Audina Hearing Instruments Audiology Online Beltone Electronics Energizer ESCO Etymotic Research Frye Electronics Inc. Hansaton InSound Medical Interton, U.S. IntriCon Corporation Knowles Electronics Micro-Tech Hearing

Instruments ON Semiconductor

Oticon Inc. Phonak Inc. Pulse US, Inc. ReSound North America Rexton, Inc. Siemens Hearing

Instruments Sonic Innovations, Inc. Sound Design

Technologies Spectrum Brands Starkey Labs Inc. The Hearing Journal The Hearing Review Unitron Hearing US Widex

• Government Relations• Statistics• Market Development

• Agencies – FDA, FCC, HHS, FTC• Legislatures – House, Senate, States• Allied Organizations

• $500 per aid• Every five years• Age 55 and older & dependent children• Household income below $200,000

www.hearingaidtaxcredit.org

• $1000 financial assist• $12,000 annual income differential• “Halo” effect

www.hearingaidtaxcredit.org

• 2,407,559 units (-0.73%!)

• 57% BTE! • 3% analog

• Q1 even

• 63% BTE!• Bye bye Analog –

Hello External Receiver (33%)

2008 2009

78/1 80/1 82/1 84/1 86/1 88/1 90/1 92/1 94/1 96/1 98/1

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HIAGDP

• Better Hearing Institutewww.betterhearing.org

• Exploring the Consumer’s Journey

• Technological excellence• Dispensing excellence• Gap between excellence and use– 20% Utilization– Public perception unchanged– 1 in 6 are in the drawer

• Results of untreated hearing loss cannot be tolerated any longer

• Phase I: Consumer Focus GroupsMay 2005

• Phase II: Online Consumer SurveyFebruary 2007

• Phase III: Delighted Consumer Focus GroupsAugust 2007

• People who had suspected they had a hearing loss but had not taken action

• Were primarily aware due to experiences and complaints from family and difficulties themselves

• Perceived people with hearing loss as old, weak, frail

• Believed from old friends and relatives that hearing aids don’t work

• Received inconsistent advice• ‘Knew’ that hearing aids were so expensive

that you shouldn’t buy them until you’re desperate

• People who had an evaluation but had not purchased hearing aids:

• Were aware due to same experiences and waited a long time• Expected but did not receive some quantifiable

measure of their problem• Doubted the validity of the recommendation• Had concerns regarding benefit, function and cost• Received no compelling reasons to act

• People who had purchased hearing aids had wide variations in their experience and views:

• Pleased– Have made my life better– Feel more confident wearing them– Received training in care and use– Participated in post-sale interactions

• Disappointed– Don’t work in all situations– Embarrassed by wearing them– Received little training in care and use– Feel ‘abandoned’ post-sale

STUDYHEARING AID USERS

SUBJECTS MATCHED FOR AS MANY VARIABLES

AS POSSIBLE

SATISFIED HEARING AID USERS

DELIGHTED HEARING AID USERS

WHAT EXPLAINS THE DIFFERENCE?

• The Survey• 95 questions about hearing aids, acquisition, use• 41 minutes to complete• Healthy Hearing/Survey Sampling International• 10 point scale – “High Delight” = 9 or 10

• The Respondents• 890 respondents (73% completion rate)• 50% women, 50% men• Average of 60 years• Over 80% binaural• Over 75% reported moderate-severe

loss

“Delight” was NOT impacted by:

• Marital Status• Employment

Status• Type of

employment• Educational level• Health Status• Income level• Hearing level

• Length/years of hearing aid use

• Style of hearing aids• Type of dispensing

professional• Type of office• Source of referral• Source of payment• Price structure• Cost

• ‘Delighted users’• Significantly female• Significantly younger• Live in home with 3+ people• New hearing aids (87% purchased

within 4 years, all within 5)• Wear hearing aids full time (not on

a situational basis)

• New hearing aids enable people to hear where and when they want to

• Performance problems reduced or eliminated• Sound quality is key determinant of delight• Return visits reduced from 4.6 to 2.8

• 25% of our target market don’t purchase due to negative information from friends

• Huge loss– 4.4 million people

– 1.75 hearing aids purchased every 5 years

– 38,200,000 hearing aids

– $69 Billion ($1800)

Source: MarkeTrak

• 54% sought out information prior to appointment (primarily, on the internet)

