Current Data Requests

The Maine Health Data Organization has, in accordance with Rule Chapter 120: Release of Data to the Public, instituted a process for the purpose of notifying users and providers of health care data when the MHDO receives a request for health data and accepts that request. In addition to sending electronic notification to interested parties and to providers that are responsible for the submission of the data, we provide the summary page of data requests below.

For all data requests, the data providers or other interested parties may submit comments related to the data request to the Executive Director. To be considered, comments must be received by the Executive Director in writing or by electronic notification no later than thirty business days after the initial posting of the data request on the MHDO web site. If the Executive Director determines that (a.) the comments received are of significant enough importance to delay the release of data and/or (b.) additional information is required from the requesting party to address the comments; then the data shall not be released until the additional information has been received from the requesting party and an additional review is conducted by the Executive Director or the MHDO Data Release Subcommittee, as applicable, to ensure that the requesting party conforms to all applicable requirements of this chapter.

The Executive Director will bring all comments received from the data providers and or other interested parties for the release of Level III Data to the MHDO Data Release Subcommittee for consideration.

Individuals who want to opt out of a specific Level III data request may do so by completing this MHDO Choice Disclosure Form no later than 30 business days after the initial posting of the data request. If you opt out of Level III data requests, you will remain opted out unless you choose to opt back in via completion of the MHDO Choice Disclosure Form.

NOTE: If you would like to be notified when new data requests are posted, please email your request.

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Request NumberRequesting PartyAffiliationDate Posted Comment Close DateSpecific Data RequestPurpose Of Request
2019100801Argue, David, Corporate VP and PrincipalEconomists Inc11-18-20191-2-2020Level II CY2018 Hospital Inpatient Encounters data.Level II Data Request: The hospital industry is undergoing significant consolidation and restructuring which can potentially affect the well-being of consumers in Maine and neighboring states. This study focuses on two announced mergers of hospitals in southeastern NH near the Maine border that serve Maine residents. The two transactions are the merger of Wentworth Douglass Hospital in Dover with Exeter Hospital and Portsmouth Regional Hospital's acquisition of Frisbie Memorial Hospital in Rochester. Economic theory predicts that consumers receive the lowest prices and highest quality in markets with sufficient competing providers, but it does not identify how many providers is enough for each market. Our econometric modeling identifies how well hospitals serve as substitutes for each other in commercial health plan networks. The model requires information about actual hospital choices made by residents in southern Maine and southeastern NH to predict patients' first-best and second-best alternatives prior to a merger. Benefit to Citizens of Maine: Our analysis of hospital markets along the Maine-NH border will benefit Maine residents because it will allow us to precisely quantify how many Maine patients stand to benefit from the healthcare transactions occurring across the state border. Antitrust regulators in Maine may find this information helpful to understand the potential benefits to Maine residents that could arise as a result of the transactions.
2019100802Mellett, JeanNorthern Light Health10-25-201912-8-2019Level II CY2019 Q1 - CY2020 Q4 Hospital Inpatient Encounters, Hospital Outpatient Encounters data released at the City/Zip, Date of Birth, Practitioner Identifiable level.Level II Data Request: Northern Light Health will use the inpatient and outpatient hospital encounters data to support its members' planning efforts around the State, as well as to advance initiatives that are important to the System and to the State as a whole. The mission of Northern Light Health is to improve the health of the people and communities we serve. Our brand promise is 'We make healthcare work for you.' In order to fulfill the mission, we must have access to data regarding: -Patient origin and demographics (zip code and birth date included) -Locations of healthcare services and providers around the state -Healthcare utilization rates and volumes -Healthcare services provided, including diagnoses and procedures. It is important to have zip code level data so that we may fully understand what distances patients are traveling to receive services. Birth date data enables us to refine program planning to meet the needs of patients in specific age groups, e.g., pediatrics, geriatrics, etc. Provider identification data rounds out these data points to inform decision-making regarding future placement of services and/or collaborative efforts to improve access to health care services. This is becoming ever more important as we recognize that the population age 65 and over is increasing in Maine. This population segment is projected to make up almost a third of the State's total population and typically exhibits a higher utilization rate for healthcare services in general. Benefit to Citizens of Maine: MHDO data is used to appropriately optimize resource allocations. Northern Light Health planning staff will conduct these analyses and others as needed to support individual projects and help provide a strategic framework with the ultimate goal of providing the people of Maine with the right care, at the right time, in the right place.
