Hello, welcome everyone to today's IHS webinar, Navigating the Hearing Healthcare Arena in 2025, sponsored by Oticon. I'm your moderator today, Sierra Sharp, IHS's Director of Professional Development. Thank you very much for joining us. Before we get started, I just want to share a few housekeeping items with you. Note that we are recording today's webinar so that it can be offered on demand through our e-learning portal. An email will go out next week when the recording is available. Closed captioning is also available and can be turned on using the Zoom toolbar as shown on your screen. This webinar is available for one continuing education credit through IHS and the CE quiz and information about how to receive credit can be found on the webinar webpage, which is shown on the screen and linked for you now in the chat box. The slides for today's presentation can be downloaded on that same webpage so you can feel free to take a moment now to do so if you'd like to follow along with the webinar. Following completion of the CE quiz, you'll be asked to take a three question evaluation. We really appreciate you sharing your feedback. We use it to create future content for our valued IHS members. Lastly, please note that today's presentation is sponsored by Oticon and represents their view on industry trends and changes. The content has been specially developed for you by Oticon and may not necessarily reflect IHS's policy and stance on hearing healthcare issues. And now to tell you about our presenter. Here today to share valuable insights about the state of the hearing healthcare industry is Gary Rosenblum, president of Oticon and former chairman of Hearing Industries Association. Gary Rosenblum has been president of Oticon since October, 2016. He's responsible for leading the U.S. Oticon organization consisting of its sales, marketing, customer experience, training, audiology, and business development teams. He brings a rich understanding of how customers and consumers are adapting to a changing healthcare environment. Prior to Oticon, Gary ran several medical device and consumer healthcare businesses for Fortune 500 companies including Johnson & Johnson, Abbott Labs, and Pfizer. Gary earned his MBA from Cornell University and a BA in psychology and history from Washington University in St. Louis. From 2021 to 2023, Gary was chairman of the Hearing Industries Association which is the national trade association representing global manufacturers, advancing hearing technology, public policy, patient safety, and education. We have a true expert sharing his perspective today. As you can see, Gary has a lot to cover during our time together. And at the end of his talk, we'll move on to a Q&A session. On your bottom menu, you'll see icons for chat and Q&A. Try to keep general conversation in the chat box and your questions, which you can send in at any time in the Q&A box. We'll get to as many questions as we have time to answer following Gary's presentation. And so without further ado, I'll let him take it away. Gary. Thanks a lot, Sierra. I'm gonna share my screen here. Hi, everybody. Hey, first of all, before I jump in, I just wanna thank IHS. I think this is probably the sixth time I've done this, maybe, and it's always a real pleasure for me because I learned a ton from you guys. So hopefully there'll be enough time for questions and dialogue because we, as always, are in a very interesting and dynamic industry and there's always new things that are popping up. So hopefully some of those new things will come across during the chat or during the question period. Again, if those of you who don't know me, I'm Gary, I'm president of Vodacon. As Sierra said, I've been around this industry for a while now, almost about eight and a half years. October will be nine years and I'm hooked. I love it. It is never boring. It is always unique things happening. And I think that's really part of what makes it fun and I think that's really part of the joy of doing this presentation. There's always new stuff to talk about. It's never, each year is different. New things happen all the time, which keeps the job and the career very, very interesting. But I guess my main goal here is to just give you some insights on how to navigate the hearing healthcare industry. As I said, it's always new, but the main takeaway that I would say I'd really like to convey to you is it is an extremely resilient business and industry. There's so many things that come our way, meaning from the practitioner level, the hearing care professional level, as well as the manufacturer level and entities across the hearing healthcare space are obviously dealing with stuff all the time and keeps it very, very interesting. But it's very resilient and there's a lot of really good demographics working in our favor, meaning there's a lot of people out there that need our help. So I think that will keep the industry quite healthy for the foreseeable future. All right, so don't be alarmed when you see some slides today showing the industry is down. It's really, I think, a blip, but there's a lot of uncertainty happening in the U.S., among U.S. consumers. And I'll share some of the insights there on what that's related to. It's mainly based on what's happening in D.C. right now. Whether it's good or bad, it's definitely impacting consumer confidence. And I think that's impacting the U.S. hearing aid market for a short period of time. All right, so let's jump in. So first of all, this is me. I mean, a lot of you have met me. I know I've been around a while, but some of you may not. So again, eight years with Oticon. The last 15 or 17 years of my career has been medical devices, but I actually started in retail. So obviously, one-on-one with consumers. I was a buyer for Macy's in New York City. Did that for a number of years, then went back to school to get my MBA. Also spent time in consumer healthcare. So I ran some large brands for consumer healthcare companies. At the time, it was called YF. It's now Pfizer. Actually, it's not even Pfizer anymore. It's Halion now. The company has changed a bunch of times, but basically I ran ChapStick and I ran