Although some companies had expected the Act to create operational 
problems, an industry study found that the financial and administrative performance payers actually improved for offered the federal and state exchanges and in expansion states.
However, doctors and hospitals continue to have relative low levels trust in insurers, the study found. This is a red flag as move toward systems based outcomes, quality and other alternatives to traditional billing for services.
The study, by athenahealth, Inc., a medical software systems company, measured the financial, administrative and transactional performance of companies. It analyzed millions transactions and $28.5 billion in healthcare services billed to insurers in 2014 by 64,000 health care .
“Market turbulence, including the , did not degrade payer performance as expected,” the study found. In 2013 and 2014, insurers in Expansion states performed better than non-expansion states.
In both years, Blue Cross Blue Shield and commercial payers offering in the exchanges performed better than carriers not participating in the exchanges. “Payers participating in implementation appear to be performing better overall,” it found.
A companion study that looked at ’ attitudes toward companies found that “provider trust payers remains generally low, with nearly all the major payers evidencing slight drops compared to last year.”
The study found that feel taken advantage by companies, feel some payers do not honor their commitments, and believe insurers don’t fairly balance their interests against those the . The doctors and hospital administrators ranked “good faith negotiations” second in importance only to rates as influencing their opinions payers.
This lack trust could be a hurdle as the sector moves away from a fee-for- model toward financial risk-sharing, the study’s authors noted. Responses from 200 hospitals showed that they still get 82% revenues from traditional billings versus 18% based on , but almost two-thirds already participate in government-sponsored pay-for-quality programs, and expect their revenue mix to swing toward risk-sharing.