provider training in the last few years. The MCO does not have specific guidelines to ensure confidentiality of STD-related care.

Kaiser Permanente of Southern California is a nonprofit, primarily group-model MCO serving several southern California counties. It is comprised of a medical group of 2,700 physicians and has an enrollment of approximately 2,200,000. Almost all beneficiaries are commercial members since Kaiser has only recently begun to accept Medical patients. Because of its centralized laboratory, Kaiser is able to closely monitor STD diagnoses and screening test results. To ensure that clinicians are aware of the latest trends in diagnoses and to further general information exchange, there are monthly teleconferences between physicians and laboratory personnel. Although Kaiser does not directly provide services to nonmembers, Kaiser has an unwritten policy to give prescriptions to nonmember partners of STD patients. In addition to sponsoring a clinic for teenagers, the MCO has an STD prevention program called "Secrets" (Appendix H) that is targeted towards adolescents. This program was largely initiated by pediatricians at Kaiser who had a strong interest in STD education for women and adolescents.

CIGNA and Kaiser represent two different types of MCO structures and missions. MCO structures range from relatively loosely organized networks of health care providers in IPAs to group- and staff-model organizations where the providers' practices are closely monitored. Missions of MCOs vary between the publicly operated, nonprofit organizations and the investor-owned, for-profit corporations. Many workshop participants believe that strong staff-model MCOs, such as Kaiser, may be more likely than IPAs to have the oversight structure and organization necessary to implement effective STD preventive services. Group-and staff-model MCOs also tend to have more centralized information systems that allow for better surveillance of health conditions and performance monitoring.

Experiences of Two Publicly Owned MCOs

The Los Angeles County Community Health Plan is one of only two publicly owned and operated MCOs in California. The MCO has an enrollment of approximately 115,000 persons, all of whom are medically or economically indigent. Because the MCO considers the enrolled population to be at high risk for STDs, the MCO conducts routine screening for gonorrhea and chlamydial as part of every pelvic exam and provides STD-related risk-reduction education with each health maintenance examination. One of the major problems that the MCO has encountered is the large turnover in eligibility for plan coverage, since eligibility is income-dependent. This problem hinders the establishment of longer-term relationships between providers and patients.

The Contra Costa Health Plan is the other county-sponsored and operated staff-model MCO in California. It has an enrollment of approximately 24,000



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