Robitussin, some big over-the-counter consumer healthcare brands, which was great because it was really a way to sort of experience how to sort of manage a business early in my career. I grew up on Long Island in New York. I currently live in Princeton and I've got two kids with my wife, Naomi, Ari, who's 15, and Elam's 13. So we are in it. We've got officially two teenagers in the house, which brings with it a lot of joy, but also a lot of drama and a lot of carpooling and a lot of schlepping. And as we say in my house, when it comes to soccer practice or drama or whatever, but it keeps things very interesting and I wouldn't trade it. It's awesome. All right. Okay, so this is a slide I showed last year and I think it's good that we're consistent about this. Some of the way I run my business is through key performance indicators, KPIs. And I thought I would do this for the hearing aid industry, which is, are these six things which are really important moving in the right direction? And I would tell you last year, they definitely weren't. This year, they still are, but some challenges there. And I think, as I mentioned in the introduction, those challenges I believe are short-lived. I think we'll get past them, but it is important to call it out. So first of all, growth. You want industry to grow. We're not growing in 2025. I'll share that with you in a minute. But as I said, there's a really good reason for it. It's not that people are in demand or there's less demand for hearing healthcare. It's I think, and I'd love to hear your thoughts about this. I believe that we have a consumer confidence challenge right now. People are really unsure about what's happening in the near future and that's hurting our first quarter or the first half of 2025. And I'll show you some stats on that. From an innovation standpoint, you and I both know no one's stopping there when it comes to innovation. The manufacturers in this space are constantly launching new products. Typically, manufacturers launch twice a year, whether it's a new style or a brand extension or a brand new platform, but it's happening all the time from all the big five manufacturers. Honestly, of course, I'm a competitive guy, but it keeps us, meaning Oticon, it keeps us frosty when it comes to innovation. We wanna innovate, we wanna give you guys the best possible products to help treat your patients. And the competition definitely drives that. And it's always about delivering something that allows you to do your job either more efficiently or better or having patients keep coming back to your practice because innovation definitely drives that. Patient satisfaction, that has definitely not changed. Patient satisfaction is at a historical high when it comes to hearing healthcare. And that's really not so much about my products. It's more about the stuff that you guys do in terms of being able to deliver a product that is very, very expensive to people that don't want it. Most cases, after a fitting occurs, patients are extremely satisfied with not only the service that they provided, but the products that they received as well. So favorable demographics. Every one of these seminars, I've showed you the slide about baby boomers. They're peaking next year. I'm not gonna show any slides this year, but next year, meaning 2026, will be the year where the most baby boomers exist. And that will be sustained for quite a few years. It's gonna kind of go up and down, but in general, we're sort of in this period of time where if you go back 65, 66 years, or maybe even 69 years based on what the average age is in your community of people getting hearing care for the first time, those were the years where the most babies were born in the history of the United States. So you have a lot of people in need of hearing healthcare. Pest analysis, that's a macroeconomic analysis, which I'll share with you, which looks at the political, economic, social, and technological environments that we're in, and are they favorable? Yes, they are. And then last, strong professional and trade association support. Do we have a voice in DC? Absolutely. IHS has a very strong voice, and that's definitely beneficial for the industry in general. All right, so that's sort of a summary of the industry KPIs. I think you should be pretty comfortable and happy that you're in this industry. You know, I've been in some industries that have essentially imploded, and everyone's looking for a new role. That's not the case in hearing care. It is a very, very strong, resilient industry because of what I just talked about. All right? So the other thing that I always look at, and this is a unique way, we don't typically talk about this in hearing healthcare, but what's the penetration for the entire US population? This includes everybody, babies, people without hearing loss, kids, people who are in their 50s and 60s who have hearing loss, but are refusing to get it, the entire US population. How is hearing technology penetrating the US, the entire US population? And we're close to 1%. I know it doesn't sound like a lot, but it is when you have a 340 million person population in the US, and it's growing quickly. As you can see, this percentage is growing quite a bit. That ultimately helps our industry overall. I think there's a lot behind this number when it comes to hearing healthcare, meaning the awareness of hearing healthcare is at an all-time high. There's clearly less stigma associated with people having things in their ears. The technology is wonderful. The word of mouth continues. And as I said, the patient satisfaction, patient satisfaction, excuse me, from the work that hearing aid specialists do is at an all-time high. So that is, of course, a beneficial concept for the hearing healthcare industry. All right, let's keep going. Adoption rates. This is also really important, which says that there's a ton of people out there who have hearing loss that have not engaged in hearing healthcare technology. 