managed care and other controversial health services, such as reproductive health (Delbanco and Smith, 1995) and HIV infection (Aseltyne et al., 1995).

Services and Programs of Managed Care Organizations

Studies show that most managed care organizations provide considerably more comprehensive coverage for reproductive health services than the traditional indemnity insurance plans (Benson Gold and Richards, 1996). Data regarding STD-related services provided or covered by health plans are limited.

Given the lack of published information regarding the potential role of managed care organizations in STD prevention, the committee sponsored a workshop on the role of managed care organizations in the prevention of STDs. A summary of this workshop can be found in Appendix G.

As a follow-up to the workshop, the committee conducted a limited survey of managed care organizations to collect preliminary data regarding STD-related services and programs in these organizations. Results of this survey are presented in Appendix H. Managed care organizations were selected primarily on the basis of their likelihood of serving high-risk populations (i.e., Medicaid, inner city), and therefore their increased likelihood of providing STD-related services. The committee found that 73 percent of responding managed care organizations requested information regarding previous history of STDs or sexual activity, and 65 percent requested information on sexual activity, on patient history forms. More than half (57 percent) of these organizations attempted to define high-risk groups for STDs, and approximately half reported STD prevention or clinical activities that specifically targeted adolescents. Only 26 percent of managed care organizations reported that they provided STD-related services to persons outside their plan, and just 17 percent had a specific individual in charge of STD-related activities.

Examples of programs and activities conducted by survey respondents are provided in Appendix H. Two examples of managed care organizations that have comprehensive prevention and case management programs that extend beyond the boundaries of the plan's enrollees are the Harvard Pilgrim Health Plan and Kaiser-Permanent of Southern California. At the Harvard Pilgrim Health Plan, all levels of services for members with HIV infection and AIDS have been integrated through a central multidisciplinary program. This program is closely linked to local health department services and provides extensive outreach and community services beyond the member population. In Southern California, Kaiser-Permanent has developed an effective system of STD-related services under the direction of an infectious disease specialist; the system includes monitoring of STD trends through reports from its centralized laboratory, implementation of STD treatment and case management protocols among its health professionals, and creation of a prevention and primary care program for STDs that is targeted to adolescents in the plan and in the general community. STD programs such as

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