Contrary to expectations, market turbulence resulting from the Affordable Care Act has not caused operational challenges for most payers, according to athenahealth's PayerView Report, which measures payers' financial, administrative, and transactional performance. In fact, those offering health plans in Medicaid expansion states and on the health insurance exchanges are performing better than those not participating.

Moreover, the top performing payers for efficiency, transparency, and consistency also received high marks in ReviveHealth's ninth Annual Payor Survey and Trust Index, which measures the reliability, honesty, and fairness of payers as perceived by hospitals and health systems. Cigna and Aetna ranked high in both reports, while UnitedHealthcare continued its year-over-year decline.

The Trust Index results also reveal that provider trust of payers remains generally low, with nearly all of the major payers evidencing slight drops compared to last year. Further, results show perception gaps forming between some payers with strong operations but low trust levels. According to ReviveHealth, these gaps imply an increased need for greater transparency and communication between the two industry segments.

“Looking back on 2014, a year marked by the implementation of the ACA, we see that payer performance improved overall yet still might not be enough to fully support provider relationships and success amidst continued industry transformation," says Todd Rothenhaus, chief medical officer at athenahealth. "

Adds Brandon Edwards, ReviveHealth CEO, "As the healthcare system transitions to more complex, value-based payment models, building on payers' operational success and improving transparency is essential to gaining provider trust and making collaboration possible. At a time when payers and providers are seeking new, untested partnerships and arrangements that require them to communicate with one another, trust is not always there. It is our desire that payers take note of these findings and use them to strengthen communications and collaboration with their healthcare provider and health system partners."

Cigna continued to lead as the most trusted payer with a composite Trust Index score of 62.7, a drop from 63.1 last year, while UnitedHealthcare continued to rank the least trustworthy with a score of 40.5 compared to 40.7 last year. The average composite Trust Index score across all payers was 51.8, down slightly down (0.7 percent) from the year before.

Providers feel taken advantage of and are skeptical about payers' ability to honor commitments. Across the board, major payers are seen as poor at balancing their interests against those of the providers. Best among the major players evaluated in the survey was Cigna (58.9); worst was UnitedHealthcare (34.7). This is further evidence of a festering disconnect between payers and providers.