Prevention of sexually transmitted diseases - A model for overcoming barriers between managed care and public health

Context: The growth of managed care has spurred re-evaluation of the roles and responsibilities of public health agencies and private health plans for providing public health services, Although rates of curable sexually trans mitted diseases (STDs) in the United States are the highest in the develope d world, many clinicians and managed care organizations are not systematica lly providing high-quality, comprehensive STD-related services to their pat ients and the community. Objective: To examine issues around managed care and STD prevention as a mo del for overcoming barriers that impede managed care organizations from pro viding comprehensive public health services and collaborating with health a gencies. Setting: Two-day invitational workshop. Participants: Representatives from 18 health plans, 10 public health agenci es, 6 academic institutions, 1 purchasing coalition, and 5 other health org anizations. Results: Major obstacles include: turnover and heterogeneity in the health cal-e system; deficiencies in clinical knowledge and skills; differences in organizational culture and language; low priority of STDs; inadequate publ ic health surveillance data and performance measures; confidentiality conce rns; and lack of coverage for sex partners. Conclusions: Potential approaches for addressing these barriers include: re quiring that STD-related services be covered by Medicaid managed care progr ams; implementing performance measures; requiring collaborative activities; promoting education of and outreach to stakeholders; funding of pilot proj ects; and researching the cost-benefit and cost-effectiveness of STD-relate d services for various populations.