2019102201Bourbeau, Brian, Director, Business Metrics and AnalysisAmerican Society of Clinical Oncology10-25-201912-8-2019Level II CY2018 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, and Practitioner Identifiable data, Payer Name/IDLevel II Data Request: This request is an extension of previously approved request 2019010401, adding 2018 medical and pharmacy claims and eligibility records. The American Society of Clinical Oncology (ASCO) is engaged with providers, payers, employers, and healthcare policy experts to develop an alternative payment model for oncology care. ASCO will conduct multiple projects using MHDO data to electronically capture quality metrics, quantify opportunties for cost-of-care savings, and to model potential alternative payment mechanisms. Deliverables from these projects will include an analysis of potential cost savings for the state of Maine, a whitepaper detailing an alternative payment model for oncology providers, and specifications for quality metrics that may be calculated with MHDO and other APCD data. The projects will also result in an application to the US Health and Human Service's Physician-Focused Payment Model Technical Advisory Committee, for consideration as a Center for Medicare and Medicaid Innovation alternative payment model. Benefit to Citizens of Maine: Deliverables from these projects will be made available to community stakeholders in Maine - providers, payers, employers, patient advocates, and Maine Quality Counts, to implement quality measurement and alternative payment model initiatives. Data may also be used to assist communities in Maine who desire to implement the resulting alternative payment model and quality metrics developed as part of these projects.
2019102301Hawkins, Summer, Associate ProfessorBoston College10-23-201912-5-2019Level II CY2009 to CY2015 Medical Claims and Medical Eligibility including Practitioner Identifiable data released at the City/Zip, Date of Birth levelLevel II Data Request: A growing body of research has demonstrated the importance of provider characteristics in the quality of care that patients receive and the subsequent implications for health outcomes. Some of these characteristics include provider-patient concordance/discordance, availability, access and referrals. Thus, we aim to assess the supply-side effects of the Affordable Care Act (ACA) and other recent health policy changes on cancer screening. Specifically, we will assess whether the number, type and location of providers offering cancer screenings changed after the implementation of the ACA and Medicaid/marketplace expansions. This project will use the provider NPI to assess where women are receiving care during the delivery as well as during the postpartum period. Benefit to Citizens of Maine: Since the ACA came into effect in September 2010, additional health policy changes have occurred at the state level that may affect preventive health services and subsequent health outcomes, including postpartum care. We aim to examine the impact of changes in Medicaid parental income eligibility levels on continuity of insurance coverage, visits for postpartum care, contraceptive use, and birth spacing in the one year following a delivery. Our results based on the APCD will be directly applicable to current policies and practices in ME, which we hope will contribute to the discussion about health insurance and Medicaid coverage of preventive items and services.
2019071701White, Chapin, Adjunct Sr. Policy ResearcherRAND Corporation7-17-20198-28-2019Level II CY2016 to CY2018 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, and Practitioner Identifiable data released at the City/Zip level.Level II Data Request: Researchers at the RAND Corporation will reprice commercial medical claims from MHDO using Medicare's groupers and pricing algorithms, and will release a public research report that includes commercial prices as a percent of Medicare prices for hospitals and hospital systems identified by name. This research report will update and expand on the findings in a RAND report released in May, 2019 (https://www.rand.org/pubs/research_reports/RR3033.html). The public research report will include hospitals from around the country, and will be created using claims data from three sources: self-insured employers, state-based all payer claims databases (APCDs), and health plans. Benefit to Citizens of Maine: This project will benefit the people of Maine by providing them with a detailed hospital price report for hospitals in Maine, as well as comparisons among hospitals in Maine versus hospitals in other states. Key audiences for the report will be (1) self-insured employers that participate in the study and that are assessing the reasonableness of the prices they are paying for hospital care, (2) other employers that are struggling with high and rising health care costs and that want to better understand patterns and trends in hospital prices, and (3) policymakers and researchers who are concerned with hospital pricing and price transparency.