• Most expected to lose some hearing as they age so didn’t wait as long

• Safety issues were driving force

• Support of family

• 72% use a cell phone• 74% use the internet• 62% have broadband at home• 43% have wireless• 10,000 people will turn 65 everyday

for the next 20 years• 50% of them expect to live until

their 90Source: Pew Internet & American Life Project

• Physical attributes of office– Location, cleanliness,

orderliness, and overall look

• Staff courteousness and professionalism

• Factors that impact perception of you– Referral source, demeanor, and reputation

Etiquette-Based Medicine

“An interaction that puts professionalism and patient satisfaction at the center of the clinical

encounter.”

Source: Michael W. Kahn, MD, New England Journal of Medicine, May 8, 2008

•Puts the patient “at the center” of every interaction•Includes patient and significant others as part of care team•Enables patient to take some responsibility for outcomes of care

• Family can amplify information, validate answers

• Family can learn care and use

• 65% of those accompanied by a significant other purchase, 35% unaccompanied purchase

Source: Robinson & Hanes, The Hearing Journal, March 2004

• Discussion about hearing problems, and completion of questionnaire

• Testing with earphones for tones, speech, and loudness levels

• High technology testing appears to reinforce hearing aid technology

• Video Otoscopy• In-depth discussion of results and

next steps – realistic expectations of aided loss

Motivational Interviewing

“A way to improve a person’s motivation to change beyond their ability to make a

change is by talking with them about their mixed feelings and helping them to work

through those.”

Source: Motivational Interviewing for Dummies

‘Delighted users’ received the following information both verbally and in print

•Benefits and limitations of hearing aids•How hearing aids would be selected•Tests that would help determine the characteristics of hearing aids recommended•Styles of hearing aids that would and would not work•What to expect•Information about the office

• Belief that their opinions were considered

• Strong recommendation of one type rather than several options

• Reinforce importance of a ‘trial period’ - adaptation

• Discussion of what it’s like to own, use and care for hearing aids

• Listening opportunities, simulated and real

• Discussion of ‘relearning to hear’ and establishment of a daily schedule

• Coaching in reducing feedback, talking on the phone

• Encouragement to visit the office as often as desired

Simulation reduces returns by 50%

Source: MarkeTrak

• Confirm that the hearing aid performance matches the prescriptive fitting targets

• Explain that to the patient

• Demonstrate how the hearing aids are working for the patient in the real world

• Modify settings for more ‘natural’ sound and ‘clear’ speech

• Real Ear Measurement – only 40% ‘almost always use’

• Measuring the benefit increases satisfaction by 15-20% (Source: MarkeTrak)

• Studies confirm highest satisfactionwith 4+ hours

• Users report ½ hour (Source: MarkeTrak)

• 90% reported that a follow-up visit was scheduled post-trial and 98% of those kept the appointment

• 75% said the professional checked on their progress, personally!

• Delighted users rate the follow-up services at 9.5 out of 10• Delighted users received a program for learning to use their

hearing aids• Although only 8% of all respondents report an invitation

to classes, those with high delight rated the classes high in benefit

• Assume that I have little or no information• Provide me with aided/unaided simulation• Offer me educational/informational sessions• Explain to me how hearing aids work• Tell me which hearing aids will work for me, which

ones won’t, and tell me why• Schedule automatic appointments for me• Provide me with a list of things I should be hearing

• Assume that I have little or no information• Provide me with aided/unaided simulation• Offer me educational/informational sessions• Explain to me how hearing aids work• Tell me which hearing aids will work for me, which

ones won’t, and tell me why• Schedule automatic appointments for me• Provide me with a list of things I should be hearing

• Provide a faster turnaround time and lower price on repairs – and give me a loaner, too!• Police advertising• Help me hear TV better and have less noise in

restaurants• Lower the price• Be professional

• Make you more employable• Help you earn more• Enhance your communications• Connect you with family and friends• 8 million of you may be eligible for FEHBP

• Today’s hearing aids have the potential to meet and exceed realistic expectations about better hearing• ‘Etiquette-based’ medicine is something we need to

practice – putting professionalism and patient satisfaction at the center of the clinical encounter• ‘Patient-centric’ medicine is a direction we need to

explore – making our system maximally responsive to patient needs, developing shared agendas about desired outcomes and helping people become active participants in their own care