The potential concerns related to expanding the role of managed care organizations in STD prevention are summarized in Chapter 5. Practice constraints and financial incentives and methods for financing managed care and other health plans are potential barriers to health plans providing comprehensive STD-related services. As long as purchasers of health services are generally basing their decisions on premium costs rather than on enrollee health outcomes, many health plans are unlikely to fulfill their potential as providers of comprehensive STD-related care. It is important to note that there is great variation in the types of managed care plans and also variation within the types of managed care organizations. The extensive STD-related programs of a few group- and staff-model managed care organizations should not be assumed to reflect the interest or commitment of the less-structured health plans, which are far more numerous and cover a larger proportion of the population. In addition, the community outreach prevention programs of a few not-for-profit managed care organizations may not reflect the commitments or programs of investor-owned, for-profit managed care organizations. The committee is particularly concerned with the rapidly growing, less-structured health plans that do not have integrated delivery systems, lack health professionals with training in STDs, and have less-developed information systems. Some of these health plans do not fully participate in quality assurance activities or adequately monitor performance. Given the great variability in managed care organizations and other health plans, quality assurance and accrediting organizations, such as the National Committee for Quality Assurance, should promote measures that monitor the quality of STD-related services provided by health plans.

With very few exceptions, STDs are not yet high priorities among managed care organizations, and most are not involved in activities to prevent STDs in the general community. The committee's assessment is based on anecdotal information and was validated by a committee survey of managed care organizations that were considered to be likely providers of community health services (Appendix H). Given the limited data available regarding the scope and quality of STD-related services provided within the range of private sector health care settings, the CDC, in collaboration with the American Association of Health Plans, the National Committee for Quality Assurance, and the Health Insurance Association of America, should jointly sponsor or conduct a study to examine such services provided in private sector settings, including managed care organizations and other health plans.

There are several explanations for the general lack of involvement of managed care organizations and other health plans in STD prevention activities. STDs are not perceived as widespread problems among plan members or by purchasers and therefore are not a priority for many health plans. Second, the general lack of involvement in community-based prevention activities is consistent with market conditions. Driven by employers' and other purchasers' demands for lower premiums, virtually no health plan can afford to provide clinical

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