38% of the 49 million people in the US with hearing healthcare have engaged in hearing technology. And this has not been updated for 2024 yet. This is a research report done that's done every two years called MarketTrack, and MarketTrack does track adoption rates. And we'll have that information fairly soon. We just don't have it for today. But in general, you can see that the adoption rate in general for hearing healthcare is quite good and growing at a very, very good clip, which means that, again, it bodes well for our industry, but it also says that there's plenty of people. There's 62% of people with hearing loss are not engaging in hearing healthcare. And that says that there's a lot of opportunity for us out there in every single community in the United States. So this is where 2024 landed. I wanted to share this with you because I thought it was important that we recap 24, not just about the overall growth rates, but also the percentage of the business. And if you look at the bottom of each one of these different channels, it shows what these channels represent in terms of overall hearing aid units sold in the United States. So the VA did not grow last year. A lot of that was because of hiring freezes. And so it was basically a little bit of a negative growth. VA is about 16% of all the units sold in the United States. Managed care, 7.4% growth rate, a little higher than the overall growth rate, which was 6%. Managed care is about 21% of the units in the United States. What's interesting about that number is that it's significantly lower than it was in 2023. Managed care, really the last five years has grown above 20%. So it's interesting to see that decline as much as it did to the 7.4. The reason for that is that hearing aid benefits are now ubiquitous, meaning if you have insurance, if you're an employee of a company and you have insurance, it's very, very likely that that insurance plan has a hearing aid benefit, meaning you can get a discount or a fully paid plan. It depends. But in general, those plans now exist across the board. So you don't have this incremental or large increase in managed care from new plans coming online. Of course, you still have Medicare Advantage, which is the majority of managed care units. And Medicare Advantage includes essentially half of Medicare beneficiaries. And Medicare, as you probably know, grows at about 10,000 more than Medicare. Medicare, as you probably know, grows at about 10,000 new patients a day. So that will, of course, grow the managed care business for the foreseeable future. But it has slowed down considerably in 2024. I'm gonna tell you about 2025 in a minute. Independent cash, this is private pay, independent cash. Really good to see that marketplace recover. It was a little bit down in 2023. Medicare growth about 5% says that we all, meaning the folks on this call as well as manufacturers are doing our job, meaning we are giving high levels of technology to the patients who need it. And they're willing to pay a significant amount of money for it, which again, you deserve it, I deserve it, they deserve it because it is a high level of technology and a high level of service that we are providing to patients. Medicaid, 3.9% growth. I think the issue there, frankly, on the Medicaid side, only about 4% of our business is awareness. I just think there's plenty of people out there in the United States that have Medicaid and they have a hearing aid benefit from it. They just don't know that they have it. And that's up to us to get that awareness out there. For retail direct, that's Costco, Amplifon, and any major retailer like Beltone or Hearing Life. That grew at 8.5%, so pretty good clip last year. A lot of that has to do with Costco shifting its business from Wednesdays and Tuesdays to a central distribution center. What I mean by that is a lot of the manufacturers are no longer shipping directly to Costco locations themselves. They're shipping products to a central distribution center where then Costco sends it out to the Costco hearing aid centers themselves. That include a pretty large sell-in last year, which is why that growth rate was so high. OTC, massive growth rate, 50 to 86%, but still only 2% of the business. A lot of that growth rate had to do with managed care companies now taking OTC, which they didn't in 2023, which was really the first full year of OTC. But as you can see, OTC really not a large percentage of the business overall. So, but overall US market in 2024, good clip for 6%. Typically you will see a growth rate in the US hearing aid market of about between four and 6%. It's been pretty standard really for the last almost 20, 25 years, which again has to do with demographics, reduction of social stigma and good technology. So let's now let's take a look at 2025, which paints a quite a different picture. So this is the situation right now, a year to date. This is essentially February year to date for the market. What's interesting about this is that January was actually a good month. The market was up in January, but since the inauguration and what has happened in DC, there's been a pretty significant decline. And I think, again, not pointing a political finger here, it's just about uncertainty. And I think there's a lot of obviously optimism, but also a lot of negatism. Negatism, I don't think, negativity is probably a better word there about what's going on with our country right now. What it leads to is uncertainty. And I think that's why we're seeing, we had a really tough February. The market was down quite a bit in February, and hence overall year to date, the market is down about 5%. And you can see across the board where it's impacting, VA down 2%, managed care down 12%. Now that's an interesting one. I'm not really sure where that is. I think usually managed care starts off slowly because of the conversion of people to new plans and programs. But it was surprising to see managed care grow, I mean, sorry, drop as much as it has. It's also lapping a pretty healthy number from 2024. Indie cash down about 3%, Medicaid up a little bit, 1.1. And then retail direct, which again, includes Costco, Amplifon, Beltone, et cetera. That's down about 6%. So pretty big change. I think it really just is a, as I said in the beginning, I wouldn't worry too much about this yet. I think this is a