Hearing Care Demystified

For 2021 and into the foreseeable future, member experience has become the rallying cry for health insurers, especially for those offering Medicare Advantage plans, as they strive to boost their Star ratings, as well as meeting member growth and retention objectives.

So, exactly what role can a hearing benefit play in enhancing member experience and Star ratings? Quality of hearing health care and out-of-pocket savings certainly come to mind. But don’t overlook the importance of the hearing aids your members put in their ears. Specifically, think about hearing aids in terms of:

• Product formulary
• Fitting autonomy
• Provider reimbursement

A hearing aid formulary is similar to a drug formulary in many respects. With drugs, the larger the formulary, the easier it is for a physician to precisely match a medication to a patient’s health condition. Likewise, an extensive hearing aid formulary, comprising a broad selection of brands, models and options, gives audiologists and hearing care providers a distinct advantage in addressing each patient’s unique hearing loss, lifestyle and preferences.

This matters for a couple of key reasons. First, when people love their hearing aids, they are more likely to fully experience the main benefit of amplification — a reconnection with the sounds that are important to their lives — directly contributing to a positive member experience. Secondly, by consistently wearing their hearing aids, individuals reduce their risk of developing costly, life-altering health conditions that have a proven connection to untreated hearing loss, including depression, dementia and injury-causing falls.

A large hearing aid formulary also helps strengthen the provider network and the ability to deliver personalized hearing health care. Providers feel more empowered to effectively address each patient’s needs and preferences. Conversely, they’re less likely to use “workarounds” (i.e., dispensing outside the formulary) to achieve the best possible outcomes for their patients.

In addition, a robust product selection contributes to a diverse provider network, further enabling a highly tailored approach to hearing health care. For example, one member may be well-suited to receiving care from a hearing aid dispenser who operates in a retail setting and offers a certain brand of hearing devices. Meanwhile, another individual requires the services of an audiologist who carries a different product mix and delivers care in a more clinical environment. Ultimately, both members get the best, most cost-effective solution to meet their differing needs and preferences.

Going hand in hand with a sufficiently large formulary is complete provider autonomy in fitting any product from the hearing aid formulary, as long as it meets medically necessity requirements and it satisfies the member’s individual needs.

With many hearing benefits, access is limited to a couple of hearing aid technology tiers from a single manufacturer. Almost inevitably, it turns out that the company behind the benefit is — you guessed it — the manufacturer of the hearing aids in the formulary. The fact is, each manufacturer brings different strengths to a hearing aid formulary, and allowing providers to make recommendations based on audiological standards and their professional experience serves the best interests of your members and your organization.

As Amplifon Hearing Health Care audiologist Carrie Meyer, Au.D., sums it up: “The hearing benefit should allow providers to fit the hearing aid to the patient, not fit the patient to a specific manufacturer. Freedom is so crucial because it enables providers to effectively address each patient’s clinical and lifestyle needs, leading to optimal outcomes and an enhanced member experience.”

Be aware that some hearing benefits base their provider reimbursements on technology selection, that is, a higher payout for more advanced hearing aids and less for economy models. The problem with technology-based reimbursement is that it may incentivize providers to recommend higher-priced hearing aids, perhaps more than the patient really needs.

Interestingly, more advanced — and expensive —technology doesn’t always translate to better outcomes for hearing aid wearers, compared to more basic technology, according to a series of research articles entitled “Impact of Hearing Aid Technology on Outcomes in Daily Life,” coauthored by Dr. Jani Johnson, Assistant Professor of Audiology, Hearing Aid Research Laboratory Director, University of Memphis.

One of the lab’s articles reports on a study comparing real-life patient outcomes from wearing two major brands of hearing aids, one with premium technology and the other with more basic technology. In conclusion, “…it appeared that the outlay of substantially higher dollar amounts to purchase premium feature engineering technology typically would not have resulted in a meaningful incremental gain in overall effectiveness relative to basic-feature technology.”

The article goes on to state that “this research should result in more cost-effective hearing aid recommendations and increased access to successful, lower cost hearing health care for many hearing-impaired individuals.”

Reimbursing providers uniformly across the entire product formulary supports this evidence-based approach to hearing health care. Specifically, it helps motivate providers to address each member’s needs and preference, in compliance with medical necessity criteria and without regard to price point.

Partnering with Amplifon Hearing Health Care gives your members access to hundreds of hearing aid models, featuring the latest technology, from all major brands; under an exclusive arrangement, this includes Miracle-Ear®, one of the most trusted names in hearing care. Because Amplifon is independently owned and operated, the hearing care providers in our network enjoy complete freedom to fit any brand and model of hearing aid in our formulary, within medical necessity criteria. In addition, we reimburse our providers uniformly across the entire Amplifon product formulary. Ultimately, our hearing benefit model incentivizes providers to address each member’s unique hearing and lifestyle needs in the most cost-effective manner.