Minnetonka, Minn —As reported in the October 3 HR Online News, hi HealthInnovations, Minnetonka, Minn, a subsidiary of UnitedHealth (UNH) Group, is now offering hearing aids discounted to their members (and with no out-of-pocket costs to certain Medicare Advantage members) as well as direct-to-consumer hearing aids for people outside the UNH network for $749 to $949. On Friday (October 7, 2011), The Hearing Review interviewed hi HealthInnovations CEO Dr Lisa Tseng, MD, and learned more about the company’s products and plans, including its hope to partner and network with hearing care professionals.

hi HealthInnovations is currently offering four styles of instant-fit devices—two BTEs (standard BTE and mini-BTE), an ITC, and a power BTE—that rely chiefly on open-fit technology. These devices are selected and programmed using the company’s proprietary online At-home hearing test, and the resulting data is used to program a hearing aid that contains three programs/memories for the consumer to choose from. (Although there is a Power BTE option in the company’s product line, that device requires the services of a hearing care professional due to the requirements of a custom earmold, venting, and specialized programming.)

Dr Tseng (pictured, right) said that the At-home hearing test was developed by audiologist Dianne Van Tasell, PhD, and a team of experienced audio engineers using a variety of approaches to arrive at the gain settings for the three programs/memories. The hearing aid is manufactured by the nearby manufacturer Intricon (formerly Resistance Technologies Inc or RTI), in Arden Hills, Minn, a long-time supplier of components to the hearing industry. Shares of Intricon rose 37% upon release of their partnership with UNH.

An insurance behemoth.

UNH is an insurer that serves 10 million Medicare beneficiaries. So its announcement of offering in-network and direct-to-consumer hearing aids was met with considerable trepidation by industry and dispensing professionals, and an HR Online poll indicated that over half of hearingreview.com readers believe that UNH is a “game changer” relative to hearing healthcare business dynamics.

In her interview with HR, Dr Tseng emphasized repeatedly that hi HealthInnovations is eager to work with all hearing care professionals in expanding the hearing healthcare market, and the company plans on building a referral network for those consumers who do not fit into what she describes as the conservative fitting guidelines of the company’s devices which are intended for mild to moderately severe loss (ie, open-fit range). “We truly value the services that hearing healthcare professionals provide and want to partner with them in serving the 36 million Americans with hearing loss,” says Tseng. “We actually believe that we are going to be a very powerful referral channel for physicians and hearing health professionals, because the people who were not aware of their hearing issues will now have increased awareness and an opportunity to self-test [in a way that was not previously available]…The more people who access our program, the more we can refer to hearing care professionals. And the individuals that we refer, not only [will they become aware] that they need specialized treatment, but they will be more likely to take action when they get to the specialized health professionals.”

At-home hearing test: A disruptive technology?

According to Tseng, the most innovative part of their company’s offering from a technological standpoint is its unique At-home hearing test. You can take the test here. She says that understanding the test and its purpose is key to understanding the company’s business model and differentiation. “The test is designed to clearly identify those people who would be good candidates for open-fit hearing devices,” says Tseng. “The test also detects those types of hearing loss that would benefit from the services of a hearing health professional. [This would include] asymmetrical hearing losses, hearing losses too severe for open-fit hearing aids, and significant low-frequency losses. For those individuals, we are not selling them hearing devices; we’re strongly recommending that they see a physician or hearing health professional. So, if you take our test online and play around with the different numbers in the audiogram section, you’ll see very quickly that, if you have an asymmetrical hearing loss for example, you will be unable to buy our devices. We don’t allow it. [That person] is advised to see a hearing health professional.” The test also permits consumers to enter results from an audiogram, if available.

When asked for details about the At-home hearing test, like how it is calibrated, Dr Tseng said that the company would not be divulging immediate information about it, since a patent for the tool has only recently been filed and Van Tasell is currently submitting scientific papers to journals. “However, I can [say] we’re not doing a ‘traditional audiogram’ over the Internet, exactly to your point [relative to calibration using earphones/headphones]. We just couldn’t calibrate people’s equipment; we don’t control their earphones, and we don’t control their computer soundcards.

“However, [Van Tasell] has developed a very innovative way to combine data from different [metrics] to estimate very accurately the person’s average severity of hearing loss and the gain prescription,” continues Tseng. “[The test takes into account] factors such as the users age, gender, test questions, and differences between their audiometric thresholds. So, there are many sources of data that we are collecting from the consumer, and then [we’re] using some very innovative ways to estimate accurately the average hearing loss severity and the gain prescription based on NAL-NL2.”

Hearing aid adjustment and face-to-face dispensing.

Once the consumer receives the programmed aids from the company, should they not be satisfied with the fit, they can return the aid for reprogramming free of charge, according to Tseng.

When HR pointed out that the majority of first-fit programming is found (through real-ear measurement) to be in need of adjustment by the dispensing professional, Tseng again agreed that dispensing professionals play a crucial role in many fittings. However, she says hi HealthInnovations also has licensed professionals who will work toward proper solutions to their customers’ individual needs. “We understand that hearing devices are only one component in the overall treatment; counseling and support are all very important. We’re having great proposals from academic universities to say ‘We think we have the way to engage people in a more positive way.’ So we’re looking at those proposals right now to [further that aspect of] counseling and support.

