selected on the basis of their likelihood of serving populations at high risk for STDs, such as having a high proportion of Medicaid enrollees and being located in an inner-city area. The remaining six MCOs were referred to us by MCOs who heard about the survey. Data were collected regarding MCO characteristics; STD-related data collection and analysis; STD-related preventive and curative clinical services; confidentiality policy; and community activities. Surveys were mailed and followed up with telephone calls from December 1995 through February 1996. Respondents who indicated that the MCO had significant activities in STD prevention or services were contacted to obtain details. The small sample size precluded analysis of correlations between variables. A median and range are reported for enrollment and demographic figures.

Results

The survey response rate was 60 percent (27/45). Of those responding to the survey, 6 MCOs (22 percent) described their structure as a sole staff/group model; 11 MCOs (40 percent) described a mixed model that included a staff/group model component; and 10 (37 percent) described their organizations as a combination of IPA, indemnity and/or PPO models. The plans had a median enrollment of 85,000 persons (range: 6,500-2,500,000). Twenty-five MCOs served Medicaid populations, representing, on average, 16 percent of their enrollment (range: 0-100 percent). For MCOs reporting demographic data (24), the median proportion of the enrolled population that was African American or Hispanic was 50 percent (range: 4-95 percent); the median proportion of adolescents age 15-24 was 15 percent (range: 10-70 percent); and the median proportion of women age 14-44 years was 27 percent (range: 10-60 percent). Forty-eight percent of the respondents were nonprofit organizations and 30 percent were among the 50 largest MCOs in the United States. Respondents were located in the Pacific (41 percent), mid-Atlantic (37 percent), New England (7 percent), East-North Central (7 percent), Mountain (4 percent), and Southern (4 percent) regions of the country.

Selected responses are summarized in Table H-1. Standardized patient history forms were used by 15 organizations (65 percent) to collect information about previous STD diagnoses and by 16 organizations (73 percent) to document a history of sexual activity. This type of information was used by 14 MCOs (52 percent) to define groups at high risk of STDs. Eight MCOs (30 percent) reported using data analysis to implement changes in STD-related activities, and four organizations (16 percent) had established performance criteria for STD-related outcomes or process measures for STD-related care.

Seven MCOs (26 percent) reported that they did not use any published STD treatment guidelines, and six (22 percent) used more than one published protocol. The Sexually Transmitted Diseases Treatment Guidelines published by the Centers for Disease Control and Prevention were used by 18 organizations (67 percent),



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