MarkeTrak VIII:
25 Year Trends in the Hearing
Health Market
How do we get on the fast track?
Sergei Kochkin, Ph.D.
Agenda
• Review MarkeTrak VIII findings:
– 25 year trends in the hearing health market (2008)
– Customer satisfaction with hearing aids (2009)
– Impact of HHP on consumer success with hearing
aids (2010)
– General observations on why the hearing aid
industry is underperforming.
• As we review this data: ask how can I turn this
problem, obstacle, misinformation, consumer
disappointment, etc into an opportunity? Focus on
why we all work in an under-performing industry.
Other planned publications in the
MarkeTrak VIII series
•
•
•
•
•
•
Impact of hearing loss on job effectiveness
(2nd edition).
Customer satisfaction with on-the-ear (open fit)
hearing aids compared to traditional style HA
Prevalence of tinnitus and efficacy of treatment
modalities
Sources of noise which most impact
satisfaction with hearing aids
Perceptions of benefit and changes in quality
of life due to hearing aids.
Impact of hearing loss on traffic accidents
Other planned publications in the
MarkeTrak VIII series
•
•
•
•
•
•
Use of assistive listening devices
Use of inexpensive listening devices (<$50) in
lieu of hearing aid adoption.
Factors which would influence hearingimpaired non-adopters to purchase and use
hearing aids.
Comparison of customer satisfaction in other
professions and with products and services in
other industries (non-adopter population only).
Media habits of the hearing-impaired
populations (owners and non-adopters).
Reasons for hearing aid returns
25 Year Trends in The Hearing
Aid Market
October 2009
Hearing Review
Are we really on the fast track?
• Original cover for
the first MarkeTrak
VIII publication
• Changed to
“Headed for the
Fast Track?”
Led to funny editorial
“…or Slow Train Coming?”
and some alternate titles
•
•
•
•
•
•
•
•
•
•
•
Are we on the right track?
Are we on the track at all?
Are we headed for derailment?
Throw Mama on the train!
Why isn't there anyone under 70 on this train?
The train has left the station leaving behind three-quarters
of its passengers
People are in denial about their need to get on the train; it
takes them 3 to 8 years just to get aboard
Why are train rides so expensive? Why can't we deduct
them from our taxes?
Some still believe the train is too big and noisy—and the
whistle drives them crazy!
My family doctor told me trains don't work
One of my friends told me that the train ride stinks
MarkeTrak Methodology
Method
• National family opinion panel
–
–
–
–
80,000 households
Balanced to 9 key census variables
Used since 1984 starting with HIA survey.
Does not include institutional settings.
• Screening questions–Phase I(11-12 /2008)
–
–
–
–
–
Hearing loss
Hearing aids
Tinnitus
Physician screening for hearing loss
Detailed employment status beyond NFO panel
data
– Traffic accident data
Method
• Screening survey:
– Returns – 46,843 households
– Identified 14,623 people with hearing loss and or
tinnitus
– Response rate: 59%
• Detailed survey - Phase II (1/2009)
–
–
–
–
–
7 page legal size survey
3,779 hearing aid owners (total population)
5,500 adult non-owners (random sample)
Response rate 84% & 79% respectively
$1 incentive
The Hearing Loss Population
Incidence of hearing loss per thousand households
There is no hearing loss epidemic only the aging of America
% Household prevalence
300
295
295
290
285
283
280
275
270
265
275
274
269
271
266
260
255
250
1989
1991
1994
1997
2000
2004
2008
For more than a generation the incidence of HL has been
about one in 10 people
12.0%
11.0%
HIA*
10.0%
10.3%
10.0%
2000
1997
1994
1991
1989
6.0%
7.7%
10.2%
7.0%
10.1%
8.0%
10.7%
9.0%
11.3%
Percent
10.0%
5.0%
4.0%
2008
2004
MarkeTrak Survey Year
* Adjusted by +.7% to account for multiple hearing-impaired per household
1984
Physician screening for hearing loss has increased primarily
among younger segments