“Another point that I want to emphasize,” continues Tseng, “is that we’re actively developing a very robust referral network. As I said earlier, there will be many people who we will not be able to serve via this model—those with asymmetrical hearing loss, more severe hearing loss, etc—so we really believe that audiologists, hearing instrument specialists, and ENTs are key. This is in no way intended as a replacement; this is just supplementing the work that they do. And we will need [hearing care professionals] in our network too, because there are things that we cannot do on the Internet or over the phone.

The company also plans to offer a variety of Webinars for patient after-care support that would deal, for example, with learning how to get the most out of their hearing aids.

HR noted that face-to-face counseling, followed by selection, fitting, verification, and validation of the hearing aid fitting has been a standard of care promulgated in guidelines set forth by all of the major professional organizations involved in hearing aid dispensing (eg, American Academy of Audiology, Academy of Doctors of Audiology, International Hearing Society, and American Speech Language Hearing Assn). In response to this, Tseng says that healthcare is adapting to the need for different patient modalities and levels of consumer involvement in managing their own healthcare issues. “I believe there are different types of consumers,” says Tseng. “There are some consumers who are more comfortable taking on greater control of their healthcare. And [a screening tool] is typically their first step in pursuing healthcare. So, for example, for myself, I would probably do an at-home pregnancy test before I would see an OBGYN. [So this type of screening provides a means of knowing] when I should see a healthcare professional.

“There are other consumers who are not comfortable doing any kind of healthcare [screening] on their own, and they would want to go directly to a hearing care professional,” continues Tseng. “We respect that, and we just want to provide more choices for consumers—especially those people, the approximately 75%, who aren’t really leveraging the traditional [hearing healthcare] channel. By encouraging them to take the first step in their own healthcare, we’re hoping that, if they are the ones who would benefit from the services of hearing care professionals, they will then proceed to that next step…Once people know that they have a problem, they’re more likely to take action. But right now, there are just a lot of people who go undetected with their hearing loss [or address it much later than they should] and are not benefiting from early treatment.”

Involving more physicians—and possibly others—in hearing screenings.

hi HealthInnovations will also be offering a new tool for primary care physicians designed to screen patients for hearing loss. Tseng said that she could not provide detailed information about the test at this time, but made it clear that physicians are not going to be involved in dispensing hearing devices. However, it appears that the way in which the test works is that the physician will administer the hearing screening to the patient, and if the patient tests positive for hearing loss, the physician could then recommend that the patient contact the company to further pursue a hearing device. Alternatively, patients whose hearing losses are not applicable for the company’s device would be advised to seek help from a hearing care professional.

Tseng said that, since 2005 when the new “Welcome to Medicare” physician’s screening recommendations were implemented which include hearing screening (for details, see the article by Dennis Hampton, PhD, in the March 2005 HR), physicians have been telling UNH that they would like to see better tools for hearing screening. She emphasized the important role that hearing care professionals play in hearing care: “We’re telling our physicians when we roll this out that this is just one additional tool and to please feel free to leverage the relationships that [they] have with hearing care professionals … In terms of [any hearing industry market concerns about this area that were mentioned by the editor], we’re not trying to displace or replace anyone because there is a dire need [for professional care] and we’d really like to work closely with hearing care professionals.”

AARP and UnitedHealth have a strong relationship, and the AARP/UNH Medicare Program is reportedly the #1 selling health program to seniors. When asked if there were plans for a hearing aid benefit to the AARP/UNH Medicare Program and, if so, if it would only be available for the hi HealthInnovations device, Tseng said that it is company policy not to discuss these types of business issues. However, she noted that the company’s hearing aids are available to the general public. Similarly, she could not comment on industry speculation that the hi HealthInnovations device might eventually be distributed via big box retailers and/or large pharmaceutical chains. She did say, however, that the programming of the devices poses a corporate challenge, and there is much to work through at this point.

Untreated hearing loss is expensive for insurers.

A major reason for UNH’s establishment of hi HealthInnovations is what they view as the hidden costs of hearing loss and a lack of access to hearing healthcare, says Tseng. “Let me highlight why it’s especially important for UnitedHealth Group to do this. Hearing loss, as we know, doesn’t only impact someone’s hearing; it impacts someone’s overall health and quality of life. Left untreated, it leads to conditions such as social isolation, depression, and [possibly even] dementia. All those things have impacts on people’s quality of life, as well as medical costs. So, we’re looking at this not in just a ‘silo’ way; instead, we’re looking at it in managing the total quality of life and the healthcare costs of our entire population.

“We want our seniors to be active and have a higher quality of life,” continued Tseng, “and prevent those hospitalizations that really are unnecessary. As you probably have heard, [there are cases of] people who lose their hearing devices or don’t have hearing devices and get admitted to the hospital because family members think that they have developed dementia. Obviously, this is not good for the patient, it’s not good for the family, and it’s not good for the overall healthcare costs of Medicare…Hearing aids also assist seniors in staying in their homes and maintaining their independence longer. Seniors who are our members have been telling us that they want to stay in their homes as long as possible and age independently. So there is a greater goal that we’re trying to achieve as we’re increasing access.”

Tseng added, “We’d like your readership to know that we’re here to supplement the great work that hearing care professionals do. We look forward to working with them. And we will be referring people to them. In fact, even in the first week, we have a lot of members calling, and we know that there are people who we just can’t serve over the phone or on the Internet. So, for [professionals] who are interested in working with us, we will have a pretty strong referral channel given that we do serve 10 million Medicare beneficiaries.”

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