Looking Back – Looking Forward HIA 2007 Annual Meeting Key Largo, FL February 16, 2007

Agenda MarkeTrak VIIMarkeTrak VII –Summarize key findings –Present new research on adult non-adopters. Better Hearing InstituteBetter Hearing Institute –Recap of last 3 year performance –Measurement of performance –Strategic initiatives going forward

MarkeTrak VII: New Opportunities for Promoting Hearing Solutions

Introduction Five Part SeriesFive Part Series –21 year trends (7/05) –Impact of hearing loss on income (8/05) –Customer satisfaction in the digital age (11/05) –Obstacles to hearing aid adoption- adults (4/07) –Obstacles to hearing aid adoption- children & dependents (6/07) – research completed and now in peer review. Sponsored by Knowles ElectronicsSponsored by Knowles Electronics When completed will be bound in booklets for HIA members.When completed will be bound in booklets for HIA members.

Agenda Brief summary of key issues from first 3 publications.Brief summary of key issues from first 3 publications. Rank ordering of customer satisfaction areasRank ordering of customer satisfaction areas Detailed review of obstacles to hearing aid adoption (adults).Detailed review of obstacles to hearing aid adoption (adults). OpportunitiesOpportunities MarkeTrak – input into Consumer JourneyMarkeTrak – input into Consumer Journey Introduction to BHI strategic planIntroduction to BHI strategic plan

Trend Summary Population admitting HL grew to 31.5 million; 41 million by 2025.Population admitting HL grew to 31.5 million; 41 million by Official Press Indices:Official Press Indices: –Generation Y & Children (0-28) – 2% Children (<18 ) - (1.4 million)Children (<18 ) - (1.4 million) –Generation Xers (ages 29-40) – 7.4% –Baby Boomer (ages 41-59) – 14.6% –Silent Generation (60+) – 29% No evidence of an epidemic or discernable > incidence (always about 1/10).No evidence of an epidemic or discernable > incidence (always about 1/10).

Trend summary Growth in people with admitted hearing loss tied to aging of America and population growth and not incidence of hearing loss.Growth in people with admitted hearing loss tied to aging of America and population growth and not incidence of hearing loss. –65+ population growth double U.S. population growth (.9%) by 2010; –And triple the population growth rate Adoption rate improvement due to VA and Internet and not private market.Adoption rate improvement due to VA and Internet and not private market. Drop in audiology dispensing (10% points) most likely due to perceptual blurring of distinction between practices of HIS and audiologists in the consumers eyes.Drop in audiology dispensing (10% points) most likely due to perceptual blurring of distinction between practices of HIS and audiologists in the consumers eyes.

Trend summary Factors negatively impacting growth:Factors negatively impacting growth: –Not enough new users (39%) –Binaural growth is over –Users getting older (70) and wealthier ($56k) –Hearing aid age increasing (4.5 years) 65% of people with hearing loss are below retirement age and that is where the opportunity is.65% of people with hearing loss are below retirement age and that is where the opportunity is.

Impact of Untreated Hearing Loss on Household Income (Oct 2005 HR)

Conclusions 44,000 household study demonstrated the clear relationship between hearing loss and income.44,000 household study demonstrated the clear relationship between hearing loss and income. The greater the hearing loss the greater the decline in household income.The greater the hearing loss the greater the decline in household income. On average, the use of hearing aids would appear to mitigate income loss by 50%.On average, the use of hearing aids would appear to mitigate income loss by 50%.

Relationship between hearing loss and household income Aided versus unaided least square means MarkeTrak VII (n=43,265 households; 3,845 hearing impaired) MildModerateProfound

Conclusions Income loss in excess of $100 billion for untreated hearing loss population and lost taxes $18 billion.Income loss in excess of $100 billion for untreated hearing loss population and lost taxes $18 billion. Solid evidence in support of tax credit bill. Presented at House Ways & Means.Solid evidence in support of tax credit bill. Presented at House Ways & Means. Needs to be leveraged better in media.Needs to be leveraged better in media.