when you include paper and pencil screening
25
18.8
Percent screened
20
15.1
15
16.3
20.2
18
16.6
16.6
14
14.6
12.9
10
5
0
May-89 Nov-89 May-90 Nov-90 Jan-92 Dec-94 Dec-97 Dec-00 Dec-04 Dec-08
Key HL population data
• Incidence of HL in U.S. population = 11.3%
– Up from 10.7% (2004)
• Admitted HL population = 34.25 million
people
– Up from 31.5 million people (2004)
• 6 out of 10 are male
• 60% are below retirement age
The Hearing Aid Market
Key hearing aid owner population data
• Current hearing aid owners = 8.41 million
people
• Up from 7.8 million (2004)
Hearing aid adoption rates are now one in four people with
admitted hearing loss
Growth primarily VA and direct mail
30
% HI Adoption
25
23.8
22.9
22.6
21.3
22.2
23.5
24.6
20.4
20
15
10
5
0
1984
1989
1991
1994
1997
2000
2004
2008
Binaural rates continue to grow impressively
Total Owners
100
86
85
79
Bilateral HL - Current year
80
% of Hearing Instrument Owners
90
Total Owners - Current year
90
79
79
74
70
74
74
70
70
65
61
65
64
60
60
51
52
47
50
37
40
30
22
25
20
10
0
1984
1989
1991
1994
1997
2000
2004
2008
Evidence for growth in third-party payment
45
Without VA
40
With VA
30
39.7
21.9
34
24.8
30.2
24.7
25.6
20.8
21.7
17.7
10
23.5
15
19.4
20
30
37.3
25
22.2
% of sales
35
5
0
1984
1989
1991
1994
1997
2000
2004
2008
Sources of third-party payment.
Average third party payment discount achieved = 84%
VA
36.2
Insurance
23.15
Medicare
17.1
Medicaid
14.8
HMO
10.4
Charity
4.4
Union
3.7
Family
1
0
5
10
15
20
25
30
35
% source of third party payment
Note: Total percent greater than 100% since respondents indicated they received financial help from
multiple sources.
40
Average out-of-pocket retail price paid by consumer
increased 17%
(includes free, direct mail hearing aids, & all third-party discounts but excludes VA
fittings)
1800
1600
1400
400
200
621
681
673
768
1097
1306
1375
600
742
810
790
1040
1434
1361
1346
800
557
581
779
852
1215
1514
1789
1000
623
680
735
917
1276
1369
1601
Dollars
1200
Total
BTE
ITC
ITE
0
1989
1991
1994
1997
2000
2004
2008
Audiologists fit nearly two out of three hearing aids
62.9
55
Audiologist
65
49.3
22
31.1
35.9
Hearing Aid
Specialist
28.8
44.7
66.4
1.5
2
2.1
1.9
Physician
4.8
4.5
7.1
4.1
4.1
6.9
Other
0
10
20
30
40
1984
2004
1994
2008
2000
50
60
70
% of hearing aid fittings
The average age of hearing aids has dropped to 4.1 years
Mean age of
hearing aids:
1991 = 3.1 yrs
60
1994 = 3.7 yrs
% of hearing aids
50
1997 = 3.8 yrs
2000 = 3.8 yrs
40
2004 = 4.5 yrs
30
2008 = 4.1 yrs
1991
1994
1997
2000
2004
2008
20
10
0
<2 yr
3-4 yrs
5-6 yrs
Age of hearing aids
7-8 yrs
9+ yrs
New user rate(%)
We are unable to attract new users to the market
60
53.4
Percent of sales
50
40.5
40
36.6
31.6
29
30
39.3
39
20
10
0
1989
1991
1994
1997
2000
2004
2008
Average age of new hearing aid users
We have not tapped into the younger markets
71
69.7
70
Average age
69
68.8
68.4
68.8
67.8
68
67
66.3
66
66
65
64
63
1989
1991
1994
1997
2000
2004
2008
The typical HA purchaser has an average household
income of $54,000 & their modal income is $125,000
Household Income (000)
$60
$56
$50
$54
$46
$40
$40
$35
$31
$31
$30
$20
$10
1989
1991
1994
1997
2000
2004
2008
What’s the REAL market for hearing aids?
• Used subjective measures to segment
market
–
–
–
–
Number of ears impaired
Subjective view of HL
Gallaudet scale
BHI quick hearing check (based on revised AAOHNS 5 minute hearing loss screener)
– Difficulty hearing in noise
• Created single HL index (factor analysis)
• Divided total HL population into 10% HL
segments called deciles
– Decile 1 = Lower 10% of HL – mild
– Decile 10 – Top 10% of HL – severe to profound
Hearing aid adoption heavily dependent
on degree of hearing loss
Hearing aid adoption rate (%)
70
60
65
Decile 5-10=
54
83% hearing aid owners
50
43% non-adopters
40
40
34
30
20
10
24
26
D5
D6
16
4
7
10
0
D1
D2
D3
D4
Hearing Loss Decile
D7
D8
D9
D10
Hearing aid opportunity by age group.
