Where does this website come from?

The CompareMaine website is a product of the Maine Health Data Organization (MHDO). The MHDO is a state agency that collects healthcare data from various entities including healthcare settings and health insurance companies. In addition, the MHDO is required by Maine State law to collaborate with another State Agency, the Maine Quality Forum (MQF) on promoting the transparency of healthcare cost and quality information via a publicly accessible website.

CompareMaine was originally developed with financial support from the Centers for Medicare & Medicaid Services (CMS). Enhancements have been made over the years with each new release in the content and the volume of information on the website.

Many people provided input to help make CompareMaine a usable, useful tool including the MHDO Board of Directors, the MHDO Consumer Advisory Group, members of industry and medical associations, and technical experts.

Where does the information come from?

The payment data on CompareMaine is based on the claims data submitted by commercial payors to the MHDO per the requirements of 90-590 CMR Chapter 243, Uniform Reporting System for Health Care Claims Data Sets, for the reporting period July 1, 2023 – June 30, 2024. The estimates do not include data from Medicare Advantage, public payors (MaineCare and Medicare), or the uninsured. A total of 1,879,255 healthcare claims from 16 commercial payors were analyzed in the development of the payment estimates.

CompareMaine reports information on over 300 common healthcare procedures performed at more than 200 healthcare settings. Healthcare settings include hospitals, surgical centers, diagnostic imaging centers, health centers, laboratories, and clinics.

MHDO requires a certain volume of claims data for each procedure to be eligible for reporting on CompareMaine. The top five commercial payors on CompareMaine represent approximately 91% of the claims data that is used to generate payment estimates on CompareMaine:

• Aetna (includes Aetna Health Inc. and Aetna Life Insurance Company)
• Anthem (includes Anthem Health Plans of Maine, Inc. and Anthem Insurance Companies, Inc.)
• CIGNA (includes CIGNA Health & Life Insurance Company)
• Community Health Options
• Harvard Pilgrim (includes HPHC Insurance Company Inc and Harvard Pilgrim Health Care Inc)

Commercial payors with insufficient volume are not identified independently on CompareMaine but their payment data is included in the statewide average payments.

CompareMaine reports on eight hospital quality measures:

1. The Five-Star Overall Hospital Quality Rating shows how well a hospital performs across different areas of quality, such as treating heart attacks and pneumonia, readmission rates, safety of care, and patient experience.
2. Patient experience survey ratings reflect how satisfied patients are with their hospital experience and the overall quality of care received.
3. How well hospitals prevent serious complications from procedures that can result from hospital services or stays.
4. How well hospitals prevent C.diff infections that can result from hospital services or stays.
5. How well hospitals prevent MRSA that can result from hospital services or stays.
6. How well hospitals prevent patients from falling and getting injured.
7. How well hospitals prevent pressure ulcers that can lead to serious infection.
8. How well hospitals prevent patients from being re-admitted within 30 days after being discharged from a hospital stay.

The data for these measures come from state and national sources. Learn more about the quality data reported on CompareMaine.

How does CompareMaine calculate payments?

CompareMaine shows the average payment for a healthcare services and procedure at different healthcare settings in Maine. The average payment is calculated using the median, the middle payment amount of a range of payment amounts ordered from lowest to highest payments. Payments include both the amount paid by the commercial payor and the patient's out-of-pocket costs (copayments, deducible, and co-insurance amounts).

When there is split billing, more than one type of claim is submitted to the insurance company for the service or procedure provided. CompareMaine displays the total median payment, which breaks down payments associated with both the technical (often referred to as the facility fee) and professional components and the number of procedures used to calculate the payment at each healthcare setting.

Actual out-of-pocket costs vary from one person to another. The amount you pay out-of-pocket for services you receive depends on several factors, including the level of coverage in your health insurance plan.

If you have health insurance, your insurance company may have a cost-calculator tool designed to assist you with calculating your personal out-of-pocket expenses.

Payments for healthcare services often varies across healthcare settings—even for the same test or service. There are many reasons for differences in payments, including geography and the contractual agreements negotiated between the healthcare setting and insurance company. The information in the Healthcare Payments section explains how CompareMaine uses these differences when calculating average payments on over 300 healthcare services and procedures.

The estimated payments on CompareMaine reflect median payments and are meant to serve as a reference point for comparison. Please contact your insurance company to find out your actual out-of-pocket costs. If you do not have insurance, please contact the healthcare setting that you are interested in to discuss the cash price. When contacted directly, healthcare settings often communicate what they charge for a healthcare service or procedure, which is often higher than the actual payments they receive from the contractual arrangements negotiated with insurance companies and from individuals without insurance.

MHDO makes every effort to provide accurate information on this website. Healthcare settings and commercial payors included on CompareMaine are sent the payment data to review for accuracy before it is published. Payments presented on this website are within 10% of estimated payments from healthcare settings and commercial payors.