Customer Satisfaction with Hearing Instruments in the Digital Age September 2005 Hearing Journal

Satisfaction Summary Customer satisfaction improving:Customer satisfaction improving: 73% for HI <4 years 73% for HI <4 years 78% for HI <1 year 78% for HI <1 year Due to 2 factors: Due to 2 factors: 50% digital penetration last 5 years 50% digital penetration last 5 years Change in satisfaction scale (somewhat) Change in satisfaction scale (somewhat) Only 44% of consumers will repurchase their current brand of hearing aids when it is time to replace.Only 44% of consumers will repurchase their current brand of hearing aids when it is time to replace. Satisfaction with HHP is 92%. When something goes wrong it is not their fault it is the product.Satisfaction with HHP is 92%. When something goes wrong it is not their fault it is the product.

1.23 million people with hearing aids in drawer; thats 1/6 owners. Defined as 0 hours per year usage.Defined as 0 hours per year usage. Half of them are new hearing aids (<1-5 years old)Half of them are new hearing aids (<1-5 years old) And consider of all HA:And consider of all HA: –61% use them more than 4 hours per day. –26% < 1 hour per day.

HA in The Drawer Half of hearing aids in the drawer represent a possible opportunity for upgrade (>5 years).Half of hearing aids in the drawer represent a possible opportunity for upgrade (>5 years). Half of hearing aids in the drawer are < 5 years old:Half of hearing aids in the drawer are < 5 years old: –Most likely due to top 5 reasons measured in MarkeTrak V (2000): Poor benefit or utilityPoor benefit or utility Poor performance in noisy situationsPoor performance in noisy situations Poor fit and comfortPoor fit and comfort Negative side effectsNegative side effects Cost of repairsCost of repairs

Reasons for Non-Use #1. Poor benefit (30%) When ______sold me the H.A., I was confident it would help me hear better. When I received it and wore it every day, it did not make my hearing any better. So, I dont wear the HA and feel like I wasted my money. I tried to return it and the person did not seem to want to help me. I am quite dissatisfied with the whole experience.#1. Poor benefit (30%) When ______sold me the H.A., I was confident it would help me hear better. When I received it and wore it every day, it did not make my hearing any better. So, I dont wear the HA and feel like I wasted my money. I tried to return it and the person did not seem to want to help me. I am quite dissatisfied with the whole experience.

Reasons for Non-Use #2. Background noise (25%)#2. Background noise (25%) I dont wear my H.A. because I need it at a dance, restaurants, and large groups. All the H.A. does is increase all sound including background sounds. No help.

Reasons for Non-Use #3. Fit & Comfort (19%)#3. Fit & Comfort (19%) Its hard to keep it in my ear. I travel for business a lot and cant risk it falling out of my ear.

Satisfaction Rankings 45 subjective evaluations ranked by average mean score.45 subjective evaluations ranked by average mean score. Satisfaction segments color coded.Satisfaction segments color coded. Is somewhat satisfied really acceptable?Is somewhat satisfied really acceptable? Satisfaction ratings actually lower when you add Very satisfied and Satisfied and then compare to previous MarkeTrak surveys.Satisfaction ratings actually lower when you add Very satisfied and Satisfied and then compare to previous MarkeTrak surveys.

Detailed Positive Satisfaction in Ascending Order (#1-9)

Detailed Positive Satisfaction in A Ascending Order (#10-18)

Detailed Positive Satisfaction in Ascending Order (#19-27)

Detailed Positive Satisfaction in A Ascending Order (#28-36)

Detailed Positive Satisfaction in Ascending Order (#37-45)

Multiple Environmental Listening Utility (MELU) is the key to improving overall satisfaction. Hearing instruments < 6 years (n=1,368)

Factors Correlated with Digital HIA statistics demonstrate 50% digital penetration previous 5 years.HIA statistics demonstrate 50% digital penetration previous 5 years. MarkeTrak survey presents consumer with a number of product features for which consumer responds:MarkeTrak survey presents consumer with a number of product features for which consumer responds: –Yes, No, Not sure –HA purchased last 5 years –MarkeTrak consumer indicates – 47% digital. Compare Yes with No.Compare Yes with No.

