The odds are slim that the implementation of the Affordable Care Act-mandated health insurance exchanges will go smoothly, but that doesn't mean the concepts underlying the ACA are necessarily in trouble.

The fact that an estimated 7 million people and 51 exchanges are new to the process almost guarantees there will be disruption, the only question is the degree of disruption that will occur. Even a modest percentage of screwed-up enrollments or inappropriate insurance choices would translate into a large absolute number of problems to be solved. If the enrollment of just 5 percent of the new health-exchange customers goes bad, that would mean 350,000 people across the country would need to get back on track.

But by the 2015 enrollment season, the kind of educational outreach, enrollment and claims processing problems likely to be encountered this fall and next year should be far less common because many of those enrolling will have been through the process before, and the exchanges will have a year of operations under their belts.

At the same time, some of the feared problems with the exchanges' strategic underpinnings may never surface, such as the cost of the insurance to consumers. Insurers so far seem to be offering products at reasonable prices, at least in the handful of states reporting so far, according to Kaiser Health News.

And while insurer participation in general definitely could be better, New York is getting an interesting addition to its exchange. Eleven-hospital North Shore-LIJ Health System is launching an insurance company, and officials there decided to do so through an offering on the New York Health Benefit Exchange.

The exchange offers a newcomer a more level playing field to compete for business than the employer market would, says Howard Gold, executive vice president, managed care and business development, with North Shore-LIJ. In addition, executives for the system say that major provisions of the ACA that are being phased in — such as encouragement of value-based care and population-based health management — offered North Shore an incentive to become an insurer. "We see all the changes going on and we're thinking fee for service reimbursement doesn't have a good future," Gold says. Becoming an insurer will better align the system's incentives with the changes taking place. "We needed another tool in our tool box and becoming an insurance company is one of the innovations that we're going to try," Gold says.

There is a major threat to the success of the exchanges concerning how many healthy uninsured people sign up for coverage, as they are vital to the actuarial health of the exchanges.

Experts in the industry tell me there's no way to gauge that data point now, but if you know of a way, shoot me an email, I'd like to hear what it is. A lot is riding on it.