2019062501Harrington, Karynlee, Director Maine Quality ForumState of Maine6-28-20198-12-2019Level II CY2016 to CY2018 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, and Practitioner Identifiable data released at the City/Zip levelLevel II Data Request: With the passage of LD 1353, An Act to Establish Transparency in Primary Care Spending, the Maine Quality Forum is required beginning January 15, 2020 and annually thereafter, to submit to the Department of Health and Human Services and the joint standing committee of the Legislature having jurisdiction over health coverage and health insurance matters a report on primary care spending using claims data from the Maine Health Data Organization. The report must include the percentage paid as a percentage of their respective total medical expenditures for primary care by commercial insurers, the MaineCare program, Medicare, and the state employees and the Maine Education Association benefits trust; as well as the average percentage of total medical expenditures paid for primary care across all payors.
2019062001Probert, Michelle, Director, MaineCareState of Maine6-20-20198-2-2019Level II CY 2013 to CY 2019 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, and Practitioner Identifiable data released at the City/Zip level Hospital Encounter Inpatient Level II CY 2016 to CY 2019 with Patient’s ZIP code; Hospital Encounter Outpatient Level II CY 2016 to CY 2019 with Patient’s ZIP code Level II Data Request: DHHS is interested in gaining a better understanding of the current and anticipated MaineCare expansion population by generating a profile of newly eligible Mainers based on demographics, likely health conditions, service needs, critical events, and anticipated costs. Both the APCD and MHDO hospital encounter data will be used as sources to build a profile of the newly eligible Medicaid Expansion population and their anticipated health status and healthcare needs. The initial focus of the analysis will be on the population likely eligible for expansion and their health care services in recent years prior to becoming eligible using MHDO’s Hospital Encounter Database, given the presence of the charity / uncompensated care and self-pay populations. MHDO APCD and Hospital encounter data may be used to better understand MaineCare expansion population including topics like: General demographics; Prevalence of chronic disease/ number of chronic conditions; Utilization of preventive services; Utilization of acute care services; Average PMPM cost; Months of coverage on MaineCare; Number of medications/ medication adherence; Previous insurance status. Similar data will be pulled for populations covered under Medicare and Commercial insurance to use as the comparison groups.
2019040902Ahrens, Katherine, Assistant Research ProfessorUniversity of Southern Maine5-10-20196-4-2019Level II CY2006 to CY2018 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility data released at the City/Zip levelLevel II Data Request: Researchers at USM will conduct a quantitative analysis of the health outcomes of women with opioid use disorder during pregnancy in Maine during 2010 - 2017. They will estimate the number and proportion of these women who receive treatment during pregnancy and the average treatment duration by treatment type. They will compare health care use and health outcomes throughout pregnancy and the first year postpartum by treatment type and treatment duration. They will also identify stakeholders and permissions needed in order to link the Maine All-Payer Claims Database with vital records (birth and death certificates). The results from Maine will be presented alongside similar results from Vermont. At no point will data sets from the two states be combined. This project will benefit the people of Maine because it addresses a pressing public health issue: opioid use disorder. By estimating the number of women with opioid use disorder during pregnancy and the association between treatment duration/type and health care use and outcomes, we can inform interventions to help women achieve recovery. This is important not just for the health of women with opioid use disorder, but also for the health and well-being of their current and future children.
