those mentioned above may have a dramatic impact on reducing STDs and associated costs in managed care organizations. For example, a recent randomized control study conducted at Group Health Cooperative of Puget Sound showed that identifying, testing, and treating women at increased risk for asymptomatic chlamydial infection reduced the rate of pelvic inflammatory disease by more than 50 percent compared to women who received routine care (Scholes et al., 1996).

Government Initiatives Related to managed Care and STDs

Public health agencies, such as the CDC, have been exploring the impact of managed care on public health services. The CDC recently established a Managed Care Working Group to foster partnerships between public health agencies and managed care organizations to improve public health (CDC, 1995b). The CDC's high-priority areas for collaborative activities with managed care organizations and other health organizations include prevention effectiveness and guidelines, Medicaid and managed care, research, and capacity development in public health agencies. In addition, a CDC epidemiologist is currently assigned on detail to the American Association of Health Plans as a resource on public health issues. As mentioned previously, CDC staff have provided input regarding public health performance indicators, including STD-related indicators, for future versions of HEDIS.

The California Department of Health Services has also recently initiated the California Partnership for Adolescent Chlamydial Prevention. This is a statewide partnership, bringing together government agencies, managed care organizations, academic health centers, and professional associations to address policy issues related to STDs among adolescents. This initiative also seeks to coordinate clinical preventive services for adolescents in managed care settings with community STD prevention activities and to coordinate all categorical state STD-related programs. Other components of this initiative include a media campaign targeted towards teenagers; development of screening, counseling, and education interventions; school-based programs; and training programs for health care providers.

The Los Angeles County Department of Health Services has developed a model contract between the agency and managed care organizations that contract under the Medical (California's Medicaid program) program (County of Los Angeles, Department of Health Services, 1995). The contract, which covers a wide range of public health services, describes STD clinical services as a ''shared responsibility between County and Plan." The contract would require managed care organizations participating in Medical to "reimburse the County for services provided to Plan beneficiaries at the Medical [fee-for-service] rate." In turn, the county agrees to "make all reasonable efforts to provide medical records to the Plan relating to STD care billed to the Plan." The county's contract language

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