zero downtime or impact to users,” said Eby.
With Red Hat OpenShift, CalHEERS reduced system complexity by replacing its monolithic architecture with a containerized and modularized system in 18 months. Importantly, it also acted as a proof of concept that could be followed by other state government departments.
Delivering a highly responsive, resilient system
Improved system and operational performance
With on-demand scaling of services, CalHEERS was able to support 170 million transactions and 288,000 user visits during the 2024 open-enrollment period. This included critical improvements in transaction throughput per second, user response times, and session capacity. Modernized integrations are also increasing application performance and responsiveness and minimizing wait times.
Moreover, the Red Hat OpenShift Container Platform allows CalHEERS to stay responsive to both regulatory changes and changing user needs, thus ensuring the state’s health insurance marketplace, Covered California, is able to continue to help consumers choose the best health insurance plans and determine consumer eligibility for healthcare subsidies. “We can now make updates to CalHEERS much faster, ensuring that users have the best possible experience without delays,” said Kevin Cornish, Chief Information Officer, Covered California.
Reduced system complexity
“Simplified components are also enabling greater system streamlining and overall performance improvements,” said Eby.
Implementing a containerized architecture is enhancing CalHEERS’ ability to integrate with modern technologies. The number of virtual CPUs has been cut from 4,400 to 1,800, while nearly two-thirds of the CalHEERS monolith has been migrated to microservices-based containers.
Improved cost efficiency and flexibility
Employing standards-based open source software allows CalHEERS to reduce lock-ins with commercial vendors: “Open source cloud technology empowers CalHEERS to adapt to an ever-evolving health landscape along with regulatory and legislative changes that require CalHEERS to be nimble, agile and receptive to changes,” said Eby.
Cost-efficient Red Hat subscriptions also reduce CalHEERS’ software licensing commitments and free staff up from ongoing maintenance of legacy products.