2019041802Harrington, Karynlee, DirectorMaine Quality Forum4-19-20196-4-2019Level II CY2013 to CY2017 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, and Practitioner Identifiable data released at the City/Zip levelLevel II Data Request: The Milliman HWC is a claims software grouper, like a DRG or Risk grouper that has been designed to use claims data to identify low value health care services including inappropriate antibiotic prescribing (currently 47 measures in total). Seven of the forty-seven measures are specific to inappropriate antibiotic prescribing measures. The plan is to run the MHDO APCD data through the Milliman HWC to generate a baseline of information specific to the inappropriate prescribing of antibiotics to help support the work of the HAI/AR Collaborating Partners Committee that are working on executing the States HAI plan which includes strategies specific to antibiotic resistance (AR). One of which is building a data infrastructure that will help focus the strategies on actionable AR initiatives. In addition, MQF will share the results of running the data through the HWC with the various state health plans, including MaineCare and the State Employee Health Plan to assist these programs with their value based purchasing strategies.
2019041601Cates-Carney, Maya, Data Integration & Policy AnalystOffice of MaineCare Services4-18-20196-3-2019Level I CY2016 to CY2018 Hospital Inpatient dataLevel I Data Request: The MOM Model would provide wrap-around OUD and prenatal services to pregnant women with OUD around Maine. The model would extend from whenever the pregnant women enrolls during the prenatal period to 12 months postpartum, and include Medication Assisted Treatment, group counseling, and group sessions that would include topics like parenting, relapse prevention, pain management during birth, and the importance of pediatric visits. MHDO data will be a critical component to MaineCare's application to the federal government to be able to secure the funding to meet the above goals.
2019041801Moylan, Christina, Assistant Attorney GeneralMaine Attorney General's Office4-18-20196-3-2019Level II Q1 CY2015 to Q3 CY2018 Medical Claims and Practitioner Identifiers released with City/Zip. Q1 CY2015 to Q2 CY2018 Inpatient and Practitioner Identifiers released with City/Zip. Q1 CY2015 to Q4 CY2017 Outpatient and Practitioner Identifiers released with City/Zip.Level II Data Request: The data will be used to conduct competitive analysis for mergers and potential anticompetitive agreements in healthcare pursuant to state and federal antitrust laws. Antitrust law's goal is to preserve competition in order to constrain costs, maintain or improve quality and maintain or increase access to healthcare. Additionally, we intend to use these data to study the use of Maine hospitals by residents of the state, and competition between these hospitals to provide those service. Patients’ ZIP Code information will allow us to analyze how far patients are willing to travel to receive inpatient and outpatient care, and to identify the hospitals in each patients' local area that compete to provide care to residents of that area. The practitioner identifiers will allow us to analyze the physicians who have privileges at each hospital in Maine, and what other hospitals those physicians may also have privileges. These overlaps in medical staff may be informative about the extent to which—depending on the patient's choice of physicians—those hospitals compete to provide care to patients. The APCD data will allow us to study competition between physician groups in Maine, and competition between hospital outpatient departments and freestanding facilities to provide outpatient care to residents of Maine.
