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persons, 65 percent of whom are Medicaid beneficiaries or other medically needy populations, including homeless persons. The Contra Costa Health Plan has a close collaborative relationship with the Contra Costa County Health Department. In a memorandum of understanding, the MCO and the county health department have outlined their specific roles and responsibilities for various health services, including STD-related care. The agreement covers STD-related education, reporting, contact investigation, and treatment. For example, when surveillance data indicate a specific problem within the catchment area of the MCO, the MCO will develop and implement a plan to provide STD-related risk-reduction information to all members in consultation with the county health department. One issue that the MCO has been dealing with is the conflict between the need for medical providers to know the treatment history of the individual and the patient's wish for confidentiality.
Because the Los Angeles County Community Health Plan and the Contra Costa Health Plan are both operated by local governments, they have built-in linkages with county health department activities and priorities. These linkages have allowed the MCOs and local health department programs to ensure that specific components of STD-related services are available. These MCOs, like other MCOs that serve large numbers of medically and economically needy persons, have found that the general package of managed care services developed for employer-sponsored or commercial populations may not be appropriate for indigent populations. There is a growing recognition that persons in publicly funded programs, such as Medicaid, have health care needs different from those of the commercial or general population.
Potential Strengths of MCOs in STD Prevention
Both opportunities and concerns were identified by workshop participants regarding the potential impact of managed care on STD prevention activities. The major potential strengths of MCOs in providing STD-related services include the following:
Coordination and integration of care. STD-related services should be coordinated and integrated with primary care. Because MCOs provide all primary care for enrollees, they will be better able to coordinate and integrate STD-related care into primary care compared to specialized public STD clinics or fee-for-service providers.
Screening for STDs. If MCOs adopt public health recommendations for screening of sexually transmitted infections as standard policy, the numbers of patients who will be screened will increase substantially compared to patients outside of the managed care environment, where screening decisions are up to individual health care providers and are not centralized.
STD-related data and information systems. Given the potential of centralized