plans, and few are involved in activities to prevent STDs in the larger community beyond plan members. Managed care organizations and other health plans should take more responsibility for providing STD prevention services, both among plan members and in the community in which they operate. By supporting such activities among plan members and in the community, significant health care costs associated with serious complications of STDs will be averted; health plan members will be less likely to be exposed to infected partners or to acquire reinfections; and long-term complications of STDs will be prevented among current and future plan members in the community. Employers, government agencies, and other purchasers of health care services are vital to ensuring that health plans provide comprehensive, high-quality STD-related services. Most local health departments have not developed billing arrangements with health plans; since most public sector providers are not in managed care networks, their services are considered to be "out of plan" and not reimbursable.

With respect to the above issues, the committee makes the following recommendations:

• Health plans should provide for or cover comprehensive STD-related services, including screening, diagnosis and treatment, and counseling regarding high-risk behavior for plan members and their sex partners , regardless of the partners' insurance status.
• Federal, state, and local health agencies should educate employers, Medicaid programs, and other purchasers of health care regarding the broad scope and impact of STDs and the effectiveness of preventive services for STDs.
• Health plans, including managed care organizations, should develop collaborative agreements with local public health agencies to coordinate STD-related services, including payment for STD-related services provided to plan enrollees by public sector providers, including public STD clinics.

Well-trained primary care clinicians are essential for effective STD diagnosis and treatment. The current system of clinical training for health care professionals, however, is inadequate in preparing clinicians to effectively manage patients with STDs. Inadequate professional training contributes to the widespread tendency of clinicians to oversimplify and underestimate the importance of STDs. Familiarity with population-based health promotion and disease prevention techniques, skills in evidence-based clinical decision making, and patient communication skills are all essential for every clinician. STD training programs should be expanded at the primary care level to improve clinician skills in both public and private settings to effectively prevent, diagnose, and treat patients with