2019010301Wang, Jun, Principal Data ScientistArchway Health Advisors, LLC3-29-20195-13-2019Level II CY2016 to CY2017 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, Practitioner Identifiers, and Payer Name/ID released with City/Zip and DOB.Level II Data Request: Maine has one of the most progressive payment landscapes in the United States with the proliferation of value-based payments, but continues to struggle with increasing costs. Episode of care models are part of the answer to reducing cost growth without sacrificing the quality of care. It has been proven to help control specialist-driven spending which accounts for 60-70% of total healthcare spending and reduce cost variation. Medicare has developed several comprehensive episode payment initiatives, but the commercial market for episode payment is underdeveloped as no forcing mechanism exists to bring payers and providers together to develop episode payment arrangements. A key barrier to the initiation of episode payment contracts is the lack of data necessary to create payments and evaluate quality. The APCD is necessary to enable providers of Maine to understand the opportunities and risks and promote episode payment to payer partners. Benefits to Citizens of Maine: This episode analysis using APCD data will identify the best performing hospitals and physicians in the state of Maine and encourage Maine people to seek care from those providers with higher quality care and lower cost, which will greatly increase both the efficiency of care delivery and the quality of care delivered. Specifically, we plan to use Maine APCD data to: Understand what are the key drivers that lead to the high episode cost and quality variation among Maine healthcare providers; Understand what are the potential and achievable quality improvements if Maine providers can align the performance with the best performers; Understand what are the potential saving opportunities if Maine providers can improve the quality performance to align the best performers; Create provider performance benchmarks to identify best performers and help Maine providers build high-value, low-cost physician networks and prioritize efforts to promote high-value care with limited resources; Produce analytical prediction models to identify high-risk high-cost patients of Maine for immediate interventions.
2018121801Bodwell, Erica, VP and General CounselNortheast Delta Dental3-1-20194-12-2019Level II CY2016 to CY2018 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, Dental Claims, Dental Eligibility, Hospital Inpatient, Hospital Outpatient data and Practitioner Identifiers.Level II Data Request: Northeast Delta Dental (NEDD) board is reviewing opportunities to improve dental access to the underserved in Maine. As a mission driven organization, they sought out DentaQuest, an experienced government program dental administrator to partner on this initiative. We are requesting the data to research utilization and other trends of the Medicaid population, for potential enhancement of dental services and access to services for Maine Medicaid beneficiaries. Benefits to Citizens of Maine: We are requesting the data to research utilization and other trends of the Medicaid population, for potential enhancement of dental services and access to services for Maine Medicaid beneficiaries.
2019010401Bourbeau, Brian, Dir. Business Metrics and AnalysisAmerican Society of Clinical Oncology2-20-20194-29-2019Level II Q4 CY2015 to Q4 CY2017 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility and Practitioner Identifiers and Payer Name/ID.Level II Data Request: The American Society of Clinical Oncology (ASCO) is engaged with providers, payers, employers, and healthcare policy experts to develop an alternative payment model for oncology care. ASCO will conduct multiple projects using MHDO data to electronically capture quality metrics, quantify opportunities for cost-of-care savings, and to model potential alternative payment mechanisms. Benefits to Citizens of Maine: Deliverables from these projects will include an analysis of potential cost savings for the state of Maine, a whitepaper detailing an alternative payment model for oncology providers, and specifications for quality metrics that may be calculated with MHDO and other APCD data. The projects will also result in an application to the US Health and Human Service's Physician-Focused Payment Model Technical Advisory Committee, for consideration as a Center for Medicare and Medicaid Innovation alternative payment model. Deliverables from these projects will be made available to community stakeholders in Maine - providers, payers, employers, and patient advocates - and in other states, to implement quality measurement and alternative payment model initiatives. Data may also be used to assist communities in Maine who desire to implement the resulting alternative payment model and quality metrics developed as part of these projects.
2018083001Kingsbury, Rebecca, Dir., Planning & AnalyticsMaineGeneral Health11-20-20181-1-2019Level II CY2015 – CY2018 Hospital Inpatient and Outpatient Encounter Data and Medical and Pharmacy Claims including Eligibility, Practitioner Identifiers, Date of Birth and City/Zip fields.Level II Data Request: As the third largest healthcare system in the state, MaineGeneral Health is entrusted with the responsibilities of both safeguarding the health of residents in 86 communities in central Maine, and for providing them with the healthcare services they need. Decisions on optimal allocation of our resources to best serve this population can be informed by access to MHDO data. This data would enable us in achieving our goals of improving health and wellbeing, enhancing treatment outcomes, offering timely access to quality care, and providing seamless care coordination across our system. Specifically, MHDO data will be used to effect improvements in the quality and safety of our services and identify cost-saving opportunities, providing tangible benefits to our patients. It would also enable reporting of market share data with our member organizations or prospective affiliates with the goal of improving care for all Maine residents. Data will also assist us in supporting member organizations taking on the responsibilities and risks of Accountable Care Organizations and Medicare Share Savings Program participation, as well as commercial payer contracts. Supporting MaineGeneral Health and its members' Certificate of Need applications, and Maine Shared Community Health Needs Assessment, as well as strategic and service line work, medical staff development, and facility planning are all additional important uses of this data.