The viable hearing aid market in the U.S. is about 11 million
more people with untreated hearing loss
Non-adopters
(Deciles 1-4)
HA owners
(Deciles 1-4)
85+
Non-adopters
(Deciles 5-10)
Age by hearing loss decile grouping
1703
2228
1181
1046
569
827
2342
1786
3175
2143
0
75-84
90
111
189
468
500
860
1500
65-74
106
277
1329
2000
55-64
24
42
33
78
195
324
471
228
2500
410
3000
45-54
1740
3500
35-44
Deciles 5-10=
6.98 Mil. HA owners
11.1 Mil. non-adopters
2997
2977
4000
350
People with hearing loss (000)
4500
1000
18-34
3949
<18
HA owners
(Deciles 5-10)
Hearing aid adoption rates redefined
• One in four people with admitted
hearing loss own hearing aids.
• 40% of people with moderate to severe
hearing loss
• 9% of people with milder hearing losses
We are at the right place at the right time
• The hearing loss population is growing at the
rate of 1.6 times the general population
growth– primarily aging population.
• Digital technology and the supporting
software is superb – and it will get better.
• We have the capability of meeting the needs
of the vast majority of people with hearing
loss.
So why are we on a such
a slow moving train?
• Explore customer satisfaction with
hearing aids
• Explore HA fitter’s role in user success
• Summarize with other observations
Customer Satisfaction with
Hearing Aids 2008
January 2010
Hearing Journal
Key HA satisfaction measures
Overall satisfaction
24
Benefit
32
29
Value
38
21
0
10
23
29
20
30
19
16
40
14
50
16
60
70
7
8
6
18
80
90
Percent
Very Satisfied
Satisfied
Somewhat satisfied
Neutral
Dissatisfied
100
Satisfied & very satisfied customers have not
grown during the digital revolution
90
80
% satisfaction
70
23
60
23
50
40
40
40
39
39
21
19
21
21
21
24
1991
1994
1997
2000
2004
2008
30
30
31
20
10
0
Very Satisfied
Satisfied
Somewhat satisfied
Percent
Dissatisfaction has dropped to 14% but….
8% of new hearing aids are in the drawer
20
18
16
14
12
10
8
6
4
2
0
18
18
17
16
15
14
10
8
1991
10
9
8
7
1994
1997
Total Dissatisfied
2000
2004
HA in the drawer
2008
Percent of total
More than half of hearing aids in the drawer
are </= 5 years of age
45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
41.5
16.1
11.7
1
9.2
2
3
7.0
4
8.9
5
Age of hearing aid in years
5.7
6
7+
Hearing aids in the drawer
• Has varied between 11.7% and 17.9%
historically.
• Current rate: 12.4%
– New hearing aids (</=4 years) : 7.5%
– Brand new HA: 5.2%
• 1,040,000 customers never use their
hearing aids.
• Why do so many people spend $2000$6000 for a product that does not meet
their needs?
Hearing aid usage patterns virtually unchanged
14
12
12
12
12
Hours HA worn
12
11
10
10
12
8.8
9.2
10
10
9.6
8.7
9.5
10
8
6
4
2
0
1994
1997
2000
Mean
Median
2004
Mode
2008
Percent
30% of new user fittings are probable failures
100
90
80
70
60
50
40
30
20
10
0
87
69.1
23.4
12.9
8.5
3.5
Drawer
<2 hours
New user
Experienced user
4+ hours
Causes for hearing aids in drawer
• Poor benefit
• Poor fit and comfort
• Poor performance in noise
We have failed to improve positive word of mouth
advertising and brand loyalty
90
81
82
82
82
82
80
80
70
Percent
60
50
44
47
47
46
48
40
30
20
10
0
1991
1994
1997
Recommend hearing aids
2000
2004
Repurchase Brand
2008
Customer satisfaction with hearing aid
product features
hearing aids are <= 4 years old.