situation where people are holding their cards close to the vest. They're just being very cautious about spending what obviously could be a very large purchase for a lot of people. And I think that's, in general, what's going on. We have, of course, a lot of competitive intelligence as well as just overall intelligence from customers that say this is exactly what's happening. People are worried they're not showing up or they're canceling appointments or they're just not, there aren't a lot of appointments. And I think this, again, is short term. I think things will, like the situation that we're seeing here, we've seen this before when there are other levels of uncertainty overall in the U.S. market in general, not just specific to hearing aids. And I think that's what's causing some of this decline. I wanted to share also just some specifics about styles and preference in the U.S. market. I haven't showed this before. So I thought I would show you what we saw from the fourth quarter of 2024. The first thing here is what is consumer preference by style, okay? What are people buying? What are people dispensing in general? And what's interesting about this is that now at this point in the history of hearing aids in the United States, about 86% of people are buying RICs or receivers in the ear. And it's the highest it's ever been. What's happening there is BTE is small and it still will be. It's mainly for obviously people seeking power or seeking, you know, there are a lot of reasons, of course, that you guys know better than I do for BTE. And it's typically for the mild to moderate patient, Mini-Rite seems to be the dominant style. But BTE is obviously out there and will always be out there. What's interesting here though is that custom has declined to 9%. Customs typically floated for the most of the time that I've been in the industry around 11 or 12%. Customs meaning ITE in the ear hearing aids has dropped to 9%. A lot of it probably has to do with just better technology continuing to be developed in the RIC category. And as I mentioned before, OTC at about 2%. From a tech tier perspective, so what percentage of patients are purchasing premium versus basic versus mid versus advanced when it comes to tech tier? And this is commercial. So this does not include the VA, which obviously would somewhat skew the data because of, sorry, give me a second, would skew the data because of the VA only does premium. So, sorry, I'm getting an issue on my screen. There we go, okay. Only does premium, so this does not have VA units in it, which makes a lot of sense. What's interesting here though is that most of us, meaning manufacturing, partnering with hearing aid specialists are doing a lot of premium, which obviously drives your average selling price up. ASP is obviously critical when it comes to managing your practice, as well as obviously you're giving the best technology to patients, and that's wonderful to see. And I'm happy that this reflects, somewhat reflects what Oticon does. Oticon typically over indexes on premium a little bit more across the US market, but great to see how much premium technology is falling into the hands or into the ears of patients. Advanced also, which is usually a fantastic sort of second tier level of technology at 21%, mid at 13%, and then basic rounds it out at 20%. So this kind of just shows you overall consumer preference, but it also says that there's a lot of opportunity to trade up patients. And there's a ton of patients out there who may be interested in premium technology, and hence when they're ready for their next hearing aid, trading them up is a definite opportunity for you. All right, that's tech tier. All right, tariffs. Obviously, I know I'm kind of throwing everything at you here, but I wanted to cover all the things that I'm thinking about when it comes to navigating the hearing healthcare world. What's great about tariffs, well, there's not a lot that's great about tariffs, but what's great about our situation is that we ship a lot of our products from Mexico, and we are able to essentially bypass the tariffs because of what is called the Nairobi Protocol. And we began importing hearing aids and parts and accessories under the subheader HTSUS code, a lot of detail here, known as the Nairobi Protocol, but it basically allows importers or manufacturers to bring products into the US without a tariff because it is essentially a medical device. And we've been able to avoid that, and we should be avoiding that for the foreseeable future, meaning the Nairobi Protocol actually shelters our hearing aids from that. While that's a great development for us, it also is a great development for you all, and that we'll be able to ship product to you without any issues. AI, another really, really big buzzword and a lot of a conversation piece that has been on the tips of our tongues for quite a while. A lot of our manufacturing competitors are just now launching AI, but AI is obviously a really important concept. A few things just to be aware of, okay? A lot of people like me, I'm a child of the 80s and the Terminator was one of my favorite movies. And we think about artificial intelligence and the machines taking over. That's not the case here. Artificial intelligence, it's a general term used to describe a system that enables machines to mimic human behavior. I think that's really important. If our hearing aids were to be modified after we sold them to you, meaning they learn on their own, the FDA would never allow that. I just wanna make sure we're clear about that. So artificial intelligence is this definition, not that they're constantly learning. If all of a sudden the hearing aid was able to modify itself and do something different from what it was when you purchased it or when a patient actually had it dispensed, the FDA would never allow that because there could be something dangerous that occurs. When people talk about AI, they're talking about how the hearing aids were developed. All right, and that's where Oticon's deep learning comes in. Oticon was the first manufacturer to launch essentially deep learning, really essentially launched AI. And we did