Factors Correlated with Digital One negativeOne negative –Ease of volume adjustment (-11%) 20% + difference:20% + difference: –Comfort with loud sounds 15-19% + difference15-19% + difference –Sound quality (fidelity) –Whistling/feedback –Workplace –Use in noisy situations –Wind noise

Factors Correlated with Digital 11-14% + difference11-14% + difference –Soft sounds audible –Telephone and cellphone –Clarity of sound –Sound of voice –Natural sounding –Chewing/swallowing –Overall satisfaction –Localization of sound –Leisure activities

Satisfaction & HL Severity User population divided into Quintiles based on factor scores of:User population divided into Quintiles based on factor scores of: –# ears impaired –Perception of HL –Unaided APHAB (with exception of AV) –Gallaudet Scale Difference scoresDifference scores –Quintile 1 (bottom 20% on subjective hearing loss) –Quintile 5 (Top 20% on subjective hearing loss)

Largest Differences 25% + difference25% + difference –Cell phone 15-19% difference15-19% difference –Comfort with loud sounds –Able to hear soft sounds –School/classroom usage –Wind noise –Large Group –Telephone –Concert/movie –Directionality –Listening to Music 11-14% difference11-14% difference –TV –Place of worship –Leisure activities –Whistling/feedback –Workplace –Use in noisy situations –Richness sound –Restaurant –Car –Outdoors –Natural sounding

Hearing Instrument Improvements Sought by Consumers MarkeTrak VI 2002

Hearing Aid Improvements Sought by Current Hearing Aid Owners (n=2,428) (Highly desirable scores =4-5 on 5 point scale)

Hearing Aid Improvements Sought by Current Hearing Aid Owners (n=2,428) (Desirable scores =4-5 on 5 point scale)

MarkeTrak VII: Obstacles to Hearing Aid Adoption Among Adult Non-users in the U.S. April 2007 Hearing Journal

Introduction Hearing aid adoption rate stubborn at about 20%.Hearing aid adoption rate stubborn at about 20%. Growth to 23% penetration due to Internet and VA.Growth to 23% penetration due to Internet and VA. Known serious consequences of untreated hearing loss.Known serious consequences of untreated hearing loss. Why do so many people delay or avoid amplification?Why do so many people delay or avoid amplification? –Close to 23 million adults –1.5 million children/dependents <age 23

Method 3,000 adult non-adopters from MarkeTrak VII database3,000 adult non-adopters from MarkeTrak VII database 77% response rate77% response rate 2,300 responded to 7 page survey2,300 responded to 7 page survey 64 reasons why they dont use hearing aids.64 reasons why they dont use hearing aids. Reasons for return if tried HAReasons for return if tried HA Factors that might entice themFactors that might entice them Focus on top 50% of people with hearing loss.Focus on top 50% of people with hearing loss.

HA owners versus non-owners Not terribly dissimilar.Not terribly dissimilar. Non-adopters younger w/ less severe loss.Non-adopters younger w/ less severe loss. –Bilateral loss (61% versus 83%) –Perceived mild hearing loss (39% versus 7%) –Ability to hear whisper across a room without visual cues (16% versus 5%) –Modal unaided APHAB (40-49% versus 50-59%) Non-adopters segmented into hearing loss decile as in income studyNon-adopters segmented into hearing loss decile as in income study –1 = lower 10% of hearing loss – U.S. population –10= top 10% of hearing loss – U.S. population

Aided versus unaided populations by hearing loss decile.

Hearing aid adoption rates by hearing loss decile. 83% hearing aid owners 39% non-adopters

Non-adopters New hearing aid user is age 70.New hearing aid user is age 70. Non-adopter ages vary from a low of age 56 (decile 1) to 61 (deciles 6+).Non-adopter ages vary from a low of age 56 (decile 1) to 61 (deciles 6+). Why such a large age difference?Why such a large age difference? Lets control for hearing loss & then look at adoption rates.Lets control for hearing loss & then look at adoption rates.

Hearing aid adoption by HL decile controlling for age; evidence for the effects of age stigma.

