A big misconception about the hearing benefit is that it isn’t as valuable as other benefits, such as those for dental, vision, and OTC products, because health plan members don’t use it as frequently. While utilization of a hearing benefit may be lower, the consequences of ignoring your members’ hearing needs can be significant — in fact, it could cost your plan millions of dollars in downstream return on investment (ROI).
Everyone, regardless of age, deserves the quality of life enhancement that hearing aids can provide. And, while a hearing benefit can serve as the catalyst for these positive impacts, not all hearing benefits deliver the goods.
We can trace the origin of hearing benefit design to a hearing aid manufacturer whose goal was, and still is, to steer members to providers who offer their hearing aid brands. Since then, other manufacturers have copied this model.
Under the manufacturer-centric design, the benefit is usually structured with a low PMPM (per member per month) fee that requires a member copay ranging from $699 to $999. In some cases, a higher PMPM fee can reduce the copay, for example from $699 to $399.
For health plans, the value of a low PMPM is cost containment. Members enjoy solid savings. However, based on the plans we’ve reviewed, we see significant drawbacks, including:
As a result of these disadvantages, we’ve observed a 1% or lower utilization of plans with a PMPM hearing benefit offered by some of our competitors. That’s hardly maximizing the benefit and hearing aid usage — which should be the goal if you’re paying a PMPM fee for your entire member base.
By contrast, Amplifon Hearing Health Care is the only major administrator NOT owned by a manufacturer. Consequently, we’re not encumbered by the above issues; specifically, you can implement a PMPM benefit that includes nearly 800 product options from all leading brands. Moreover, your members will enjoy access to the full breadth of our 7,000+ provider network locations and 1,600+ mobile provider locations who cover a large geography.[1] Add it all up, and you’ll see increased utilization (up to double that of our competitors) and greater downstream ROI.
Many Medicare Advantage plans have asked us about an allowance model that gives members a defined number of dollars (e.g., $500 per hearing aid).
The biggest potential drawback of the allowance model: Because the plan is responsible for paying claims up to the allowance amount, it will almost always result in higher and more unpredictable costs than you’d incur with a PMPM benefit. On the positive side:
Hearing loss does not occur in a vacuum — meaning that it’s directly linked with several serious and costly health conditions, including chronic kidney disease, diabetes, ischemic heart disease, and stroke. (I encourage you to read an important article on this topic by Dr. Carrie Meyer, our Director of Clinical Programs.)
To help amplify this discussion, I want to share a personal story. As someone who’s dealing with a serious health condition, I spend a lot of time at doctor appointments and often overhear conversations with older patients. I’m frequently amazed (and dismayed) at how many of these patients have hearing loss and can’t hear or understand what their clinicians are telling them. These individuals are not wearing hearing aids and frequently don’t have a companion to help them absorb vital information.
Overall, healthcare providers in the U.S. are not equipped nor prepared to work with patients with significant hearing loss. Quite simply, when patients can’t effectively communicate with their clinicians, they are unlikely to follow the instructions they are given. On the other hand, if we can make hearing aids more affordable and easy to purchase, and if we can motivate members to wear the devices four or more hours per day, ideally at least 8 hours per day, we’ll increase the likelihood that they’ll be able to communicate with their providers and take the appropriate steps to mitigate chronic conditions.
Now let’s look at the cost of chronic conditions. According to CMS, such costs increase exponentially for someone with more multiple chronic conditions (MCCs)[2]:
0 to 1 MCCs = $2,061.28
2 to 3 MCCs = $5,843.53
4 to 5 MCCs = $11,036.05
6+ MCCs = $30,118.69
Given these escalating costs, the goal of any health plan should be to prevent members from moving from 0-1 chronic conditions to 2-3 MCCs and so on. By increasing utilization, you can reduce the risk of members developing additional chronic conditions. This is especially true under a PMPM/copay model, which typically have less than 1% utilization.
By comparison, Amplifon’s top-performing plans generate more than double this utilization, which means higher downstream savings for your organization. To this point, we partnered with Healthmine, a leading health care consulting company, to develop an ROI calculator for our partners. Among their findings: A plan with 100,000 members can realize nearly $6 million in savings by working with Amplifon to increase utilization and therefore reduce the likelihood of multiple chronic conditions.
In addition to the chronic conditions discussed above, untreated hearing loss presents a proven increased risk for potentially life-altering comorbidities, starting with social isolation. As I touched on previously, social isolation leads to a host of negative consequences. For seniors, in particular, social isolation doubles the risk of depression, which comes with an average annual cost of $20,000 per member to treat. Furthermore, individuals with untreated hearing loss are five times more likely to develop dementia, a disease that costs $28,000 annually to treat.
Injury-causing falls are another well-established comorbidity of poor hearing. In fact, seniors with untreated hearing loss are three times more likely to experience a fall than their normal-hearing peers, and 37% of those who fall will sustain an injury. Sadly, falls are the leading cause of death from injury among people 65 and older. It’s also well-documented that the average cost of hospitalization for fall victims is $35,000.
Preventing injury-causing falls is especially important because they consistently represent one of the two lowest scores among Star Rating measures for Medicare Advantage plans. By potentially doubling member utilization with an Amplifon hearing benefit, you’ll significantly boost your downstream ROI. Bigger picture: For the same plan with 100,000 members mentioned above, this doubling of utilization can directly contribute to as much as $7 million in potential downstream ROI due to a reduction in depression, dementia, and injury-causing falls in addition to chronic conditions cost savings.
Through this article, I’ve aimed to build a strong case for why you should consider a hearing benefit that will positively transform the lives of your members and boost your health plan’s ROI. At Amplifon we’re fully focused on elevating what we view as a “check-the-box” hearing benefit into a true differentiator for your members and your organization. This commitment includes being at the forefront of innovation. (Please check out this article on hearing health innovation by Manpreet Saini, our Director of Innovation and Continuous Improvement.)
One of our biggest investments was developing Amplifon-branded hearing aids. While conventional thinking might dictate cost savings by reducing the level of technology, we determined that a substantial technology stack would help maximize usage. This approach involved coupling the best available technologies with exclusive virtual services, giving members additional smartphone control over their hearing aid experience. Currently, these technologies are available at Miracle-Ear® locations with plans to expand distribution to private practices.
The issue at hand is that members often struggle to develop the habit of using their new hearing aids effectively, particularly during the initial 1-3 months. To address this challenge, we created a team of care monitoring advocates who act as coaches to help with non-clinical hearing aid concerns. Their role is to assist members by eliminating obstacles—such as providing education on charging, cleaning practices, and usage tips—so that members can successfully establish and maintain a consistent hearing aid routine.
At Amplifon the ultimate goal of these and many other projects is to increase hearing aid usage, which in turn will have a positive impact on key comorbidities while enhancing the member experience. To help validate our belief in the power of hearing health care, we initiated a research project with the University of Minnesota pertaining to hearing aid usage, coaching, and the impacts associated with key health conditions. Among the study findings:
Based on the results of these early studies, Amplifon will continue to invest in hearing health innovations, knowing that increased hearing aid purchases and usage will boost our partners’ ROI.
[1] As of September 2024
[2] Spending by count of select chronic conditions among original Medicare (FFS) beneficiaries, 2018 Multiple Chronic Conditions Dataset, Centers for Medicare and Medicaid Services, accessed January 3, 2024. https://data.cms.gov/medicare-chronic-conditions/multiple-chronic-conditions