33
28
27
Ease/battery change
Fit/comfort
Ease of insertion/removal from ear
45
44
44
24
24
Reliability
Visibility
43
43
35
Length of trial period
16
16
18
Frequency of cleaning
Battery life
Warranty
Ease/volume adjustment
0
10
34
45
35
36
21
17
On-going expense
34
30
13
7
13
11 6
16
8 6
17
15
6
18
22
18
9
14
12
20
11
32
20
10 5 7
15
6 7
14
7 8
11
40
50
9
25
26
14
60
70
80
90 100
Percent
Very satisfied
Satisfied
Somewhat satisfied
Neutral
Dissatisfied
Customer satisfaction with hearing aid
signal processing and sound quality
hearing aids are <= 4 years old.
17
17
15
17
17
13
14
13
14
11
10
Clearness tone/sound
Sound of voice
Directionality
Natural sounding
Whistling/feedback/buzzing
Able to hear soft sounds
Richness of sound/fidelity
Comfort with loud sounds
Chewing/swallowing sound
Use In noisy situations
Wind noise
0
10
39
41
36
37
33
31
37
31
34
26
27
20
30
40
21
15
13
9
20
14
17
13
19
18
25
19
17
13
23
19
16
14
24
25
21
22
50
60
70
80
10
18
15
16
13
12
19
14
22
14
20
90
100
Percent
Very satisfied
Satisfied
Somewhat satisfied
Neutral
Dissatisfied
Customer satisfaction with hearing aids in
various listening situations
hearing aids are <= 4 years old.
36
One-on-one
40
Small groups
24
41
T.V.
25
19
38
Outdoors
Listening to music
Car
Restaurant
39
37
23
Place of worship
0
10
20
17
19
21
20
35
20
30
40
17
50
60
70
4
6
17
20
40
41
38
17
18
While shopping
20
40
18
20
20
Leisure activities
14
9
13
11
8
17
14
12
5
8
11
15
8
11
14
14
80
11
90
Percent
Very satisfied
Satisfied
Somewhat satisfied
Neutral
6
9
Dissatisfied
100
Customer satisfaction with hearing aids in
various listening situations (continued)
hearing aids are <= 4 years old.
22
Telephone
Concert/Movie
33
19
36
21
31
Cell phone
Large group
15
Recreation and exercise
15
At sports events
15
0
14
15
26
10
20
20
40
8
23
11
26
9
31
14
30
16
24
19
26
13
While in bed
12
18
30
13
15
25
32
17
15
17
35
18
School/classroom
10
17
28
21
Workplace
18
10
40
50
60
70
7
80
90
Percent
Very satisfied
Satisfied
Somewhat satisfied
Neutral
Dissatisfied
100
Hearing aid multiple environment listening utility
(MELU) is not impressive.
% of HA owners
60
55
50
40
30
20
23
17
16
10
10
8
10
15
14
11
5
5
5
40-59
60-79
80-99
6
0
None
1-19
20-39
Percent of listening situations
Very Satisfied
Satisfied or higher
100
% of HA owners
Multiple environment listening utility (MELU) is highly
related to brand repurchase and positive word of mouth
advertising.
100
90
80
70
60
50
40
30
20
10
0
92
91
86
79
66
64
60
52
43
42
35
24
11
None
16
1-19
20-39
40-59
60-79
80-99
Percent of listening situations
Recommend hearing aids
Would repurchase HA brand
100
Satisfaction with HA benefit
Satisfaction with benefit is highly dependent on the
number of listening situations hearing aids work
…and Somewhat satisfied is hardly an endorsement
Very Dissatisfied
6
Dissatisfied
7
Somewhat dissatisfied
6
Neutral
23
Somewhat satisfied
31
Satisfied
64
Very satisfied
80
0
20
40
60
80
% listening situations satisfied or very satisfied
100
Changes since MarkeTrak VII (2004)
• Practical (at least 5% point increase) and
statistically significant improvements:
– Whistling and feedback (12% points,
p<0.0001)
– Sound of chewing and swallowing (9%
points, p<0.0001)
– Wind noise (7% points, p<0.0004)
– Use in noisy situations (7% points,
p<0.0001)
– Comfort with loud sounds (5% points,
p<0.001)
The Impact of the Hearing Health
Professional on Hearing Aid User Success
April 2010 Hearing Review
Co-authors & Reviewers
•
•
•
•
•
•
•
•
•
•
•
Co-authors
Sergei Kochkin, PhD (BHI)
Douglas L. Beck, AuD (Oticon)
Laurel A. Christensen, PhD (GN
ReSound)
Cynthia Compton-Conley
(Gallaudet U)
Brian J. Fligor, ScD (Harvard)
Pat B. Kricos, PhD (U of Florida)
Jay McSpaden, PhD (Retired
audiologist - Oregon)
H. Gustav Mueller, PhD
(Vanderbilt)
Michael Nilsson, PhD (Sonic
Innovations)
Jerry Northern, PhD (Starkey)
• Co-authors (cont.)
