Addressing Wondering, Reducing Friction and Integrating Behavioral Health: Belle’s Q&A with Rufus Howe

Rufus Howe is an experienced healthcare Innovator with a deep background in healthcare consulting, disease management, performance improvement, Medicaid, and case management. He currently serves as Board Chair for Belle. Rufus has served in the U.S. Army as a nurse practitioner and in leadership positions for an array of leading organizations, including Xerox, Healthspring, ACS Healthcare, Healthways, Access Health and McKesson. Belle caught up recently with Rufus to get his take on several interesting healthcare trends. Here’s what he had to say.

What are you focused on right now as a lever for improving the health of populations?

I am keenly focused on the intersection between chronic illness and mental health. There is a lot of research that demonstrates a strong correlation between these two domains. Some companies have data that demonstrates patients who spend more per month in claims costs are much more likely to have behavioral health issues. The same research is available to demonstrate that those with behavioral health concerns are more likely to be managing chronic conditions. What’s obvious is that there is significant portion of our society that is wrestling with the combination of physical and behavioral health issues. As a result, we need more solutions that address both sides of this equation.

What would you like to see change about how we support behavioral health in this country?

There are no gaps in care for behavioral health. It’s just a little fuzzier and not as tangible as, say, diabetes or cardiac disease. It’s more driven by behaviors and not a specific lab test. At the end of the day, we all experience mental health on a continuum from good to not good. There is no perfect mental health score. The average primary care physician is very likely to refer mental health issues to a specialist very quickly, partly because they are not fully comfortable addressing these issues and partly because they don’t want to step on toes. I think we need to more effectively integrate behavioral health support into primary care settings.

Do we need to alter our basic understanding and approach when it comes to supporting individuals in their health pursuits?

Health is deeply personal, and deeply relational. People are just trying to live their best lives. That means meaningful relationships and experiences. People don’t think about health in the same way as medical professionals. Health is how they feel right now, and whether there is anything that is preventing them from doing what they want to do. Seeking health care is something that happens on “top” of their lives. It’s an errand, a necessary task when they can’t’ figure out how to manage their illness or pain.

In any given year, you might spend 30 minutes with doctors or nurses. It’s a fast and largely awkward time. The only saving grace is when you “like” them because they smile, are friendly, and seem to listen. A trusting relationship that extends to daily positive behavioral actions is a stretch. That is a challenge, because forming a trusted relationship with each individual is the only way to achieve meaningful outcomes. All of that to say, yes we do need to fundamentally change how we engage individuals. If we don’t prioritize a trusted relationship as a foundation, none of our efforts will ever be enough.

Are there other dynamics at play that make it hard to engage the healthcare consumer?

There is still a lot of unnecessary friction when it comes to healthcare interactions. Patient portals are typically not well designed. Most of healthcare is not consumer friendly. Consider your banking website. If it didn’t do anything for you or provide any value, you wouldn’t use it. But it does offer value, and it facilitates important interactions in a very user friendly way. Why don’t we have something like that for healthcare? Why do we have to make it so hard? The more frictionless we make the experience, the more effectively we will engage the consumer.

You believe we need a more effective way to address the act of “wondering” among older adults. Can you elaborate?

We all wonder what that feeling is. What is going on in my belly? Why do I have this headache? It is rare that you can see your doctor or access an expert opinion when you are in the wondering mode as an individual. Wondering drives so much The Internet can satisfy this need, at least in a small way. But most people don’t know how to evaluate the credibility of information online. The old school answer for wondering was the nurse call line. This solution was helpful as a frontline response to wondering. Nurse lines have somewhat fallen out of favor in recent years. The dynamic of patients wondering about what is going on in their bodies has not. I think we should consider modern approaches to addressing this need. If we appropriately address and satisfy the wondering of patients, it will make a big difference.

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