it in the form of DNN, which is the deep neural network, which is a subset of this machine learning that I just talked about that enables the computation of multi-layer neural networks. What that means is when the sound signal comes into a hearing aid, there is a trained hearing aid that is essentially navigating those sound signals to the best output for the patient, okay? So it isn't necessarily a specific algorithm, which is the way hearing aids were working in the past. Before AI, it is a essentially, the hearing is essentially ready for the sound system to go through its deep neural network to deliver the best output, okay? So it's really important that you understand those differences. And also, again, I'm not here to sell Oticon too much here, but I just want to remind you that Oticon has had DNN, again, which is a subset of AI since our Oticon More launch in 2021. So we've now been managing AI. Essentially, we're coming up on our third generation of AI when we launched new products, either later this year or early next year. Okay, so this is my last slide. I wanted to definitely leave some time for questions and obviously some discussion. But this is a PEST analysis, and I think it's a really important analysis to be aware of. Sorry, this is not my last slide. It's my second to last slide. I'm forgetting my presentation. But this is an important analysis to look at the U.S. hearing aid market from a macroeconomic perspective. Are things going okay? And it's P-E-S-T, political, economic, social, and technological. The first is political, right? Is there a legislation that is being proposed that has significant impacts on the hearing aid or hearing care industry? The answer to that is no. Yes, there's always bills that are being proposed and being approved. In general, and I know IHS specifically is managing one right now in Georgia. But in general, the political environment is quite favorable for national legislation, such as Medicare access, et cetera, for the hearing aid business. The reason why I bring up Medicare access is back in 2022 when Build Back Better was a bill that was being discussed among U.S. Congressmen or Congress, sorry, Congress people, I should say. There was an opportunity where there was a potential for hearing aids to fall under what is called competitive bidding should that Build Back Better bill be passed. And if competitive bidding was enacted, it would have driven down the reimbursement rate across all channels, including private pay. That would potentially render our business unprofitable for everybody. And it was very dangerous. Luckily, that didn't pass. And the concept of Medicare coverage for hearing aids is really not something that is being discussed. Again, it sounds on the surface like it would be a great thing to improve Medicare coverage. But remember that right now, Medicare Advantage is covering more than 50% of Medicare beneficiaries. So we're in a really good place right now with respect to how hearing aids are covered by insurance and the split between insurance and private pay. Economics. So as I said in the beginning, consumer confidence related to recent administrative changes is definitely impacting industry growth. As I said, it's likely temporary. We should see this recover. What it also means is that there's a pent-up demand that is building, meaning people were intending to go and buy hearing aids. They did not because of this uncertainty. Typically, this is exactly what we saw in 2021 when there's a lot of buildup from 2020, people who didn't buy because of COVID who bought in 21. The same thing will happen once this level of uncertainty passes. From a social perspective, the growth of OTC, hearables in general. Sure, most of you saw Apple's Super Bowl ad. I don't think that's impacting our business at all. I think it's great for Apple. It creates a tremendous amount of awareness for us. So all good, all positive developments and increasing the awareness of hearing health. And the last is technological, which is obviously we have a very, very strong innovation pipeline across all industry players. I think that's really, really important. And that is not stopping. It's definitely not stopping on the Oticon side and I don't see that stopping with any other manufacturer, right? So just important to understand that this is the overall perspective. Again, goes back to the beginning. KPIs look really good for our industry, especially as I said here, this pest analysis. Okay, so last slide, just one thing to just talk about with Oticon. Oticon has really not wavered from its commitment to the private practitioner, okay? We fight the bad actors. What I mean by that is we do not allow online sites to essentially acquire our products and then sell it to undercut you all, meaning the independent practitioner. So we will typically either try to shut those sites down, I've sued them directly myself, or we'll make sure that they take Oticon off that site. In addition, we will, if there are customers of ours that are sending our own hearing aids to those websites, we'll find out who they are by secret shopping them and then shut them down as well and not allow them to purchase from Oticon anymore. So just important that you understand that that's what our goal is, is to really support the private hearing aid specialist. No DTC, no OTC, we're not in that business at all. Right now we're not supplying any DTC, it's called entities, nor are we doing OTC. We are working with some online entities like Hear.com and ZipHearing because they do involve the hearing care profession. We celebrate our partners, meaning we have at Oticon, we're part of the DeMont family, so we work very closely with CQ, with E3 and other partners because there's a lot of value that those providers provide in this industry. Really these value-added resellers are very, very important of our mix and we work with them quite closely. We improve CX, meaning customer experience. We are relentless about this. We have a very, very strong team to make sure our customer satisfaction levels are at the highest level, meaning you're getting your product shipped very, very quickly and it's