• Thomas A. Powers, PhD
(Siemens)
• Robert W. Sweetow, PhD
(U of C)
• Brian Taylor, AuD (Unitron)
• Robert G. Turner, PhD (LSU)
•
•
•
•
•
•
Reviewers
Harvey B. Abrams, PhD (VA)
Ruth Bentler, PhD (U of Iowa)
Vic S. Gladstone, PhD (ASHA)
Larry Humes, PhD (Indiana U)
Michael Valente, PhD
(Washington U)
Top 10 mistakes of clinicians
Christensen & Groth (AAA)
•
•
•
•
•
•
•
•
•
•
Failing to use new tests to help with selection, fitting and
counseling,
assuming that automatic environmental steering programs
are accurate and that the hearing aids switch appropriately,
fitting a hearing aid without buy-in from the patient,
using first time, new user, or inexperienced user gain settings
and not revisiting the settings over time,
not doing the appropriate counseling,
not performing appropriate validation measures,
not taking manual dexterity into account when selecting the
hearing aids,
assuming the manufacturer defaults are right for every
patient,
not understanding when to use an open fitting and when not
to,
failing to verify the fitting with probe tube measurements.
THESIS
The HHP has direct control over
hearing aid user success
•
•
•
•
•
Hearing aid quality control prior to fit
Fit and comfort of hearing aid
Verification of fit
Validation of fit
Optimal amplification of the residual auditory
area of the consumer
• Vast array of counseling tools
• Measureable BENEFIT GUARANTEE
• And a money back guarantee
Method
• Measured 17 items of the hearing aid fitting
protocol.
• Measured 7 real-world success measures
• Related use of protocol items to real-world
success.
• Related total weighted protocol to success
• Related unweighted protocol to success (e.g.
simple counting of steps performed)
Protocol items measured
•
•
•
•
•
•
•
•
•
•
•
Hearing tested in sound booth
Real ear measurement verification
Subjective benefit measurement
Objective benefit measurement
Patient satisfaction measurement
Loudness discomfort measurement
Auditory retraining software therapy
Aural rehabilitation group
Received self-help book
Received self-help video
Referred to self-help group
Protocol items measured
•
•
Fit and comfort of the hearing aid (single Likert
scale item)
Achieved Sound quality :
–
–
–
–
–
–
–
–
clearness of tone/sound
whistling and feedback
use in noisy situations
natural sounding
sound of voice
ability to hear soft sounds
comfort with loud sounds
single index from Factor analysis. Proxy for:
• Optimal amplification of residual auditory area of
patient
• Functionality of hearing aid (quality control pre-fit)
Protocol items measured
•
Attributes of the hearing healthcare
professional:
–
–
–
–
–
–
–
–
–
knowledge
professionalism
empathy
creation of realistic expectations
explained care and maintenance of hearing aids
quality of service during the fitting process
quality of service after the hearing aid fitting
all measured on a 7 point Likert scale
single index from Factor analysis
Protocol items measured
•
Attributes of the hearing healthcare
office:
–
–
–
–
–
–
–
front office staff
hours of operation
attractiveness and comfort of the office
ease of access to the office
convenient location
all measured on a 7 point Likert scale
single index from Factor analysis.
Protocol items measured
•
Counseling:
– the amount of time spent in hours
explaining care and maintenance of the
hearing aids and
– the hours spent in aural rehabilitation
– total counseling hours spent in the first 2
months of the new hearing aid fitting.
•
The number of visits to get the
hearing aid working just right for the
patient.
Success measures
•
•
Hearing aids in the drawer and hearing aid
usage in hours.
Benefit.
–
–
–
Satisfaction with benefit (7 point Likert scale)
Perception of % hearing handicap reduction in
10 listening situations.
Multiple Environmental Listening Utility (MELU).
The percent of 19 listening situations in which
the patient was satisfied or very satisfied.
•
•
Quantified Client Oriented Scale of Improvement
(COSI) measure.
Only situations for which patient had need to hear.
