National Academy of Sciences, Engineering and Medicine

The National Academy of Sciences, Engineering and Medicine concurred with the Hearing Partnership recommendation in this study's Final Report published on June 2, 2016.  Read our news release here. 

The Institute of Medicine has become part of The National Academy of Sciences, Engineering, and Medicine

Hearing Partnership™ Comments to the Institute of Medicine Committee on  Accessible and Affordable Hearing Health Care for Adults

The Institute of Medicine (IOM) of the National Academies has convened a study committee on Accessible and Affordable Hearing Health Care for Adults.  The purpose of this IOM study is to “provide short- and long-term recommendations for solutions” to improve the hearing health care system.  The first public meeting of the committee was on April 27, 2015.  Hearing Partnership submitted the following comments after this meeting:

Barriers to patient access of hearing care are connected with quality concerns related to technology, services, and other social inhibitors.  Public health roles and approaches provide new opportunities to improve patient access to treatment, especially in response to social barriers.  

The presentations and discussion on April 27 were very important.  The technology is essential.  But four-fifths of the target population is not accessing the available technology or services.  How are we going to understand all the diverse needs of four-fifths of the target population?   We are engaging with only one-quarter to one-fifth the people.  Many seem to think that if the right technology was affordable these people would come forward and miraculously succeed.   Evidence suggests a more complex set of barriers.  Other countries where socialized medicine provides free hearing aids have comparable percentages as in the U.S. of eligible patients not accessing treatment.  This supports another perspective that sees a far deeper social challenge than just reaching those people that tried hearing aids and failed.  It’s not just an audiology problem.  I applaud the committee for recognizing the problem as a public health challenge, much more than just an issue impacting public health. 

The committee should shine a bright light on social aspects of successful approaches to service delivery.  What delivery models show the greatest promise in aural rehabilitation?  Also, what kinds of service delivery models are working outside of audiology that can help? 

Hearing Partnership promotes ‘community health worker’ (CHW) delivery models in particular as an important opportunity for expanding population access to hearing health care.  Can the committee hear from researchers doing work using CHW approaches to promote access to hearing care?  Since four-fifths of the target population must represent cultural worlds that are not being served under the present delivery system, much experimentation is needed with CHWs helping patients in a broad range of demographic and cultural perspectives. 

The committee has a valuable opportunity to promote better understanding of what community and public health practitioners can contribute to increase eligible patient access to hearing care – this is key to encourage more collaborative work between audiology and public and community-based health.  For example, grant mechanisms could target more public health investigators to collaborate with practitioners in audiology and hearing instrument science.  Some projects should even originate from the CHW perspective.  And provide incentive for fresh approaches designed to facilitate where and how that four-fifths of the patients fit into the conversation!

How do we get there from here?   

Transition to a system based on quality rather than volume requires that services and quality outcomes are measured and good social and health outcomes rewarded.  These are not exclusively audiology related issues.  And sustaining a quality driven business model requires financing mechanisms to provide the needed professional services.

The Center for Medicare and Medicaid Services (CMS) published a Final Rule on January 1, 2014 authorizing states to make payments for CHW services.  The committee should recommend a plan for ensuring that CHW services and quality outcomes related to hearing care are recognized and supported by the payment systems being developed.  Doing so would greatly encourage more practitioners providing clinical hearing care to offer socially motivated services that effectively engage members of the target population not currently accessing treatment. 

Conclusion

The barriers to patient access are not just about audiology or the technology, and public health methodologies, especially ‘community health workers’ (CHWs) can be integrated into hearing care to greatly increase patient access to successful treatment.  

Hearing Partnership™ is dedicated to this kind of work with our patients, and we seek research partners and providers to collaborate with us.

Thank you for the opportunity to comment.

Respectfully,

David Bergeron, MM, CHW

April 28, 2015