Welcome to the 'Just Good Enough' Era

Author: Brian Taylor, Au.D.

A recent McKinsey report1 builds a strong case for the growing demand of medical devices that are “good enough. ” In essence, these are devices that are lower priced and don’t possess many of the value-added features that are often found in the premium category. According to the report this new segment of the market – one that values no-frills solutions – is growing twice as fast as the industry as a whole in many medical device categories. Quoting the report, “as decision makers become more cost conscious and competition intensifies, opportunities to serve value-oriented customers in medical devices are growing fast…the key to success does not always lie in changing the product itself, but could involve altering sales models and service offerings.” Although this report doesn’t directly mention hearing aids, it is not too big of a leap to draw parallels to the commoditization of technology occurring within our own profession.

As Cox, et al (2014)2 attest, higher cost, premium hearing aids do not provide superior outcomes when compared to lower cost, basic level technology. In a carefully designed study involving 25 participants, the researchers compared laboratory speech understanding tests, standardized self-reports and open-ended diary entries for four pairs of hearing aids: two basic and two premium level. Results of the month-long field trials showed no statistically or clinically significant differences between the premium and basic level hearing aids on any measures of outcome for both new and experienced hearing aid users. The results of this study suggest hearing aids, regardless of technology level or price point, provide patients with favorable laboratory and real-world outcomes. It should be noted, however, that all hearing aids evaluated in this study were painstakingly fitted using best practice protocols, which likely contributed to the across-the-board positive outcomes.

Similarly, in one unpublished research3 study that compared basic and premium devices to two different high quality PSAPs, the researchers found that both types of conventional hearing aids were rated higher than PSAPs for listening to conversations in quiet. Conversely, for two other listening conditions, listening to everyday noises and music, the PSAPs performed as well as the conventional hearing aids. Like the previously mentioned study, all the devices were meticulously fitted using standard protocols. Obviously, more research examining the benefit of various levels of amplification technology is needed, but some trends are beginning to emerge:

Following a best practice protocol trumps the level of technology being dispensed. In other words, hearing aids with basic technology fitted by an audiologist using a standardized approach is likely to outperform premium products taken straight out of the box and placed onto a patient’s ears using a minimalist protocol.

Feature creep adds complexity, cost and time but not necessarily value. Every 12 to 18 months hearing aid manufacturers launch a new product with updated features. For about two decades, this has been an effective strategy because the marketplace (audiologists and hearing instrument specialists) is on a quest to provide patients with the latest innovations to address their needs. According to the peer reviewed study cited above, these incremental improvements in feature performance don’t equate to incremental improvements in patient outcomes. Cost controls by third party payers and large purchasing organizations as well as the use of evidence-based decision making by clinicians may be the only ways to stymie feature creep.

High quality PSAPs that meet a strict performance criteria may be “good enough” for some patients – it’s up to hearing care professionals to ensure those criteria are well-defined and verified for every individual.

The commoditization of amplification technology does not necessarily mean the sky is falling for the profession. After all, professional expertise and judgment is needed to verify that any amplification device, regardless of sophistication and price has a smooth, undistorted frequency response, along with other acoustic characteristics of a well-fitted hearing aid. (Not to mention helping people overcome the myriad behavioral and societal consequences of gradual, adventitious hearing loss in adults.) Rather, the rise of the “just good enough” market, is an opportunity for audiologists to broaden the scale and scope of patient offerings. In addition to fitting conventional hearing aids, audiologists may have the opportunity to adapt an ala carte approach to technology with a menu of offerings tailored to the “just good enough” needs of the individual. This menu may include alternative technologies such PSAPs, hearables, and devices like Hypersound. Even the standalone delivery of therapeutic services, which could be centered around cognitive behavioral counseling and motivational interviewing, need to be more widely embraced by audiologists. In short, the ability to provide truly patient-centric care revolves around addressing the behaviors and attitudes of the individual, rather than the provision of a device. Lower prices for medical devices doesn’t necessarily mean less technology or inferior service. It could mean using more simple-to-use gadgets, specialized for specific purposes—a device for the phone, one for TV & home audio and ear worn devices for conversations outside the home. All simple-to-use, high quality and customized to the patient by their audiologist who serves as the hub. It starts with audiologists putting their critical thinking skills to good use.    
References
Llewellyn, C. et al (2015) Capturing the new ‘value’ segment in medical devices. McKinsey Report. Accessed 2/17/15 from McKinsey.com.

Cox, R. et al (2014) Impact of advanced hearing aid technology on speech understanding for older listeners with mild to moderate, adult-onset, sensorineural hearing loss. Gerontology. 60, 557-568.

Breitbart, D. (2014) Is there a preference between hearing aids and personal sound amplification products (PSAPs)? AuD Research Project. Assessed 2/17/15 from HarlMemphis.org