Percent of hearing-impaired evaluated for hearing loss and recommendations received.

Number of positive recommendations for hearing aids compared to negative recommendations by professional ( ).

Hearing Screening Problem resolution begins with problem identification.Problem resolution begins with problem identification. 50% of adult non-adopters never had their hearing professionally tested.50% of adult non-adopters never had their hearing professionally tested. Huge progress when comparing positive to negative recommendations from professionals.Huge progress when comparing positive to negative recommendations from professionals.

Hearing solution adoption model BHI Mission Specific drivers: Internal stigma External stigma Influencers Product perception Service perception Physicians attitude Fear Physical impairment Stages of denial Perceived loss of communication performance & need Attitude toward getting hearing solutions Behavior intent/ Hearing health solutions Predisposition Price & hearing health solution delivery model Drivers: Perceived age Communication situations Change & emotional reaction Social comparison Alternative solutions General moderators: Socio economic status Health Personality Lifestyle Social network Emotional state Medical care Surgery Aural rehab Cochlear Impl. Hearing Aids ALDs Behavior Modif.

Reasons for non-adoption of hearing aids: Top 5 deciles of hearing loss

Reasons for not-adoption of hearing aids Factor = Hearing Loss

Reasons for not-adoption of hearing aids Factor = financial

Median income comparing people who state they can and cannot afford hearing aids controlling for age.

Reasons for not-adoption of hearing aids Factor = Minimization or lack of need

Reasons for not-adoption of hearing aids Factor = Attitudes towards hearing aids

Reasons for not-adoption of hearing aids Factor = Attitudes towards hearing aids (Cont.)

Reasons for not-adoption of hearing aids Factor= Knowledge & experience

Reasons for hearing aid return (n=237)

Reasons for not-adoption of hearing aids Factor = Stigma

Reasons for not-adoption of hearing aids Factor = Professional recommendations

Reasons for not-adoption of hearing aids Factor= Social network recommendations

Reasons for not-adoption of hearing aids Factor = Trust

Hearing aid adoption intent by hearing loss decile.

Positive impact of hearing aid enhancements on the total hearing loss population currently not using hearing aids.

Reasons for intent to purchase hearing aids

Opportunities

Motivation Key reason for purchasing is recognition that hearing loss has gotten worse.Key reason for purchasing is recognition that hearing loss has gotten worse. 50% need testing50% need testing Concerted effort to test either objectively or subjectively (e.g. BHI Quick Hearing Check).Concerted effort to test either objectively or subjectively (e.g. BHI Quick Hearing Check). –Physician offices –Free hearing checks by HHP in and outside of office. Problem recognition is a critical precursor to problem resolution.Problem recognition is a critical precursor to problem resolution.

Professional Recommendations Significant improvement over last 20 years.Significant improvement over last 20 years. Continued physician education needed:Continued physician education needed: –Efficacy of hearing aids –Improved customer satisfaction –Evidence based critical –Need hearing testing as part of best practice protocol for family doctor.

Surgery and HA Trial 12% of population may not be candidates for hearing aids.12% of population may not be candidates for hearing aids. Thats 2.75 million peopleThats 2.75 million people Close to 1 out of 10 tried and rejected hearing aids and found:Close to 1 out of 10 tried and rejected hearing aids and found: –Insufficient benefit –Problems in noise 40% of most serious hearing loss group (decile 10) found that HA did not help their hearing loss.40% of most serious hearing loss group (decile 10) found that HA did not help their hearing loss.

Attitudes towards hearing loss People with serious hearing loss still believe:People with serious hearing loss still believe: –Hearing loss too mild for HA –Many believe their life style precludes need for better hearing. Continued PR on impact of untreated hearing loss especially for younger segments critical to move them toward a solution.Continued PR on impact of untreated hearing loss especially for younger segments critical to move them toward a solution.

