Adapting Your Practice to a New Generation of Consumers



Author: Austin Singleton, Au.D. and Patty Greene, M.A

For years, the hearing care industry has been saying, “Get ready, the Baby Boomers are coming!” But for most audiologists the “boom” has never materialized. They’re still waiting for Baby Boomers to storm their offices and increase hearing aid sales like never before. For most dispensing practices, hearing aid sales rely heavily on Traditionalists (those born prior to 1946), but Traditionalists are dwindling in numbers. On the other hand, 10,000 Boomers turn 65 years old every day, and the oldest Boomers are turning 72 this year. Given that nearly 25% of Boomers are experiencing meaningful hearing loss1, there is only one conclusion: Attracting Baby Boomers is key to long term growth of hearing aid sales.

Audiologists are accustomed to working with Traditionalists—they know how to market to, communicate with, and care for them—but what about Boomers? Each generation has their own attitudes, behaviors, expectations, and ways of communicating, making Boomers culturally and behaviorally different from Traditionalists. These fundamental differences mean Boomers will not transform into Traditionalists as they age. Audiologists with a clear understanding of how Boomers differ, and who adapt their practice accordingly, will more effectively attract and address Boomer needs and expectations, than those who continue with business-as-usual. This is not to imply that audiologists are not successful with the Boomers they see in their practice today. However, audiologists who wish to attract and retain a greater share of this new generation of consumers must evolve as the consumers they serve change. To successfully adapt will require an understanding of how Boomers think and act.
How Do Boomers Think and Act?
By and large, Boomers are accustomed to using their mobile phones, tablets, and computers to communicate, research, and shop. They go online for everyday needs such as clothing, electronics, and home goods as well as expensive items like cars. Boomers value the ease and convenience of readily available information, pricing and purchasing options. Therefore, it’s natural to expect Boomers to go online to research their hearing care needs. Information about hearing loss, hearing aids and pricing widely available online, arguably leads many Boomers to purchase through channels other than local hearing care providers – channels including online retailers, big box retail stores, and Third-party managed care companies. Understanding how Boomers differ from Traditionalists will help audiologists position their practices to attract more Boomers.
How Do Traditionalists and Boomers Differ?
Baby Boomers and Traditionalists both value good customer service and quality of care. They want to get the best perceived value when buying hearing aids. Both are concerned about cosmetic appearance and want a comfortable fit. However, there are many distinct differences as well. As the hearing aid consumer demographic shifts from predominantly Traditionalists to more Baby Boomers, it’s important for audiologists to evaluate each patient individually and determine their generational tendencies. This will allow the audiologist to offer communication options, and testing and treatment services, based on the individual’s preferences, as opposed to a one-size fits all approach. The table below describes some of the values and characteristics that are unique to each generation.2
Traditionalists (Age 73+) Baby Boomers (Age 54-72)
Core Values
Conformity Individuality, being in control
Trust in authority Skeptical of authority
Having a nest egg is important Willing to spend if they’re “getting a good deal”
Hearing Aid Consumer Characteristics
Loyal to provider Likely to research online and comparative shop
Places high value on provider relationship Explores multiple options before deciding
Trusts provider as “the authority” and follows recommendations Well informed about hearing loss, hearing aids, and pricing
Accustomed to paying out of pocket, little or no hearing aid coverage or benefit from their health plan Values convenience and choice
Accustomed to bundled pricing Expects health insurance to help cover cost of hearing aids and looks to health plan for guidance
Responsive to traditional marketing methods like direct mail and print advertising Influenced more by online information, pricing, and reviews than traditional marketing methods