accurate. We wanna answer the phone quickly. We want to make sure that you're responsive, or we're very responsive when you have issues. It's a really, really important area for us. We're constantly improving CX. It's never, our job is never done. We're never gonna be perfect there, but we are constantly improving it. And then the last is a training center of excellence. This is critical for us. Not only are we training you all how to understand our products, but also helping to train you how to train your patients because that is obviously a really important area for us in this business is to get that partnership with respect to training you how to sell and how to provide value to your patients overall. All right. So I think that is it for my presentation. Why don't we jump into Q&A? Thanks a lot, guys. Thank you so much, Gary. We do have a ton of questions coming in. So as I said at the top, we'll get to as many as we can. First one here is from David, who would like to ask your opinion on the direct-to-consumer changes that are expected, that are in progress in Florida? Yeah. I will be very honest with you. I don't think it's gonna really impact the business very much at all. DTC is a very, very small percentage of the business. And if anything, it'll create awareness. You may have an issue where someone who is, who has the ability now to shop, meaning their price to you versus their price to, or their price from a DTC company, my advice then is sell on your value and sell on the service that you are providing. You know, hearing aids don't cost $6,000. It's the entire service, the entire what's called package of service that patients get that costs $6,000. And that's what I would do there. You know, again, Oticon is not supporting any of these DTC entities. So, you know, obviously, if that's a question for you, you won't see Oticon on those very much at all. Okay. But again, it's going to be somewhat challenging, but I think it's more of a blip than it is an overall pain point to your business. Thank you. The next question is from Caleb, and it's sort of for me, but I want to address it out loud so that everybody can hear. So the question is, what bill is IHS supporting in Georgia? There was actually an initiative that IHS collaborated with many of the manufacturers to defeat, which was a deregulation attempt for hearing aid specialists. So we were able to defeat that. It's done. And I just collaborated with a lot of manufacturers on that effort. Next question, Gary, is from Mark. Mark says, CES introduced a wave of new OTC products, and it seems every week there's something new with more features. What impact do you think OTC will have in the next five years? And additionally, at what point do we see an intersection of technology with features and sound quality? Okay. Let's address the first question first. So I'll just give you an anecdote that might help answer the question. I was at a very large customer recently who has, you know, I would say an OTC presence, you know, on their shelves and in their practices. And they're seeing a massive decline, meaning they're not seeing much growth at all of this in the space. One thing that you might also want to be aware of, if you're not seeing a lot of innovation from the big five manufacturers, obviously Oticon's not in the OTC space, but if you're not seeing a lot of innovation in OTC from the big five that are in the OTC space, that means that they're not focused on it, which means that they're not hitting their numbers, and they're focusing elsewhere. So I think that is a very good indication that OTC is not panning out for them. You know, I think the challenge, especially with CES and other manufacturers overall, especially a lot of overseas manufacturers, is that they say, oh, wow, 49 million patients in the United States and only 38% are actually engaging in hearing health care. That's a massive target for me to go after. The problem is that they forget about the importance of the hearing health care professional. The hearing aid specialist provides a massive amount of value. And that's why hearing aids get sold. It's not because it's a cheap hearing aid on the shelves at Best Buy, right? So I think that no one has really been able to figure that out. And mind you, OTC has existed now since 2022, since October of 2022, officially, meaning FDA approved category, but it's really existed for about 30 years, and it has never impacted the prescription hearing aid business. So I see a lot of these guys, and look, I'm as paranoid as the next guy because I'm from New York. But in general, I just I don't see it very much hurting us. Yes, there might be a large, I shouldn't say, I don't mean large, I mean, a niche part of the market that some of these guys can go after based on their features and benefits. But in general, it's not much less expensive than going to you guys. So there isn't a real reason for people to go and not use a hearing aid specialist. Okay, sorry, Sarah, what was the second part of the question? At what point do we see an intersection of technology with features and sound quality? In the OTC space? I think so. You know, it's really tough to build a hearing aid and price it the way that they are in order to make a profit. So, you know, I don't know if that's going to happen. You could say that it exists right now, or existed with with Eargo, you know, because their hearing is pretty good. But, you know, Eargo was never even remotely profitable when it comes to their business. They sold a lot of hearing aids. But it's not sustainable when you're losing $40 million a year, right? So, so I don't see that actually being a situation that will exist, because it takes a lot of R&D effort to build a hearing aid. That is as effective as the ones that you know, that we sell. But you know, again, our competition has got great hearing aids also. And but it's it's about years of effort and, you know, understanding, you know, micro electronics and nanotechnology, to get these hearing aids to be as effective as they are. I just don't see it happening in the OTC space in the OTC space, because of what it takes to actually build a hearing