Success measures
•
Patient recommendations
–
–
–
•
Would recommend the hearing healthcare
professional
Would recommend hearing aids to friends
Would repurchase current hearing aid brand
Overall success.
–
–
A composite measure of success derived from
factor analyzing the above variables
Converting to factor scores and standardizing to
a mean of 5 and standard deviation of 2 (stanine
scores).
Consumer perceptions of hearing aid fitting protocol
received comparing new and experienced users.
Referred to self-help group (HLAA)
Auditory retraining software therapy
Received self-help video
Customer satisfaction measurement
Aural education group
Subjective benefit measurement
Received self-help book
Real ear measurement verification
Objective benefit measurement
Loudness discomfort measurement
Hearing tested in sound booth
0
10
20
30
40
50
60
70
Percent of patients
New User
Experienced user
80
90
100
Outcome measures comparing new and experienced users
58
Would repurchase HA
brand
42
74
73
Would recommend
dispenser
87
Would recommend HA
75
71
Satisfaction with benefit
63
54
Multiple environment
listening utility
58
56
54
Hearing handicap
reduction
0
10
20
30
40
50
60
70
80
Percent of patients
New User
Experience user
90
100
Summary of statistically significant relationships between
outcome measures and protocol items for new and
experienced users
16
Would repurchase HA brand
15
14
14
Multiple environment listening utility
12
Would recommend dispenser
15
12
Satisfaction with benefit
14
13
Would recommend HA
12
11
Hearing handicap reduction
Hearing aids in draw/hearing aid usage
8
4
8
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
N of significant relationships
New User
Experienced User
High-low analysis
• Compare patients experiencing below
average (-1 std) and above average (+1
std) real-world success.
• Let’s look at the patients’ experience
during the hearing aid fitting
process!
A comparison of above average (+1 std) and below average (-1 std)
hearing aid success as measured by subjective real-world outcomes
showing protocol received based on consumer perceptions.
82
Measure loudness discomfort
58
23
Measure customer satisfaction
6
79
Measure objective benefit
53
32
Measure subjective benefit
7
51
REM
31
88
Sound booth testing
76
0
20
40
60
80
100
Percent of patients
Below average success
Above average success
A comparison of above average (+1 std) and below average (-1 std)
hearing aid success as measured by subjective real-world outcomes
showing protocol received based on patient perceptions.
Number visits to adj HA
36
one
13
40
Two
27
17
Three
14
7
4 or more
47
0
10
20
30
40
Percent of patients
Below average success
Above average success
50
A comparison of above average (+1 std) and below average (-1 std)
hearing aid success as measured by subjective real-world outcomes
showing protocol received based on patient perceptions.
Hours of counseling received
22
None
37
47
One
43
31
Two or more
20
Counseling Methods Used
10
Three or more
4
15
15
Two
39
One
34
36
None
47
0
10
20
30
40
Percent of patients
Below average success
Above average success
50
Percent of patients
A comparison of above average (+1 std) and below average (-1 std)
hearing aid success as measured by subjective real-world outcomes
showing protocol received based on consumer perceptions.
50
45
40
35
30
25
20
15
10
5
0
Below average success
Above average success
45
36
33
30
28
29
21
18
16
13
15
17
13
19
19
18
12
9
8
2
Below avg Below avg Average Above avg Above avg Below avg Below avg Average Above avg Above avg
(-2 std)
(-1 std)
(+1 std)
(+2 std)
(-2 std)
(-1 std)
(+1 std)
(+2 std)
<--------Dispenser Attributes ------- > <-------- Office Attributes
------- >
A comparison of above average (+1 std) and below average (-1 std)
hearing aid success as measured by subjective real-world outcomes
showing protocol received based on consumer perceptions.
Fit & Comfort
Satisfied/Very satisfied
99
63
1
Neutral/Somewhat satisfied
17
Dissatisfied 0
20
Achieved Sound Quality
Above avg (+2 std)
56
3
Above avg (+1 std)
32
9
9
Average
15
3
Below avg (-1 std)
18
Below avg (-2 std) 0
0
55
10
20
30
40
50
Below average success
60
70
80
90
Above average success
100
High-low analysis #2
• Use high/low difference scores from
past analysis to weight protocol
received.
• Sum weighted scores
• Compare top and bottom 15% weighted
protocol scores.
• Now let’s look at the patients’ real
world outcome!
Impact of a weighted protocol comparing the top and
bottom 15% of consumers on hearing aid success.
