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Care Working Group in January 1995 to foster partnerships between public health agencies and MCOs to improve public health. In a recent publication, the Working Group outlined its high priority areas for CDC's collaborative activities with MCOs and other health organizations, including prevention effectiveness and guidelines, Medicaid and managed care, research, and capacity development in public health agencies (CDC, 1995). The CDC recently initiated several collaborative activities with managed-care-related organizations. For example, a CDC epidemiologist is currently assigned on detail to the American Association of Health Plans (formerly Group Health Association of America) as a resource on public health issues. In addition, CDC staff have provided input regarding public health performance indicators, including STD-related indicators, to be used in the next version of HEDIS (3.0).
Funding for STD-Related Services
Given the recent and likely future reductions in public funding for public health services, many workshop participants believe that alternative funding streams for STD-related services, including public STD clinics, will need to be explored. Given that capitation encourages MCOs to keep costs down, there is a potential danger that MCOs may refer their patients with STDs to public STD clinics. In order to prevent this type of cost-shifting, local health departments will need to establish a mechanism for reimbursement of services.
The following are the major conclusions expressed by various workshop participants during the meeting. They do not necessarily represent a consensus of workshop participants or the conclusions of committee members.
Increase emphasis of STDs among MCOs. Most MCOs are currently not focused on the problem of STDs. MCOs and other providers need to be encouraged to consider STD prevention as priorities. Changing "organizational norms" or the prioritization process of MCOs through methods similar to those used by employers and other purchasers should be considered. Additional incentives for MCOs to become more involved in STD prevention will have to be developed for many MCOs to offer comprehensive STD-related services.
Define roles and responsibilities. The roles and responsibilities of MCOs, local public health departments, community-based organizations, and other stakeholders in STD prevention need to be clearly defined. In an era of limited resources for public health, it is important to identify what each potential provider of STD-related services does best and determine how each provider should function in an integrated system of STD-related services. Often, a formal mechanism for defining roles and responsibilities does not exist at the local level. A collaborative