aid that is quite effective, which also, of course, involves a hearing, a hearing care professional. Thank you. The next question here is from Ryan. And what Ryan asks is, why would we want to chase insurance government or otherwise? He says, I can't cash flow my business with third party transactions. And I think I would just expand that a little bit to ask, you know, I think what we often hear at IHS is like, is there a magic split? Like, is there a percentage of my business that I should be saying, okay, I want it to be 10% you know, third party 90% cash? Or, you know, what is that split? What recommendations do you have for the private practitioner who's trying to strike that balance between patient care and profitability? Yeah, so I'll just throw a plug into my my business development group team, who lives and breathes this question on a daily basis. And if you want to talk to them about this, they can talk to you ad nauseum about it, because they are the experts. But what I'll tell you is this, you know, in general, which is, it really depends on so many things. Is there a perfect split? Absolutely not. Because it depends on your practice, and how profitable you want to be, right. The positive about managed care is that managed care brings new patients into the category without any marketing expenses involved. The cost of acquisition is extremely low with respect to managed care. But as you know, the cost or the revenue per patient is significantly lower, right? So the so if I'm, if I'm you, and I'm thinking about that, I'm asking myself a lot of questions, I'm asking, well, how much revenue per patient am I getting from managed care? Am I selling premium technology to those patients, which for some of the TPAs, or managed care companies, hearing benefit managers, however you want to describe it, for some of them, they deliver a higher fitting fee for premium technology. If you're able to deliver a premium technology to patients who have managed care, then it's very possible that the profitability per patient may reach your hurdle rate, whatever that hurdle rate is, in your practice, you always have to think about the opportunity cost per hour, right? Is my hour better spent trying to fit a private pay patient with a close rate of, you know, whether it is 60 or 70%, versus a managed care patient with a close rate of 95%, because they have managed care, and they're likely to likely to get it. But if you have open slots in your schedule, then yes, managed care might be the right place to go. But if you're fully booked with private pay, and maybe private pay is 100% what you want to do, it really depends on your own analysis of the business and determining that opportunity cost per hour, right? I mean, if there's a there's a fitting fee that you are getting that is lower than your operating cost per hour, then obviously that might not be the right thing to do. So it's just to answer your question, you have to do an analysis of your business, which I'm sure you do as well, to determine what the right place is. But I always go, I always go back down, when this question is asked of me, I always go back to the operating cost per hour, and your own your own revenue hurdle rate per hour. And can you maximize that with a split of private pay and managed care? Thank you. Okay. The next question is from an anonymous caller, who asks, how do we change hearing aid stigmas in the industry that have been prevalent from decade old problems? Furthermore, what responsibility do the manufacturers have, in your opinion, and marketing directly to consumers? Yeah. What can we do about stigma? Well, I think we're already doing this. I mean, as you can see, I think if stigma was really an issue, we wouldn't see the growth rates that we have over the last five, six, seven years. Growth rates have been pretty spectacular. Yeah, I know this year's been a challenge, but I don't think the decline this year is related to stigma at all. Okay. So number one, there's awareness that is critical in your own community, right? Word of mouth, delivering a really good, really good service and a really good experience to patients is probably the best thing that you can do to minimize the stigma in your community. Because people realize how good the technology is. Like I said before, I mean, the satisfaction rate is super high once the hearing aids are in their ear and they've actually walked out of your office, right? And people will realize that this is worth it and I can get over the stigma, right? The second thing is, again, I would always look for opportunities to promote what Apple is doing and what the OTC guys are doing, because they're not going to steal share from you. It's not going to cannibalize your business. And it's about awareness of hearing health, right? Hearing health is critical. I always go back to the bottom line, which is, have you had your hearing checked? It's such an important concept that maybe if you guys are working with other practitioners in your community, you can have them ask that question, right? Because we have to get over the concept of stigma and we can get over it by promoting hearing healthcare much more so. So I think that's critical. One thing I would tell you that we are doing, and this is something that you may not be aware of, HIA, which is, as Ciara mentioned earlier, is the trade organization that all the hearing aid manufacturers are a part of, and we work very closely with IHS on this, is we have our own campaign, which is, it's called, you know, I'm forgetting what it is right now. It's- HearWellStayVital. Thank you. HearWellStayVital. Thank you. HearWellStayVital is the name of our campaign, which does exactly what you just said, increasing the awareness and the importance of hearing health and demystifying the stigma associated with it. So we're doing that. We actually spend, you know, in terms of media value, about $20 million a year media value to get the word out. So it is happening. Should it be happening faster? Absolutely. But it definitely exists. Ciara, did I cover all that answer? You did. Yes. Thank you. And I would just add that the HearWellStayVital campaign