In essence, Baby Boomers are much more likely than their older counterparts to take an active role in their health care. The internet has been a key driver in shaping Boomer behaviors and expectations relative to their hearing care. This is a generation accustomed to going online to research, read articles, blogs and consumer reviews, and explore purchasing options. Boomers weigh consumer reviews and recommendations prior to making a hearing aid purchase decision. This allows Boomers to follow the same patterns when purchasing hearing aids as they do in other consumer transactions.
What Do Boomers Want from Their Hearing Care?
Boomers want options, ease, convenience, and control over their hearing care. It might appear that these needs are already being served under the current audiologist business model. However, Boomers differ in ways that make the business model, which has been successful with Traditionalists, not as well suited for Boomers. It is important for audiologists to offer different communication, care, and service options to better support the varying needs of different consumers. The following table describes some suggestions for how the current dispensing audiology business model could be adapted to attract and improve interactions with Baby Boomers.
What Boomers Want What Audiologists Can Do
To be involved and in control Engage throughout the decision-making process and answer questions thoroughly
Define expectations and get agreement along the way
Offer hearing aid apps and accessories
Options for service and communication Offer online appointment scheduling and extended hours
Provide email, text, and chat options
Quick, efficient, personalized service Streamline visits for quick in/out service
Offer remote hearing aid programming
Personalize communication methods, care, and services
To make an informed decision/to know what they are paying for Provide printed information, news articles, and consumer views on:
  • Hearing loss, technologies, hearing aid experience, and provider value proposition
Offer choice of bundled/unbundled products and services:
  • Gives consumers a control/say in their care
  • Provides desired price transparency
  • Places value on care and services when these are clearly outlined and itemized
Health plan referral and hearing aid coverage Partner with health plans: either directly or through Third-party managed care companies


Baby Boomers are a growing and influential market segment. Their influence on the hearing aid industry is evidenced by the various distribution channels now available to address Boomer expectations. Managed care is one of the distribution channels which continues to expand its presence in the hearing healthcare industry year after year. As a result, hearing care providers are faced with deciding whether to participate in managed care and how to integrate the operational demands of managed care into their clinic. While many audiologists view managed care as an opportunity to attract more of this growing consumer segment, others have an opposing view.
Managed Care: Threat or Opportunity?
Independent hearing healthcare providers have been feeling increasing pressure on the hearing aid market for years. Not only are they facing competition from other independent providers, but big players like Costco, United Healthcare, and manufacturer-owned retail are making aggressive inroads into the hearing aid market. Additionally, many more health plans are starting to offer hearing aid benefits and are turning to third parties to administer their hearing aid benefit programs. What are the implications of these changes for the independent audiologist? Does this change present a threat or an opportunity? To answer these questions, it’s important to understand both the dynamics of today’s hearing industry and the influence hearing aid consumers have on these changes.
The Hearing Industry Today
Most U.S. adults with hearing loss do not wear hearing aids. In fact, of the 37.5 million adults with some degree of hearing loss1, only about 1 in 4 (27%) purchase hearing aids, leaving approximately 73% untreated (based on our calculations from industry sources1,4). These statistics have caused many within the hearing industry, as well as outside the industry, to express concern and look for ways to address this problem.

Some approaches to increasing hearing aid adoption rates include hearing care providers as part of the hearing aid delivery process, while others do not. For example, the passage of the over-the-counter (OTC) legislation to create a basic hearing aid category would, at least in part, exclude hearing care providers in an effort to reduce consumer costs and increase hearing aid adoption. Some companies like UnitedHealth Group’s hi HealthInnovations®, Buyhear.com, iHear and others are already trying a direct-to-consumer approach, removing local hearing care providers from the delivery process.

In recent years we’ve also seen managed care expand its reach in the hearing care industry with more health insurance plans offering hearing aid benefits through a third-party company such as TruHearing, EPIC, or Hearing Care Solutions. While this approach does include the hearing care provider through participation in the third-party network, some providers have questioned whether they can accept referrals from these programs and maintain a successful practice.
What Is Managed Care?
Managed care is “a health care delivery system organized to manage costs, utilization, and quality.” In a health insurance setting, this consists of restrictions around which providers you can see, which products and services are covered and the financial contribution from your plan. For example, dental insurance may provide coverage for a crown but not a dental implant and may require the patient to be seen by an in-network dentist, and then only cover a portion of the total cost of the crown. With hearing aid benefits, health plans may limit the amount of coverage, products and services included, and may require members to be seen by an in-network provider to use their benefits, which are increasingly being administered by third-party companies.
Why Is Managed Care Expanding Its Reach within the Hearing Industry?
To understand why more health plans are now offering hearing aid benefits and partnering with third-party companies to administer them, it is necessary to consider the market conditions that have contributed to this industry development. The health plan landscape is becoming more and more competitive. Consumers have many choices for health insurance, and health plans are under increased pressure to provide high quality benefits, while keeping their costs and their members’ out-of-pocket expenses low. This influences which benefits a health plan may elect to offer.

