- services related to STD prevention are being provided by MCOs? How do MCOs handle confidentiality issues related to STDs, and who has access to this information? What are the experiences of MCOs that are serving populations at higher risk for STDs or participating in Medicaid managed care contracts?
- Public/Private Partnerships: What types of public/private partnerships related to STD prevention exist? What are the major barriers to successful public/private partnerships? How will MCOs that rely on publicly funded STD programs deliver STD-related services if public funding for these programs decreases or is eliminated?
- Roles and Responsibilities: What should be the roles and responsibilities of the public versus private sectors regarding STD prevention? How will decreased public funding and government oversight affect these various roles and responsibilities? How can MCOs coordinate their efforts with public agencies to improve the combined effectiveness of programs and to reduce duplication of efforts? What are the responsibilities of MCOs for the health of persons who are not plan beneficiaries? What incentives exist or need to be developed, and what barriers need to be addressed in order for MCOs to make STDs a priority?
- Monitoring and Accountability: How should MCOs, public health officials, purchasers, and accrediting organizations ensure quality and accountability and monitor performance of STD-related services? What is the role of purchasers in establishing STD prevention activities as priorities in MCOs?
The following is a summary of the major issues that were discussed during the workshop. The perspectives reflected in this document do not necessarily represent the consensus of workshop participants or the committee.
Experiences of Two Privately Owned MCOs
CIGNA Healthcare of Southern California, a for-profit MCO that serves several southern California counties, is primarily comprised of a network of IPAs, medical groups, and individually contracted physicians (the staff-model component was sold in 1996). CIGNA serves a mostly commercial population of approximately 500,000 members but also has 108,000 Medical members. Anecdotally, rates of STDs among the commercial population have not increased in the last few years, but STD rates among Medical members have increased approximately two- to threefold. All STD-related services, including education, are triggered by and centered around patient visits to primary care providers. There is a system for automatic tracking and reporting of STDs, with nurses conducting patient follow-up for appointments. Although printed literature on STD-related topics is disseminated to providers, there has not been any STD-related