81
Would repurchase HA brand
14
86
Multiple environment listening utility
14
94
Would recommend dispenser
39
99
Satisfaction with benefit
12
97
Would recommend HA
56
66
Hearing handicap reduction
35
3
Hearing aids in draw/hearing aid usage
18
0
10
20
30
40
50
60
70
Percent of patients
Bottom 15%
Top 15%
80
90 100
Success Score (mean=5, std=2)
Total hearing aid user success achieved as a function of a
weighted fitting protocol (in stanines, n=1,613)
Correlation = .70
8
7
6.8
7
8
9
4.9
5
4.1
3.5
4
2
6.6
5.8
6
3
6.4
2.8
1.9
1
0
1
2
3
4
5
6
Weighted protocol (mean=5, std=2)
High-low analysis #3
• Simple count of protocol steps
• Collapsed counseling methods
• Compare minimum (0-2 items) to
comprehensive protocols (10-12 items)
• Are protocols additive or multiplicative?
• Let’s see how the patients did in the
real world!
Impact of a protocol on hearing aid success comparing a
minimum protocol (0-2 items) to a more comprehensive
protocol (10-12 items).
84
Would repurchase HA brand
13
85
Multiple environment listening utility
18
96
Would recommend dispenser
29
93
Satisfaction with benefit
18
95
Would recommend HA
46
64
Hearing handicap reduction
32
4
Hearing aids in draw/hearing aid usage
19
0
10
20
30
40
50
60
70
80
90 100
Percent of patients
Minimal protocol
Comprehensive protocol
Success Score (mean=5, std=2)
Total hearing aid user success achieved as a function of an
additive hearing aid fitting protocol (n=1,613)
Correlation = .50
8
7
6
5
4.3
4
5.1
5.8
7
8
9
6.8
6.5
11
12
3.4
3
2
4.7
5.6
6
6.4
2.3
2.7
1.2
1
0
0
1
2
3
4
5
6
Protocol steps performed
10
Other findings
• Factors explaining less than 1% of variance in the
hearing aid fitting protocol:
–
–
–
–
–
–
–
Age of the patient
Gender
User (new versus experienced)
Size of city (rural to metropolitan)
Price of hearing aid
Style of hearing aid
Degree of hearing loss
• Occupation of person (Audiologist/HIS) fitting hearing
aid explained < ½ of 1% of the protocol used OR
real-world hearing aid user success.
– Confirmed by the Hearing Industry Association Consumer
Journey Study.
– Audiologists and HISs are equivalent in both protocol and
ability to generate successful hearing aid users.
Conclusions
• What occurred in HHP offices has a very
strong relationship to real-world success.
• Evidence that a weighted protocol is better
predictor of success then simple count of
steps performed.
• Variability of protocols performed and the
distribution of patient success is massive in
America.
• Consumer Reports estimates in a small scale
study that 2 out of 3 hearing aids are misfit.
• Anecdotal reports from expert fitters indicate
that many NEW hearing aids brought in to
their practice were programmed incorrectly.
Conclusions
•
•
Believe that the clinical laboratory is the “real world”
and that we can get a handle on the degree of misfit
hearing aids in America as well as quantify the
relative importance of various aspects of the protocol.
Further research needed:
– What is the state of misfit hearing aids in the U.S?
– How many malfunctioning hearing aids are in
patients’ ears?
– How much more benefit do patients experience
when their residual auditory area is optimally
amplified by experts given today’s technology and
software?
– How many patients are fit with inappropriate
technology (e.g. a CIC or open fit when they need
a power BTE or full-concha)?
Conclusions (Cont.)
– Can we reduce the number of hearing aids in the
drawer?
– What is the relative importance of aspects of the
protocol on real world success?
– How many patients have been inappropriately fit
with hearing aids when they are not good
candidates (e.g. motivation, acceptable noise
level (ANL) exceptionally high)?
– When hearing aids are expertly fit what is the
likelihood of improvements in positive-word-ofmouth advertising and brand loyalty?
Quality control at the point of sale is
critical to user success & industry growth
• Not all consumers are tested in a sound booth.
• Many hearing aids are not tested for functionality prior to
the fitting.
• The majority of dispensers fail to verify the hearing aid
fitting with REM.
– Considered by the industry intelligentsia to be
unethical and unprofessional
• Many dispensers do not validate the fitting pre/post with
objective or subjective benefit measures.
