Sound Advice

Ann Mond Johnson Co-founder and CEO Subimo LLC

BUYING A HOME. Choosing a career. Getting married. Are there any decisions more important than these? What about choosing the best hospital?

Make that choosing the best hospital for cardiac care when your spouse is in cardiac arrest in the back seat of your car. That's what happened to Ann Mond Johnson, co-founder and CEO of Subimo LLC, supplier of online healthcare decision-support tools to HMOs, employers and consumers.

"A year after we started [Subimo], my husband went into cardiac arrest in the back seat of my car as I was driving him to the hospital for what we thought was acute gastritis," Mond Johnson says. "The EMTs wanted to take him to one hospital, and I insisted on another, a bit further than the first. I was adamant because I was familiar with the data, and we were lucky because we knew this in advance."

At a glance

Subimo's suite of decision tools provide, in one source, a combination of data, content and personalized, interactive tools so consumers easily can select hospitals, doctors, and drugs; select among insurance coverage; fund tax-preferred health savings accounts (HSAs); and determine costs for medical services. Nearly 60 million Americans have accessed Subimo's tools through their insurance company or employer.

After undergoing quadruple bypass surgery, Mond Johnson's husband now is in good health. "Not a week goes by without reading about what you might do in the event of a stroke, a coronary or other emergencies," Mond Johnson says. "As people become familiar with healthcare using credible data—in conjunction with a host of other sources they may rely on—they often tell us that our information confirmed what they had heard previously, or gave them cause to research their options further. This is especially true of parents with small children or individuals who are living with certain conditions."

Q. How do decision support tools help consumers achieve better health?

A. When a consumer is given reliable and credible healthcare information, they will use it to seek the most effective treatment. When the company started, we learned about the Voluntary Hospital Assn.'s consumer market research, where consumers were given brief explanations of evidence-based medicine or what should occur, for example, if you are brought to an ER with a suspected heart attack. The interesting thing was, consumers readily understood what "good medicine" was and were outraged when they learned it wasn't practiced at all hospitals.

The American consumer is fundamentally smart and knows how to use information, even in the field of medicine where problems frequently lack a clear solution. Our approach is to provide the relevant data and information in a fashion that people can understand and use to make better decisions. Consumers who are more engaged in their care have a better likelihood of a good outcome. Consumers know that the healthcare system in not infallible, and are beginning to realize that they can help mitigate their risks by making informed decisions.

Q. How do online decision tools help control healthcare costs?

A. Our suite of tools help consumers understand their options, and the relative risks and cost of their choices. Take the hospital selection tool, as an example. One of the misperceptions we address is that people are initially afraid that they are at a high risk of dying when they undergo a particular procedure. In fact, the risk of death is pretty low for most procedures. The real risks are in the avoidable complications (e.g., infections), which add costs to the system along with other factors. Doing it right the first time costs less.

In addition, we have a number of applications that enable a consumer to see the relative costs and efficacy of different medications—prescription, brand versus generic and reasonable OTC alternatives—and different treatments that are likely to fall within their deductible. It is clear that as consumers are more financially engaged in their healthcare, they are interested in weighing the relative tradeoffs of these items.

We also have a new application that enables a consumer to go through the insurance plan selection process and understand how they might maximize their tax-preferred accounts or minimize their out-of-pocket cash outlays.

Q. The Los Angeles Times recently published an article addressing whether rating doctors will improve quality. The comment was made that there is lack of uniformity with rating systems such as Subimo's. Your response?

A. As a general rule, we don't rank providers. Rather, our site allows a consumer to become more knowledgeable and then use that information to make decisions that closely match their criteria.

As it relates to physicians, currently our physician tools offer standard demographic information, such as age, office location and where the physician went to medical school. In many instances, we are also able to link the physician to the hospital where he or she has admitting privileges so the consumer can get a more comprehensive picture. And then there are nine states that also have physician identifiers appended to the patient record so we can also provide summary-level information—volumes—on specific physicians.

Instead, our focus has been to give consumers the information and questions they need to ask—by helping them understand what their expectations should be when they have been diagnosed with type 2 diabetes or what they should expect in their treatment for coronary artery disease. In this fashion, the consumer as the patient will understand what should happen or what they should expect, and then they can evaluate their care accordingly. In the absence of perfect or credible information, this is one place to start.

In addition, we always have been quick to integrate regional data sources that our clients find credible. Likewise, we have had growing interest from clients in our ability to integrate their own or selected external datasets on physicians.

Q. One of the concerns with consumer-driven healthcare (CDHC) is that it simply represents cost shifting from the payer to the consumer. What do you think?

A. It's clear that healthcare costs for the plan sponsor are unsustainable, even if the pace has abated in the last year. CDHC is one response, and has many definitions, permutations and too many associated acronyms. The reality is that with the media focus on healthcare, with the growing access to information through the Internet, and with the affluence and attitude of consumers, "consumer directed" is not going away. Consumer directed reflects how we live our lives in other sectors of the economy, and the demand on the part of consumers to have access to information and data in healthcare is no different from what they expect elsewhere. Consumer directed in healthcare requires a number of pieces to be successful.

Q. What's next for decision-support tools?

A. We've focused on a few things. First, we are seeing a continued convergence of health and wealth. Our more recent applications reflect the growing interest of being able to manage and allocate tax-preferred dollars between health savings and retirement savings accounts. A March 2005 study from Fidelity Investments found that today's average retiring 65-year-old couple will need approximately $190,000 in today's dollars to cover medical costs for the next 15 to 20 years.

This clearly quantifies the gap between what people are likely to need and what they have saved, assuming nothing changes with Medicare. We anticipate this trend to continue and people will begin to find it to be a very sobering reality. The nature and type of modeling that a consumer will want to do will change, and expand beyond the traditional health risk assessments that are currently available. It also means that we need to address how decisions are being made, and not just what decisions are being made.

We also see our clients evolving in terms of what they are offering on their Web sites for their members. Increasingly, they are reevaluating the slew of tools and material placed on their sites three to four years ago, and resorting to a streamlined and consequently more user-friendly approach which keeps the consumer within the portal and provides a "contextually integrated" and more personalized experience. Subimo works closely with our clients to ensure that what they need to be successful gets developed in short order. We have had a nice track record of developing applications in conjunction with our clients, and I see that continuing.