are particularly important not only in improving quality of dedicated STD clinics, but also in providing professional training required to expand STD-related services into the private sector.

Therefore, the committee makes the following recommendation:

  • Health professional schools, including schools of medicine, nursing, and physician assistants, should partner with a local health department for purposes of STD clinic staffing, management, and professional training. Support from federal and state governments should be provided as incentives for such collaboration.

Involving Managed Care Organizations and Other Health Plans

The committee believes that, if certain concerns are adequately addressed, there is substantial potential for managed care health plans to improve both the quality of and access to STD-related services. As summarized in Chapter 5, managed care organizations have several characteristics that represent important opportunities for enhancing STD-related services among persons enrolled in managed care health plans. Compared with other health plans, the structure and resources of many managed care organizations allow for improved coordination and integration of care, accountability of services, incentives to provide preventive services, and quality monitoring of services through information systems. Managed care organizations have the potential to provide higher quality, more comprehensive STD-related services than traditional indemnity health insurance plans and independent private practice clinicians, who may have little incentive to provide preventive services.

The committee identified some notable and impressive STD-related programs and activities among managed care organizations, as described in Appendix H. Some managed care organizations have developed and implemented STD or HIV prevention activities for both plan members and the community. Some large group- and staff-model managed care organizations are fully incorporating STD-related clinical services into routine practice. For example, Group Health Cooperative of Puget Sound, Harvard Pilgrim Health Care, and Kaiser-Permanente of Southern California offer a range of STD-related services, including education, screening, diagnosis, and treatment, relying on public health agencies for outreach, partner notification, and, often, counseling.

Although the committee believes that managed care health plans are capable of improving STD-related services, it recognizes that they have not yet fully demonstrated this capacity. Therefore, as managed care expands in the United States, the performance of such health plans in providing STD-related services should be carefully monitored and evaluated to determine the impact of such health plans on access and quality of services, especially among persons at high risk for STDs.

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