Claims Data: An Evaluation Opportunity for Public Health

The Maine Health Information Center (MHIC) was created in 1976 as a centralized, non-profit, data consortium for the State of Maine. Today, the MHIC houses large databases with insurance claim data from Maine, New Hampshire, Massachusetts, and Vermont. Claims data has been largely utilized to help determine the drivers of healthcare costs, which has been utilized by companies, the provider community, etc. However, public health has only just started utilizing this rich database for in depth population based analyses.

The purpose of this presentation will be to describe the process for creating the claim data warehouse, describe how the data is currently being used, and will illustrate the potential this data has with public health. Currently, the Data Processing Center (DPC) receives and processes payer data from 33 states and territories. The processing center combines the data from all payers and adds value added components, such as grouping codes into standard Episode Treatment Groups (ETG). The MHIC also has a provider linkage process that runs through all of the physician provided information and de-duplicate the incoming data.

Currently, the data has been used in the medical utilization and cost analysis, and interventional studies. Now, we are starting to see application for the data with public health, particularly with programmatic evaluation. The MHIC has worked on studies evaluating cardiovascular interventions, Hepatitis C profiles, and geographic disease prevalence. Further, there is immense potential to look at the effectiveness of programmatic and IT initiatives. We hope to see further discussion and ideas from conference participates.