2018102201Smith, Wm. Douglas, DirectorSnowsport Safety Foundation10-29-201812-10-2018AD Hoc report on Snowsport Accident and Incidence Report for 2010 - 2018Snowport accidents and injuries are a significant public health and safety concern. However, there is no publicly accessible data on the frequency and severity of accidents and injuries. Ski resorts have no reporting requirements and do not disclose information they might have. Hospital admission and ER visit data represent reasonable proxies of the number and cost of the more serious accidents and injuries. Benefit to Citizens of Maine: This information is needed to inform public policy and public education initiatives and establish baseline outcome measures against which to track improvements in accident prevention.
2018082201Regan, David, Finance and Strategy LeadHarvard Pilgrim10-1-201811-12-2018Level II CY2016 thru CY2017 Medical Claims, Eligibility, and Practitioner Identifiers. Data release will exclude identifiable data elements related to the submitter and payer fields. MHDO will remove the MC001 and MC002 fields.Level II Data Request: The data will be used to support corporate planning by analyzing hospital and professional utilization and reimbursement patterns for diagnoses and procedure codes by geographic region. Benefit to Citizens of Maine: The examination of Statewide medical cost structure, distribution of services, and utilization patterns provides additional information that can be used to guide product and benefit design. The goal of this work is to directly benefit Maine consumers through either reduced premiums or plan designs better suited to their needs, both in-network and out-of-network.
2018062601Travis, LoriMaineHealth9-10-201810-22-2018Level II - CY2018-CY2022 Hospital Inpatient and Outpatient Encounter Data, including Practitioner Identifiers released at the City/Zip level and Medical and Pharmacy Claims and Eligibility data including Practitioner Identifiers and City/Zip levelThe MHDO data will be used to support MaineHealth and its members' strategic, service line, medical staff development and facility plans, Certificate of Need applications, and Maine Shared Community Health Needs Assessment. The Maine Shared CHNA is intended to improve the health status of Maine residents and track results. The Maine Shared CHNA collaboration consists of a unique public/private partnership among the four largest health systems in Maine - Eastern Maine Healthcare Systems (EMHS), MaineGeneral Health (MGH), Central Maine Healthcare (CMHC) and MaineHealth (MH) and the Center for Disease Control and Prevention (Maine CDC) which is part of the Maine Department of Health and Human Services. The end product consists of a comprehensive written profile of Maine's health status, including assessments for the state, 16 counties, 5 multi-county public health districts and urban areas (Portland, Bangor and Lewiston/Auburn) based on analysis of multiple sets of secondary data as well as community feedback collected as part of the process. Benefit to Citizens of Maine: MHDO data may be used in reporting of market share data with potential future affiliate/member organizations in an effort to improve patient care for the residents of Maine. The MHDO data will be used to inform MaineHealth system's efforts to improve the quality and safety of the services provided, identify opportunites to make the services provided less costly, and support member organizations and strategic affiliates to assume the responsibilities and risks of Accountable Care Organizations participating in the Medicare Shared Savings Program and similar arrangements with commercial payers and the MaineCare Program's planned managed care initiatives. MaineHealth is the largest healthcare system in Maine and has a direct impact on the health, healthcare services, and cost of care for a large majority of Maine people. Our use of the MHDO data directly impacts quality and cost improvement activities in our organization and therefore directly benefits patients who receive our services. The MHDO data will help accomplish our purpose by informing decisions regarding the allocation of healthcare resources to serve Maine's population. In doing so, the data will help improve health status, care coordination, outcomes, and access to services for Maine residents.