As a health plan’s membership grows, it can offer better benefits to beneficiaries through economies of scale. However, because health plans have struggled to control costs for hearing aids, the majority have not offered hearing aid benefits. For those plans that do, the most common benefit is an allowance that can be applied towards the purchase of hearing aids (e.g. a $500 or $1000 allowance). This effectively controls the health plans cost exposure but does not address the underlying cost of the hearing aid, which can still leave beneficiaries with significant out-of-pocket costs. Beneficiaries are pushing health plans to address their costs through increased benefits or more effective cost controls.

The health plan landscape is especially competitive for those plans wishing to attract consumers aged 65 years and older. These consumers can elect to enroll in a Medicare Advantage plan, which is privatized insurance, or traditional Medicare (Medicare Parts A and B), which is administered by the Federal government. Medicare Advantage plans have limited budgets to offer “extra” benefits and must decide which combination of benefits like vision, dental, transportation, fitness, or hearing aids will best attract and retain members. Plans seek solutions that allow them to offer valued benefits but still control costs. This is one of the reasons why more health plans are offering hearing aid benefits administered through a third party; it offers a way to provide a high value benefit to their members while still controlling costs for both themselves and their members.

In fact, plans that previously offered a hearing aid allowance can often achieve significant cost reductions for their beneficiaries by partnering with a third party to administer the benefits. This in turn increases subscriber satisfaction, making it easier to retain and recruit new subscribers.
Why Are Third-Party Companies Involved?
In recent years, the hearing industry has experienced a rising trend of health plans offering hearing aid benefits, increasing hearing aid accessibility and reaching some of the 73% of U.S. adults with untreated hearing loss. Some involve hearing care providers in their programs while others do not. For example, the largest health insurer in the country, United Healthcare, utilizes a primarily direct-to-consumer model, eliminating in-person fitting and programming services. Without the need to manage a large provider network or reimburse hearing care providers for their services, their costs are reduced.

Another approach many health insurers have adopted is to partner with third-party companies. This approach is attractive to insurers, because it allows them to control costs by outsourcing the management of the provider network, administration of the benefit, hearing aid price negotiation with manufacturers, and product expertise. Though health plans excel at these functions in other major areas of healthcare, they do not have the resources or knowledge to effectively handle these items for smaller, more specialized disciplines like hearing aids. In fact, many health insurers had never offered hearing aid benefits prior to partnering with low-cost third-party solutions and may have never chosen to do so without these alternatives.

Direct-to-consumer and third-party benefit programs are reaching more adults with untreated hearing loss, and both are a viable option for health insurers. Each insurance company will seek to offer the best value proposition they can to their members, weighing the benefit and cost of including professional services from local providers.
What Role Does the Consumer Play?
Clearly, consumer pressure is one of the reasons health insurers are including hearing aid benefits as a valuable differentiator. People in the market for both hearing aids and health plans are more likely to choose a plan that offers an attractive benefit than one that does not. So how and why did this consumer pressure increase?

In addition to today’s consumers being more informed about hearing healthcare solutions, pricing, and purchase channels, they have different attitudes and behaviors towards hearing care and hearing aids than their predecessors. In general, they are more likely to exercise their buying power in the market than the hearing aid consumers of 5-10 years ago, whether it’s shopping around for better pricing or being more demanding about the products or services they receive.

For their overall healthcare needs, consumers are accustomed to reaching out to their health insurance company and primary care physician (PCP). Given that most view hearing loss as a healthcare issue, it’s not surprising they reach out to their PCP or health insurer first and expect their health plan to offer a benefit and a provider recommendation. Understanding these consumer behaviors helps provide insight into why health insurers want to offer a hearing aid benefit. An affordable benefit both attracts subscribers and satisfies consumer demand, resulting in higher satisfaction.
Threat or Opportunity?
To get back to the original question - with more health plans offering hearing aid benefits to attract consumers, what does this mean for audiologists: a threat or an opportunity? There are several factors to consider in answering this question.