Misinformation about candidacy Opportunity to correct misinformation on who can be helped with hearing aids.Opportunity to correct misinformation on who can be helped with hearing aids. –High frequency hearing loss –Low frequency hearing loss –Nerve damage – probably sensorineural –Unilateral hearing loss

Tinnitus 4 out of 10 also have tinnitus4 out of 10 also have tinnitus May be contraindicative of candidacy or may be an opportunity.May be contraindicative of candidacy or may be an opportunity. For PR purposes need greater understanding of effectiveness of hearing aids in masking tinnitus.For PR purposes need greater understanding of effectiveness of hearing aids in masking tinnitus.

Attitudes towards hearing aids Need to demonstrate to this population:Need to demonstrate to this population: –Improved ability to communicate in noise –Reduction in aversiveness of sounds when using hearing aids. –Reduction in hassle factor (maybe now with open fit HA) –4.4 million potential users were told NOT to try hearing aids by HA owners. –17% have hearing aids in drawer – needs to be reduced because of impact on negative word of mouth advertising.

Attitudes towards hearing aids Need to demonstrate to this population (Continued):Need to demonstrate to this population (Continued): –Benefit has to be increased. 28% absolute benefit28% absolute benefit Translates into 44% problem resolutionTranslates into 44% problem resolution –Need greater utility in various listening situations especially phone, cellphone, and group situations.

Finances Significant barrier to two out of three (64%)Significant barrier to two out of three (64%) Evidence that finances NOT a convenient excuse.Evidence that finances NOT a convenient excuse. Initiatives to mitigate this problem critical:Initiatives to mitigate this problem critical: –Tax credit bill –Insurance –Education on available help (e.g. charities, VA, union, flex dollar programs in corporations, etc) 40% indicate greater likelihood of HA trial with tax credit of $500.40% indicate greater likelihood of HA trial with tax credit of $500.

Conclusions Model of hearing aid adoption is complex.Model of hearing aid adoption is complex. No one initiative will be enough.No one initiative will be enough. First – person must recognize their loss.First – person must recognize their loss. Second – must recognize loss causes them problems.Second – must recognize loss causes them problems. Third – must believe there is a reasonable probability that visiting a HHP will sufficiently solve their problem.Third – must believe there is a reasonable probability that visiting a HHP will sufficiently solve their problem. Some obstacles are perceptual and some are real.Some obstacles are perceptual and some are real. HIA research on improving consumers journey is a critical step in introducing more people to the world of better hearing.HIA research on improving consumers journey is a critical step in introducing more people to the world of better hearing.

Conclusions Demography – demonstrates extent of problem.Demography – demonstrates extent of problem. Challenge common myths about hearing loss (e.g. only an issue of aging).Challenge common myths about hearing loss (e.g. only an issue of aging). Positive customer satisfaction ratings can elevate image of hearing aids and HHP.Positive customer satisfaction ratings can elevate image of hearing aids and HHP. Impact of untreated hearing loss on QOL (e.g. Income) can motivate younger hearing- impaired.Impact of untreated hearing loss on QOL (e.g. Income) can motivate younger hearing- impaired. Build interventions based on understanding barriers to seeking a hearing loss solution.Build interventions based on understanding barriers to seeking a hearing loss solution.

Looking Back – Looking Forward Strategic Plan

Goals Summarize 3 year performance of BHI CY2004-CY2006.Summarize 3 year performance of BHI CY2004-CY2006. Establish strategies and tactics for the immediate future – CY2007 forward.Establish strategies and tactics for the immediate future – CY2007 forward. –Core activities (BHI & PR firm) –Special projects

Re-birth of BHI Rebrand CY 2004Rebrand CY 2004 –New logo, look and feel –Develop consumer literature –Develop website –Recruit world-class technical advisory council –Mission and strategy Measure value of physician marketing efforts in 40 test citiesMeasure value of physician marketing efforts in 40 test cities Retain PR firm (Strategy XXI, NY) April 2005Retain PR firm (Strategy XXI, NY) April 2005

Mission Educate public and medical profession:Educate public and medical profession: Hearing loss Hearing loss Hearing loss treatment Hearing loss treatment Hearing loss prevention Hearing loss prevention BHI dual nature:BHI dual nature: Educational component – Better Hearing Educational component – Better Hearing Institute component – research. Institute component – research.