2017101201Mayeda, EricThe Chartis Group7-27-20189-10-2018Level II - CY2015 thru CY2017 Hospital Inpatient and Outpatient Encounter data, including Practitioner Identifiers released at the City/Zip levelLevel II Data Request: The Chartis Group, LLC, and its wholly owned subsidiary iVantage Health Analytics, LLC. intends on utilizing this data to support its “iVantage Market Intelligence” solution. iVantage Market Intelligence is a strategic market planning tool that helps hospital strategic planners research healthcare utilization, cost, & quality across their local geographies, ultimately assisting them in making informed decision based on sound analytics. iVantage Health Analytics, LLC utilizes this data to support hospitals & health systems in Maine who have contracted with us. We provide our client hospitals with strategic planning, market performance and healthcare delivery performance SaaS tools using this data and data from CMS that is aggregated and displayed via our products and reports. Hospitals and health system do not receive raw data elements. Outputs from our tools and reports are aggregated, de-identified data; we follow all low volume restrictions on release of information. Benefit to Citizens of Maine: Citizens of Maine benefit when their healthcare providers understand the health needs of the communities using Maine data and our tools. Providers can then develop programs targeting gaps in coverage or services; improve the quality of care provided and uncover efficiencies in delivery to reduce healthcare costs for everyone.
2018052201Matusovich, Becca, Executive DirectorPartnership for Children's Oral Health6-28-20188-10-2018Level II CY2015 thru CY2017 Medical Claims, Medical Eligibility, Dental Claims & Dental Eligibility.Level II Data Request: The Partnership for Children's Oral Health is a broad network of oral health stakeholders who are collaborating toward a shared mission: eradicating dental disease among Maine children. A key piece of this work is to strengthen the capacity of Maine's oral health service delivery systems to reach all children in Maine with effective preventive and restorative dental care. In order to create a shared understanding of the strengths and challenges of the current delivery system, we propose an analysis of all-payer claims data that will provide a snapshot of current patterns in utilization of preventive and restorative dental services and look at variations in utilization and cost across payer/insurer type, age group, location/geography, provider type, and setting of care. Benefit to Citizens of Maine: This project will benefit the people of Maine because it will help to build shared understanding of ways in which the current delivery system is able to meet the needs of Maine children, and what gaps remain. This will allow for collaborative planning to align resources and coordinate efforts to fill the gaps and increase children's access to recommended oral health care.
2018051801Wilson, Douglas, Agewell Prog. Spec.Southern Maine Agency on Aging6-15-20187-30-2018Level II CY2017 Hospital Inpatient and Outpatient DataLevel II Data Request: The purpose of this analysis is to measure the annual utilization of emergency departments for unintentional injuries related to falls for older adults. Project Objectives: The primary objective of this study is to understand how many ER visits are related to falls, specifically for older adults. The secondary objective is to use this information to help educate providers, payers, and consumers on falls prevention programs that have proven to be effective in reducing the number of falls and fall-related injuries. The CDC estimates that every 13 seconds in the country, an older adult visits an emergency room with a fall related injury. These unintentional injuries are the leading cause of injury for adults over the age of 65 and the leading cause of death for persons over the age of 85. This data request is intended to measure the impact of falls for older adults in Maine. Benefits to Citizens of Maine: The Southern Maine Agency on Aging has the lead on the efforts of the Know Falls for ME/Statewide Falls Prevention Coalition in increasing the awareness of falls prevention programs in order to help reduce the number of falls-related injuries across the State.
