The Differentiating Strategy of Managed Care Engagement

Audiologists are facing an influx of new and growing competitors in the hearing healthcare space. Online and big box retailers, including self-assessment, in-person, over the counter, direct to consumer, and brick, legacy manufacturer owned clinics and mortar hearing instrument dispensers’ practices offer consumers often lower cost, more accessible amplification solutions.

As I have discussed many, many times before, audiology has many unique offerings and opportunities available to them. Audiologists, whether they want to recognize it or not, have a specialized skills set. While many physicians and even some hearing instrument dispensers mistakenly believe they can provide hearing healthcare equitable to that provided by audiologists, in reality most physicians have no idea how to practically and personally provide an audiology service and hearing instrument specialists do not have the training or licensure to be able to provide care beyond basic audiometry and traditional amplification delivered in a conventional manner.

Audiologists have so many clinical skills and offerings, most of which extend well beyond traditional hearing aids. From hearing conservation and prevention, to diagnosis of hearing loss, tinnitus, vestibular and auditory processing disorders to treatment of auditory and vestibular conditions through cerumen management, rehabilitation, counseling, implantable device programming, and the dispensing of amplification devices, audiologists have the background, training and experience to effectively evaluate and manage auditory and vestibular conditions and change the quality of life of those we serve. When we practice patient centered care, to the top of our license and education, we are unparalleled and can significantly impact an individual’s quality of life.

Managed care has been a huge part of my professional life over the last 30 years. While I have always seen consistent, while often poor, coverage of diagnostic services, coverage of treatment, including hearing aids, has always been limited. As a result, I have advised many, many audiologists to explore out of network engagement, over in-network participation. In many situations, third-party network or administrator participation just made no practical clinical practice or business sense. This paradigm though is beginning to shift.

The world of managed care and third-party administrators has changed exponentially since I started in this space in the 1990s. Every year, more and more individuals gain access to hearing aid coverage through employer based health plans, Medicaid, Medicare Advantage, Medi-Gap plans, and VA Community Care, as well as hearing aid coverage mandates at the state level.?In my subjective opinion, as managed care coverage continues to rise, it has becomes harder and harder to remain on the outside of hearing aid coverage. More individuals want to access their growing insurance coverage and benefits.

I have come to realize that managed care participation, which has often been our Achille’s Heel, can now become our strength and differentiator. You see, while we have many new and rising competitors in our space, including self-assessment and management, we still have one ace in the hole. That ace? Managed care participation.

See, this is an ADVANTAGE we have over our competitors. Hearing instrument dispensers have no access to traditional Medicare coverage and often have limited access to commercial insurance plans. This market is even more restrictive to over the counter and direct to consumer retailers and is not available to big box retailers. Managed care network, even third-party administrator participation, can give us an upper hand on these competitors. Even Costco cannot compete against a fully funded hearing aid benefit.

Despite what you hear on social media, audiologists can be professionally and financially successful in a managed care world, even with some third-party administrator plans. I have been helping audiologists navigate this minefield for decades. Success is possible.?Are all managed care plans a win-win for audiologists and those we serve? No. Are they universally bad? I would say no to that as well. Success requires education, legwork, and consistency.?We cannot will managed care and third-party administrators away. If we do not participate, they will just create their own workforce and find another delivery channel to sidestep us.

Please THINK OUTSIDE THE NOW and make BUSINESS decisions and not emotional ones. Please stop listening to colleagues who want you to blindly take on their insurance strategy.?This rationale is one that helps them justify their decisions rather than benefit YOUR practice. Make sure the strategy they are sharing is compliant, transparent, and patient centered.?Do YOUR own research. Run your OWN data and numbers. ASK questions when you lack answers. If the numbers do not add up, do not participate but do not discount managed care engagement without thoughtful exploration. I have seen it as a stepping stone to growing a practice and can truly differentiate your practice from disruptive entities. Change is upon us and how we respond is paramount to what happens next.