Although some insurance companies had expected the Affordable Care Act to create operational
problems, an industry study found that the financial and administrative performance of payers actually improved for plans offered on the federal and state exchanges and in Medicaid expansion states.
However, doctors and hospitals continue to have relatively low levels of trust in insurers, the study found. This is a red flag as providers move toward payment systems based on outcomes, quality of care and other alternatives to traditional billing for individual services.
The study, by athenahealth, Inc., a medical software systems company, measured the financial, administrative and transactional performance of companies. It analysed millions transactions and $28.5 billion in healthcare services billed to insurers in 2014 by 64,000 health care providers.
“Market turbulence, including the ACA, 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 plans and commercial payers offering health plans in the health exchanges performed better than carriers not participating in the exchanges. “Payers participating in ACA implementation appear to be performing better overall,” it found.
A companion study that looked at health care providers’ attitudes toward insurance companies found that “provider trust of payers remains generally low, with nearly all of 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 of the providers. The doctors and hospital administrators ranked “good faith negotiations” second in importance only to rates as influencing their opinions payers.
This lack of trust could be a hurdle as the health care sector moves away from a fee-for-service model toward financial risk-sharing, the study’s authors noted. Responses from 200 hospitals showed that they still get 82% of revenues from traditional billings versus 18% based on the value of service, but almost two-thirds already participate in government-sponsored pay-for-quality programs and expect their revenue mix to swing toward risk-sharing.