is so well done. And at IHS, we've shared it on our social media as well. And it's really kind of a capsule for you to then be able to share it on your own social, on your website, on your LinkedIn, whatever the case may be, to repurpose that marketing. Just very professional, very well done consumer. Basically, what we're telling you is to steal our commercial, use it in your own practice, because it's exactly what we want. So that exists. Just go to, is it betterhearing.org, I believe? Yeah, I think it's betterhearing.org. I'll try to confirm that and drop it in the chat. Yeah, betterhearing.org has access to that information. Perfect. Next question is from Martin, who asks, do deep neural networks affect processing time? Yes, and they improve it. So every time a deep neural network is launched in a new hearing aid, the processing time will be reduced. Great. Thank you. It doesn't, I mean, it's not, it's static for that specific hearing aid. But again, as we improve it, each time we improve it, we'll actually improve the processing time. Excellent. Thank you. Next question is from Ryan, who asks, how are you at Oticon training your customers to sell hearing aids? Okay. So I could probably spend three hours on this, on this question. I'll give you three minutes. Okay. So a lot of different ways. Obviously, so a lot of different ways. Obviously, you know, when we are launching a new product, we equip our account managers with sort of the five things that you, you need to know, right? And it's not just about what they need to know, but it's what you need to know. I mean, the, the, the hearing aid specialist needs to know when they're talking to a patient, right? So we try to keep it very, very concise and clear so that it's very easy for you to then learn from us and then take that learning and apply it to patients. That's at the most simple level to answer your question. On the other side of the spectrum, as I mentioned before, is our BDG team is our business development group. Okay. How we teach practitioners is how to, whether it's through motivational interviewing or through an analysis of your business to actually sell premium every single day of the week, right? That's what I said, I said before about Oticon's business overall over indexes on premium, because what we've been able to do is to really teach our customers not to assume anything about a patient walking into an office. And every, every, every patient should, in our opinion, get standard of care technology, meaning premium tier one technology. And that is something that our team overall, but specifically our BDG team does a really good job of in terms of teaching premium. So that is two ways. But again, if you want to talk offline and have a half hour conversation about it, I'm happy to do it because there's a, there's a ton that we do to teach, essentially train the trainer when it comes to, to patients. That's great. Thank you. The next question really piggybacks on that and maybe invites you to expand a little bit. Matthew asks, what would your rebuttal be for those consumers you've sat are experiencing uncertainty in the industry, in the marketplace to encourage them to upgrade their hearing technology when they're currently using hearing aids? So current wearer, time for new hearing aids, they're feeling uncertainty in the world. How would you encourage them to upgrade? Yeah. So I always go back to sort of, I take the high road, the high integrity road road. And I really, you know, in my experience in this industry, we sometimes forget that we're in the healthcare business, right? We, we really are. And when you're, when someone's uncertain, great, take care of your health. That's the first thing that you should be taken care of and improve the quality of the life that you have right now. So you can ignore some of the elements that you, some of the issues that you have with your life, because your life is so uncertain, right? So I would say, look, take care of your hearing health. First, your quality of life is going to improve your interactions with your, with your relatives and your coworkers and your friends are going to improve so that you can get past some of the challenges that you might see on the news. And you can get back to your, to living your, your, you know, your daily, your best daily life, right? Because again, people should never be delaying healthcare, right? Are you going to delay getting glasses? Are you going to delay going to doctor? To have your heart checked because of a financial reason? Of course not. So that's the way that I would sell it to a patient is that this is about your healthcare and your quality of life that you should be focused on. That's great. Thank you. I wish I just recorded that because that was a great speech. Don't you think? It was recorded. We'll share the recording with you as well as all of our attendees. That was sort of impromptu, but I'm passionate about it. That was excellent. Thank you. Couldn't have done it better if it were scripted. All right. That was actually the last question. So we will go ahead and wrap up. Thank you all so much for your participation. As a reminder, we do have a continuing education credit available. And I also invite you to watch your inbox for another webinar from Oticon that's going to drop with IHS on July 22nd. That webinar, which is titled Customizing Hearing Aid Fittings to Improve Patient Outcomes will be released on demand to IHS's e-learning portal and is free for IHS professional members. Thank you again so much to all of you for attending. Thank you, Gary, so much for your time. You can see Gary's email address there on the screen. He's told me that he really does welcome communication and conversation with you all. So please feel free to take advantage of that if you think of questions now or later. You'll receive an email next week when the webinar recording is live. We thank you so much for joining us today and hope that you have a great day. Bye-bye.

hearing healthcare

Oticon

AI in hearing aids

industry trends

OTC hearing aids

insurance transactions

patient communication

independent practitioners

market tactics