- automated information systems, there is a great potential for better information and data on STDs and STD-related services in managed care populations. The larger, more structured MCOs (such as groupand staff-model MCOs) are likely to have particularly useful patient population data. This assumption may not hold true for less-structured MCOs, such as some IPAs that lack centralized data systems. The information systems of publicly sponsored health insurance programs (e.g., Medicaid and Medicare) have been traditionally structured around the delivery of curative services on a fee-for-service basis and have not been particularly useful in evaluating public-health-related or preventive services.
- Quality of STD-related care. As a result of automated information systems, most MCOs have systems for monitoring quality of care and measuring performance. Standardized performance measures, such as the Health Plan Employer Data and Information Set (HEDIS) system coordinated by the National Committee on Quality Assurance, have the potential to greatly improve STD-related care in MCOs.
- Accountability for services. MCOs, by virtue of being organized systems of care, facilitate increased accountability of providers to purchasers and, ultimately, to beneficiaries. Purchasers are able to hold MCOs accountable by ensuring that specific services are available and delivered within the specifications of negotiated contracts and agreements. Through contract obligations, it may be possible to hold MCOs accountable for all aspects of STD-related care.
- Preventive health. Compared to traditional fee-for-service insurance companies, MCOs have emphasized preventive health services because many preventive health measures are cost-saving. Since MCOs are responsible for covering health conditions occurring within the enrollment period, they are more likely to emphasize health promotion and disease prevention and to encourage healthy behaviors among their enrolled populations compared to noncapitated providers.
- Access to care. Because the mission of MCOs and government regulations require that beneficiaries have convenient access to primary care services, MCOs are more likely to have greater access to care than dedicated public STD clinics. In addition, some communities that are currently at high risk for STDs do not have access to local public STD clinics.
- Cultural barriers to care. MCOs that serve populations at high risk for STDs are more likely to have providers of different cultural backgrounds and language capabilities than many public STD clinics or health plans that serve only commercial populations. These MCOs may be better able to provide culturally sensitive STD-related services to diverse populations than public STD clinics and health plans that do not serve high-risk populations.
Potential Limitations of MCOs in STD Prevention
The major potential limitations of MCOs in providing STD-related services include the following: