Summary
This report examines the extent to which managed care organizations (MCOs) that serve Medicaid beneficiaries are promoting effective management, control and prevention of sexually transmitted diseases (STDs) among their enrollees — and whether these organizations’ policies correspond with the actual practices of the primary care providers in their networks. In 1996 alone, 15.3 million new STD cases were reported in the United States, and the prevalence of these infections is even higher due to the accumulation of viral non-treatable STD cases. Beyond the suffering caused directly by a particular disease, STDs can lead to infertility, pregnancy complications, cancer, and a greater susceptibility to HIV infection, among other complications. The advent and dramatic growth of Medicaid managed care plans increases the importance of MCOs’ policies and programs to combat STDs, particularly since the Medicaid population of mostly low-income women and children includes a large proportion of individuals who are considered at higher risk for STDs.
For this report, authors focused on MCOs that serve Medicaid beneficiaries in metropolitan areas with a high prevalence of STDs, and looked at the extent to which STD practice guidelines are promoted by MCOs and by their contracted medical groups (CMGs) and used by the CMGs’ affiliated primary care providers (PCPs). We employed a systematic sampling method to select MCOs in seven large U.S. cities that had both high rates of reported STD cases and large percentages of Medicaid beneficiaries enrolled in managed care. These cities included: Baltimore, MD; Charlotte, NC; Dayton, OH; Louisville, KY; Memphis, TN; Norfolk, VA; and Oklahoma City, OK. Interviews were conducted with 21 MCO medical directors, 33 CMG medical directors, and 50 PCPs.
The following guidelines and practice protocols, drafted by the research team and reviewed by an expert advisory panel formed for this study, were used to measure the performance of MCOs, CMGs, and PCPs in the delivery of STD care to the Medicaid managed care population: Take a sexual history on all new patients during first non-emergent visit. Provide preventive counseling while taking the sexual history. Make condoms available without charge for patients in the provider’s office. Screen sexually active adolescents annually. Presumptively treat chlamydia in the presence of gonorrhea. Use single-dose therapies (azithromycin) for chlamydia. Treat minors without parental/guardian consent. Advise infected patients to notify partners and urge testing.
Alert the public health department to notify partners. Test and treat partners regardless of membership or reimbursement. Authors also examined whether MCOs and CMGs provided, promoted and monitored adherence to STD treatment guidelines and provided PCP training; and whether MCOs established reimbursement relationships with outside providers and collaborated with the local health department on STD control efforts — all of which are components of effective STD control.