2018032001Kilbreth, Will, CIO.Community Health Options5-23-20187-5-2018Level II CY2016 - CY2017 Medical Claims, Pharmacy Claims, and Practitioner Identifiers.Level II Data Request: Community Health Options intends to use the MHDO CompareMaine site (comparemaine.org) to comply with 24-A MRSA Section 4318-A (Comparable Health Care Service Incentive Program). In order to validate and ensure the incentives we provide based on that tool align with potential member responsibilities under our contracts with providers, we need to perform an analysis on MHDO comparative data. Benefits to Citizens of Maine: Community Health Options intends to use the MHDO CompareMaine site (comparemaine.org) to comply with 24-A MRSA Section 4318-A (Comparable Health Care Service Incentive Program).
2018051001Dugan, Sean, Dir. of Contracting & Network Dvlp.MaineHealth5-21-20187-2-2018All current FY17 and forward Audited Financial Statements for non-MaineHealth Maine hospitals.Audited Financial Data Reports Request: The requested audited financials will be used to provide certain data elements (operating margin, total margin, long term debt, etc.) that at times may be used as components for internal comparative data sets that involve select hospitals, systems and/or geographical areas within Maine.
2018011801Kikut, Sara, Senior AnalystDecision Resources Group5-21-20187-2-2018Level I - CY2017 Medical Claims, Medical Eligibility, Pharmacy Claims, Pharmacy Eligibility, Hospital Inpatient, and Hospital Outpatient dataLevel I Data Request: DRG's mission is to improve health outcomes for patients accross the country, including Maine. We achieve this by delivering quality health market reports for consumers, to support their needs as they strategize marketing and operational planning. We work with several providers and market research actors that are using our products to improve the efficiency of their operations and understand the best practices for certain drugs and procedures according to specific cohorts and identify trends from a population health perspective. Our use of APCD will better inform us on the quality of the products we are delivering. We are investigating how our product compares to benchmark data so that we can understand if we are feeding our consumers biases we are unaware of. Benefits to Citizens of Maine: The data will ultimately help us improve the value we are bringing to providers in Maine who can return that value to the people of Maine.
2018031601Hawkins, Summer, Associate ProfessorBoston College5-21-20187-2-2018Level II CY2012 – CY2014 Medical EligibilityLevel II Data Request: The ACA's preventive health services with no cost sharing provision applies only to adults with private health insurance. While the ACA has the potential to improve preventive care there are gaps in this current coverage which may ultimately increase disparities. Health insurance claims for preventive health services can be used to evaluate the success of the ACA as well as identify gaps. APCD's are available in MA, NH, & ME. While MA & NH expanded their Medicaid programs, ME chose not to adopt the expansion. Differences in Medicaid expansion across states creates a natural experiment which we can evaluate using the APCD data. The overarching goal of this study is to examine impact of the ACA preventive health services and Medicaid expansion on screening tests, vaccines, and health-related behaviors and outcomes among adolescents and adults. The Specific Aims are 1: Evaluate overall impact of the ACA preventive health services on the uptake of preventive care and screening. 2: Evaluate impact of the ACA preventive health services across social determinants. 3: Evaluate impact of the ACA preventive health services across states. We received ME APCD 2012-2014 medical claims data to examine the impact of the ACA on breast pumps. We are now requesting eligibility files for our original request years 2012-2014, which would allow us to link with our medical claims data for the current project. The study aims are the same, but we now realize that we need the member eligibility file to help create a denominator for monthly claims, enrollment dates, member relationship to subscriber, and information on primary or secondary coverage. Benefits to citizens of Maine: Through this project we intend to identify gaps in the coverage of preventive health service provisions between the ACA and Medicaid as well as help close those gaps through policy recommendations. While we intend to publish our findings in peer-reviewed journals, we will also prepare a summary of the project and results, which can be posted online. We also plan to send copies of the journal article and summary to the Office of MaineCare Services and other relevant government programs. Our results based on the APCD will be directly applicable to current policies and practices in ME, which we hope will contribute to the discussion about health insurance and Medicaid coverage of preventive items and services.
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