Can Managed Care Increase Hearing Aid Adoption? Despite decades of trying, providers, hearing aid manufacturers, the Veterans Health Administration (VHA), and retail chains have only been able to reach 27% of adults with hearing loss, in part due to financial constraints3. Today’s consumers are more informed about hearing loss, hearing aids and prices, and many expect their health plan to offer a hearing aid benefit. They also report being more motivated to purchase with greater insurance coverage3. These consumer dynamics make managed care a promising solution to expand the hearing aid market by reaching more first-time users. Audiologists who align themselves with health plans either directly or through partnerships with third-party companies, will have access to those first-time users.

How Does This Compare to Alternative Solutions? Consumers are increasingly aware they have many choices for hearing care, from direct-to-consumer solutions to local independent providers to big box retailers. When compared to direct-to-consumer options and the market potential of OTC hearing aids, managed care is the solution which is most likely to drive more consumers to local provider clinics.

Some existing hearing aid users are likely to explore cost-saving options being offered through their health plan if they previously paid out-of-pocket for their hearing aids. In that respect, managed care does represent a threat—turning a previous retail customer into a third-party referral. On the other hand, it’s also an opportunity for providers to participate in the customer’s health plan network, either directly or through a third-party company. In-network providers will have an opportunity to retain their relationship with existing patients who elect to take the health plan route, as well as to receive referrals for potential first-time users.

How Will Managed Care Affect Providers? In 2018, 73% of Medicare Advantage enrollees nationwide chose a Medicare Advantage plan that offered a hearing aid benefit. This is an increase over 47% in 2015 and 65% in 2017. While hearing aid benefit adoption is lower in other health plan segments, there are others where hearing aid benefits are increasingly being adopted. As mentioned previously, to handle the administration of these benefits, more health insurers are partnering with third-party managed care companies. This trend is a clear indication of the direction the healthcare industry is going.

To be successful with third-party managed care referrals, audiologists will need to adapt many areas of their practice. For example, audiologists will need to determine whether to selectively or completely unbundle services for their retail patients to be consistent with the service model offered to third-party managed care referrals. While this allows audiologists to put more value on their expertise and services and not just product, audiologists must determine how they will incorporate this into practice. Providers may also need to adapt to working with a higher volume of patients and manage the different requirements of the various third-party companies.

Traditional marketing methods will continue to be a necessary and important part of a successful practice. However, it would be a mistake to ignore the first-time users that managed care has been successful in reaching, especially because there is no marketing cost to acquire referrals through this channel.

Any one of these changes may cause some providers discomfort. However, with the number of health plans offering hearing aid benefits expected to grow, managed care presents an opportunity for the provider who is willing to evolve and adapt.
A Changing But Promising Outlook
Baby Boomers are a growing hearing aid consumer segment with different expectations and demands than their Traditionalist predecessors. Although Boomers are buying hearing aids, they research and shop for them in more diverse ways than Traditionalists. Therefore, employing a marketing, communication, and service approach designed for Traditionalists is unlikely to achieve the same effectiveness with Boomers. Consideration of the core generational differences will empower audiologists to make the changes needed to attract and retain a greater share of this growing consumer segment.

Managed care presents a promising solution to reach many adults with untreated hearing loss who have not been attracted through traditional marketing methods, because it can maintain both quality of product and quality of care, while dramatically reducing their out-of-pocket costs. Providers who evolve to successfully incorporate these patients into their practices will be able to take advantage of this growing opportunity.

The hearing care industry is evolving. Opportunities exist for audiologists willing to evolve with it.    
Patty Greene, M.A.,F-AAA is the Director of Provider Engagement for TruHearing. She can be reached at patty.g@truhearing.com.
References
1 See National Institute on Deafness and Other Communication Disorders (NIDCD). Quick statistics about hearing. December 15, 2016.Click here to access
2 For a more in depth study of the generational differences, a good source is Boomer Consumer: Ten New Rules for Marketing to America’s Largest, Wealthiest and Most Influential Group, by Matt Thornhill and John Martin (July 2007).
3 See Abrams HB, Kihm J. An introduction to MarkeTrak IX: A new baseline for the hearing aid market. Hearing Review. 2015;22(6): 16-23. Click here to access
4 See Strom KE. Hearing aid sales increase by 7.2% in 2015 after strong Q4 by private sector. January 13, 2016. Click here to access