The Maine Health Care Claims Data Bank
- Can we make affordable health insurance coverage available to more Maine people?
- Why do health care services cost so much?
- What can we do to improve the health status of Maine people?
A growing number of people across Maine now believe that in order to understand and address these important questions, we first need access to more accurate, timely, and comprehensive data about how people use health care services. Health insurance claims appear to be the best available source for this information.
In 2001 the Maine Legislature and Governor King approved the establishment of what is believed to be the nation's first comprehensive statewide Health Care Claims Data Bank. Beginning in January 2003, every health insurer and third party administrator that pays claims for Maine residents will be required to submit a copy of all paid claims to the Maine Health Data Organization (MHDO), the state health data agency with the statutory authority to collect health care data in Maine. A new entity called the Maine Health Data Processing Center will build, maintain, and verify the accuracy of the database. It's estimated that the Data Processing Center will handle more than 30 million health insurance claims each year!
The creation of the new Claims Data Bank represents an important step toward solving critically important problems that affect the health of all Maine people. Today, health care providers, public health officials, health insurers, researchers, and others support this initiative and are working together to develop this valuable new resource.
A New Resource For Understanding Health Access & Cost Issues
- Maine's Health Care Claims Data Bank will contain detailed information about how Maine people use every element of the health care system, from primary care to outpatient services; from hospital care and prescription drug purchases to mental health services and alternative care. If health insurance is used to pay for the service or product, that information will be collected and integrated into the Claims Data Bank by the Maine Health Data Processing Center. Plans are being made to obtain claims data from Medicaid and Medicare beneficiaries and incorporate them into the new database. The Claims Data Bank will not include the uninsured population because no claims are involved in the payment for their care. Discussions are under way to determine how information about the uninsured could be collected and incorporated into the new database.
- The information contained in the Claims Data Bank can be analyzed in many ways to help us better understand a wide variety of issues that can lead to more informed decision-making about how we can improve the health status of Maine people, moderate the growth of costs, extend insurance coverage, and improve quality.
Key Players
The Claims Data Bank will be developed through the new Maine Health Data Processing Center, a unique public-private partnership between the Maine Health Data Organization (MHDO) and the independent, nonprofit Maine Health Information Center (MHIC).
- The Maine Health Data Organization, the state agency that has statutory authority to require all insurers and third party administrators to provide their paid claims, also is responsible for making available the information contained in the Claims Data Bank to a wide variety of users, protecting patient privacy and proprietary information. A funding mechanism and data submission guidelines have been approved. Beginning in January 2003 all health insurers and third party administrators that pay claims for Maine residents will be required to submit a copy of all paid claims to the MHDO.
- The Maine Health Data Processing Center (MHDPC) is serving as the technical arm for this project. The MHDPC will build, maintain, and verify the accuracy of a huge Data Bank designed to meet the needs of a wide variety of users. The Center will be responsible for updating the database each quarter and providing it to the MHDO. By mid-2002 the Maine Health Data Processing Center had organized a board of directors, approved a mission statement and bylaws, received status as a non-profit organization, and begun the process of determining exactly how it will collect paid insurance claims information.
- The Maine Health Information Center, which has established itself as Maine's primary nonprofit health data organization over the past 26 years, will provide the experience and technical expertise to assist in the development and management of the Claims Data Bank for the new Maine Health Data Processing Center. Much of the MHIC's experience in this area was gained through the development of a large health insurance claims database for the Maine Health Management Coalition, a group of more than 30 employers from across the state.
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