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APPENDIX G
Pages 370-382

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From page 370...
... model MCO (CIGNA Healthcare of Southern California) , and two publicly owned MCOs (Contra Costa Health Plan and Los Angeles County Community Health Plan)
From page 371...
... What are the major barriers to successful public/ private partnerships? How will MCOs that rely on publicly funded STD programs deliver STD-related services if public funding for these programs decreases or is eliminated?
From page 372...
... 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.
From page 373...
... 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.
From page 374...
... MCOs that serve populations at high risk for STDs are more likely to have providers of different cultural backgrounds and language capabilities than many public STD clinics or health plans that serve only commercial populations. These MCOs may be better able to provide culturally sensitive STD-related services to diverse populations than public STD clinics and health plans that do not serve high-risk populations.
From page 375...
... This may result from public hospitals and clinics shutting down or curtailing services and from decreasing eligibility thresholds for publicly financed programs such as Medicaid. Therefore, even if MCOs assume full responsibility for STD prevention and provide the same spectrum of services as public programs, public STD clinics may still be needed to provide services to persons who neither have private insurance nor qualify for Medicaid or other public assistance.
From page 376...
... For example, a survey conducted by the Pacific Business Group on Health showed that approximately 56 percent of enrollees in contracted staff-model MCOs reported that their physician or other health professional had not discussed STDs with them in the last three years (Pacific Business Group on Health, unpublished data, 1994~. In addition, if we accept that STD-related care is specialty care that requires extensive training and experience, then it may not be cost-effective for MCOs to replicate the technical competency found in public STD clinics.
From page 377...
... Preventive Services Task Force regarding clinical preventive services into their negotiated benefits packages and has implemented performance measures for many of these services. To ensure that MCOs are accountable for meeting performance goals, the Pacific Business Group on Health holds 2 percent of premium payments "at risk," pending a review of health plan performance.
From page 378...
... In addition, the contract requires that MCOs reimburse the county STD clinics for services provided to MCO members. In January 1995, the California Department of Health Services required that all Medi-Cal managed care contractors in 12 counties have subcontracts with respective county or city health departments regarding responsibilities in nine public health areas, including STDs.
From page 379...
... 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.
From page 380...
... This may be particularly important if the numbers of the uninsured increase. Therefore, services provided by public STD clinics should be maintained and delivered by public STD clinics or by other publicly funded programs in high-incidence areas.
From page 381...
... Local, state, and federal policymakers in private and public health agencies and organizations should be educated regarding the issues associated with managed care in STD prevention. Local health departments, in particular, should develop expertise on issues related to managed care and public health.
From page 382...
... . Prevention and managed care: opportunities for managed care organizations, purchasers of health care, and public health agencies.


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