Health insurance exchange (HIX) operations involve many moving pieces: they serve a variety of populations, coordinate with numerous agencies, and must continually adapt to changes in policy and public health demands. At GetInsured, we have found that HIX operations work best when their system architectures reflect this complex and dynamic nature – and that a microservices architecture better aligns with the mission of health exchanges than the unified nature of monoliths.  

What are Monolith and Microservices Architectures? 

A monolith architecture operates as a single unit with deeply connected code and intermeshed functionality. If we think of system architectures as kitchens, a monolith architecture would be one where all chefs work in close coordination, sharing ingredients, supplies, equipment, and one large area to create dishes.  

A microservices architecture, on the other hand, operates as a collection of multiple independent but connected services, each with their own code. This model is similar to a kitchen divided into several discrete stations; each chef works only in their assigned station to create a certain dish or part of a dish, and each station is supplied only with what is necessary for what is made there.  

Architectures for Different Contexts: Benefits of Monoliths and Microservices 

Monolith and microservices architectures each come with strengths and limitations, and each is best suited to certain systems and goals. Monolith architectures are more suited to simple systems with stable goals and parameters that don’t undergo many changes or adjustments. Benefits of monolith infrastructures include:  

  • Simple set up with fewer initial costs and resources: There is only one system (cooking area) to set up, rather than numerous discrete services (stations).   
  • Easy to update or scale as a whole: Changes to the whole system only need to be configured once, rather than adapted to each individual service. 
  • Streamlined security approach: Security and debugging efforts are streamlined, as the whole system can operate on one security framework. 
  • Built-in system coordination: Because all code is developed as part of the same system (all chefs are trained to work together), coordination is inherent to the architecture. 

For complex systems with regularly changing goals and parameters, however, microservices architectures present a more suitable option. Netflix, for example, with its many users, categories, and services, was one of the first big companies to transition to a microservices approach and did so with great success; they currently operate over a thousand microservices. Benefits of a microservices architecture include:  

  • Adaptability and long-term cost efficiency: Specific system changes are generally less complex and resource-intensive, as they can be made to individual services (kitchen stations) without impacting or involving the whole system. 
  • Targeted scalability and updates: Scaling and updates can be targeted where they are most needed, so the system (kitchen) can grow based on how it is used without allocating resources to unnecessary changes. 
  • Increased fault tolerance: With a monolith architecture, a bug or security flaw introduced in one area is likely to impact the whole system; with microservices, security issues are typically isolated to a specific service (station), making microservices a more fault-tolerant option. 
  • Enhanced interoperability with external agencies: If one service requires integration with an external entity (one chef needs to acquire external ingredients or assistance), that coordination can happen without impacting other services. 

Microservices Align with the Future of Health and Human Services 

As the past five years and global pandemic have illustrated, flexibility and adaptability are key to reliable and effective health exchange operations. They may also be key to the future of health and human services as a whole. In 2023, the U.S. Department of Labor Deputy Director released a modernization plan stating that the “high cost of adapting systems to meet changing needs” specifically associated with monolith architectures was the greatest hurdle to agency modernization. The flexibility and adaptability provided by microservices make it easier for agencies to adapt to changes in policy and service demand but also to incorporate innovations to continually improve service quality and modernize agency operations.   

At GetInsured, the microservices approach has allowed us to continually grow and customize the integration between our HIX platform and contact center services, which are currently operated in tandem in Georgia, Nevada, Pennsylvania, and Virginia (with Illinois and New Mexico going live in 2025). This integration has enabled ongoing service improvements, leading to extremely high customer service quality ratings in these states. For example, to assist consumers in making informed decisions, we used microservice application programming interfaces (APIs) to build and integrate a ProviderInsights directory into our platform. Microservices also made it possible for us to quickly incorporate  data sharing enhancements that helped our state clients mitigate the impacts of the recent Public Health Emergency (PHE) unwinding.  

Additionally, we have leveraged the interoperability of microservices to offer enhanced, custom integrations between health exchanges, Medicaid agencies, and other state services. In Pennsylvania, for example, we support enhanced integration with the State Department of Revenue to provide the option for tax filers to indicate interest in health insurance programs and initiate information sharing with state Medicaid and HIX agencies by simply selecting a box on their tax forms  – demonstrating the potential of microservices in advancing No Wrong Door functionality across health insurance programs as well as health and human services more broadly. As an added bonus, research indicates that teams who have shifted to microservices architectures experience an increase in team happiness. 

With the Right Partners, Microservices are Accessible and Manageable 

A common concern with microservices architectures is their seemingly complex and resource-intensive set up, but with the right partners, this hurdle is easily overcome. GetInsured offers a proven microservices-based solution for state-based HIX operations, providing states with easy set-up, flexible pricing options, and extensive customization opportunities. Our partners at Change & Innovation Agency (C!A) also offer microservices-based solutions for child care exchanges, unemployment agencies, and other safety net programs.  

We take pride in helping health and human services agencies adopt a microservices approach but also in helping agencies continually manage and optimize that approach. We incorporate numerous Amazon Web Services (AWS) features to help agencies operate diverse microservices architectures across the country, keeping them continually secure, up to date, appropriately scaled, and effectively integrated. AWS microservices features we have used to enhance our solutions include but are not limited to: 

  • Service management and scaling support: To containerize microservices (neatly segment/arrange kitchen stations) and manage resources and functionalities within and across them in a simplified, streamlined manner. 

Health and human services are not monoliths – neither are health insurance exchanges – and it’s time we stopped asking them to operate as such. Microservices architectures offer many benefits, and at GetInsured and C!A, we look forward to helping agencies leverage those benefits for improved service delivery and long-term success.  

Learn more about how GetInsured uses AWS to support health exchange operations, or get in touch to chat about our microservices solutions and how we can tailor them to the specific needs of your agency.