– “We just don’t want to know” (Ignorance is bliss!)
– “What should we do if we can’t find benefit – refund
the customers money”? (greed and unethical)
• Ultimately we take the short term sale and sacrifice the
long term growth and our reputation in our community.
• Aural rehabilitation is virtually non-existent.
Opportunities
• Establishment and enforcement of a standardized and
comprehensive hearing aid fitting protocol (similar to
Optometry) with a measureable benefit guarantee will
result in:
– Massive market share shifts
– More positive word-of-mouth advertising
– Tapping new markets
– Greater brand (hearing aid and distribution) loyalty.
– Transforming the lives of many more hard of hearing
people, after all isn’t this our REAL business?
– And believe it or not stigma will evaporate for most
people when they achieve SUBSTANTIAL BENEFIT.
• ULTIMATELY QUALITY WILL WIN!
Some Additional Observations on
the Hearing Aid Market
Sales growth
• We are doomed to 2-3% growth unless we fix
the hearing aid industry.
• This is roughly the growth rate of the elderly
population.
• A key problem is quality control at the point of
sale. The fitting process has not kept pace
with technology.
• Improvements in technology are wasted if the
hearing aid is inappropriately fit.
Our value proposition to society is
inequitable
• We benefit ($$) more than the consumer (the
improvements in their life for which they are
willing to pay)
• Estimated hearing handicap reduction:
– 41% (Absolute benefit)/Unaided hearing problem
(MarkeTrak VI)
– Current direct measure in MarkeTrak VIII: 55%
Satisfaction
Customer satisfaction is highly related to $$$
spent per 1% improvement in hearing disability
where % change = (benefit/unaided APHAB)
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
Overall
Benefit
Value
Poly. (Overall)
Poly. (Benefit)
Poly. (Value)
5
15
25
35
45
55
65
75
85
95
125
Price ($$) spent per 1% disability improvement
200
500
Overall customer satisfaction is dependent on price
relative to hearing disability improvement
(Statistical Model)
Overall
Customer
Satisfaction (%)
Price
Hearing disability
improvement (%)
R2=.86
Negative word-of-mouth is severely
depressing throughput into HHP offices
and therefore sales
• 19% of total adults with admitted hearing loss
don’t purchase because of other hearing aid
owners telling them of their disappointment.
• That’s 4.4 million people
• Assuming 1.75 hearing aids each over 5
purchase cycles of 5 years (their average
age is now 60)
• Assuming we cannot win them back:
– That’s potentially 38,200,000 hearing aids not
purchased over their lifetime
– That’s 19 years of lost sales for the whole US!
– That’s $69 billion in lost revenue!
The utility of hearing aids is poor
• With the exception of a handful of activists we
have not made public places accessible to
people with hearing loss as has been done in
Europe.
– Inductive looping (until the real wireless revolution
in the HA industry)
– Use of telecoil to double or triple functionality of
hearing aid.
– Some HHP are now looping their patient homes
and therefore creating real value.
Hearing aids and those who fit them
have a horrible reputation
• Typical 1st media question to me: Why
do so many people hate hearing aids?
• Need to demonstrate to non-adopters:
– That hearing aids do indeed work
– That we can provide substantial benefit
and
– Therefore that we can substantially
improve their lives
We should leverage QOL research
more in marketing hearing aids
• Improvements in:
–
–
–
–
–
–
–
–
–
–
Earning power
Communication in relationships
Intimacy and warmth in family relationships
Ease in communication
Emotional stability
Sense of control over life events
Perception of mental functioning
Physical health
Group social participation
Safety
We should leverage QOL research
more in marketing hearing aids
• Reductions in
– Discrimination toward the person with the hearing
loss
– Hearing loss compensation behaviors (i.e.
pretending you hear)
– Anger and frustration in relationships
– Depression and depressive symptoms
– Feelings of paranoia
– Anxiety
– Social phobias
– Self-criticism
Hearing aid returns are killing us
• Current rate: 18.6%
• Top reasons:
–
–
–
–
–
Benefit (51%)
Background noise (49%)
Whistling/feedback (38%)
Poor value (36%)
Poor fit and comfort (35%)
• Nearly a completely solvable problem
Overall Conclusion
• Markets are perfect!
• If we do not adequately service people
with hearing loss someone else will
take away our business and do it better.
• We have a lot of baggage to overcome.
• Consumer stigma, while existent, is an
industry scapegoat.