Key Strategies Elevate the problem of hearing loss in America. (general public, medical profession, media).Elevate the problem of hearing loss in America. (general public, medical profession, media). Remove or mitigate obstacles to earlier hearing loss solutions.Remove or mitigate obstacles to earlier hearing loss solutions. Establish BHI as go-to place for credible information.Establish BHI as go-to place for credible information.

Overall Goals Reduce the average age of new first time users of hearing aids.Reduce the average age of new first time users of hearing aids. Increase the traffic into hearing healthcare professional offices.Increase the traffic into hearing healthcare professional offices. Improve the quality of life of millions of Americans with untreated hearing loss.Improve the quality of life of millions of Americans with untreated hearing loss. Accomplish by employing tactics that generate positive impressions in the media.Accomplish by employing tactics that generate positive impressions in the media. Attitude changeAttitude change Behavioral changeBehavioral change

Model for BHI Mission BHI Mission Specific drivers: Internal stigma External stigma Influencers Product perception Service perception Physicians attitude Fear of solution Physical impairment Stages of denial Perceived loss of communication performance & need Attitude toward getting hearing solutions Behavior intent/ Hearing health solutions Predisposition Price & hearing health solution delivery model Drivers: Perceived age Communication situations Change & emotional reaction Self awareness Alternative solutions General moderators: Socio economic status Health Personality Lifestyle Social network Emotional state Medical care Surgery Aural rehab Cochlear Impl. Hearing Aids ALDs Behavior Modif.

Impression Flow BHI HHP MD/ nurses Public

Impression Flow 2005 Forward BHI BHI Web HHP MD/ nurses Media Corporate Public Medical Org. HH Org Mfgs. TV Print Radio Web Business Pharmacy Health Targeted Senior Targeted Lifestyle Listening situations

Hierarchy of Impressions Hearing loss demography without reference to BHI Reference to BHI literature or website in key publication or website. Feature article on hearing loss focusing on quality of life such as employability. Wide-scale PSA placement or syndicated news feature on BHI QOL agenda; 9.5 minute PBS documentary. Millions of impressions Weak impression Powerful impression BHI website at 13 minutes per consumer visit.

BHI Main Tactics Hearing Solution Key Consumer Tactics Physician Involvement Advanced Technology HOH Person Leverage QOL Denial Solution Stigma alleviation Recognize HL Encyclopedic Resource to Family

Evaluation of BHI Activities and Tactics Looking Back

BHI Website

Value of Web Print media continues to decrease as people get instant access to information via the Internet. We would expect the Internet to be even more important as the target audience (baby boomers) explore options for their hearing loss.Print media continues to decrease as people get instant access to information via the Internet. We would expect the Internet to be even more important as the target audience (baby boomers) explore options for their hearing loss. For a modest investment of about $18,000 a year we continue to upgrade our website.For a modest investment of about $18,000 a year we continue to upgrade our website. –More resources –Articles for consumer, medical, press –Videos (PBS documentary, virtual tour of ear with commentary, notable radio/TV appearances) –Website for physicians –Website for hearing health professionals

BHI Visitors Traffic (406k) up 87% over last year Average time – 13 minutes AARP iPodPBS

Top 10 Pages Read (CY 2006) Rank Web Page/section 1 HL and quality of life 2 Hearing loss 3 Celebrities and hearing loss 4 Hearing aids 5 Request information (Guides) 6 HL prevention 7 Quick hearing check 8 Research (MarkeTrak) 9Tinnitus 10Press

BHI Physician Program

Physician Referral Development ProgramPhysician Referral Development Program Only BHI initiative Only BHI initiative Program to dateProgram to date 2,400 hearing healthcare practices currently enrolled 2,400 hearing healthcare practices currently enrolled Approximately 25,000 physician kits distributed. Approximately 25,000 physician kits distributed. Demonstrated to increase referrals in controlled 36 month market analysis.Demonstrated to increase referrals in controlled 36 month market analysis. Estimated retail value - $29 million per year.Estimated retail value - $29 million per year.

Medical PR PSA accepted by:PSA accepted by: –NE Journal Medicine 2 B & W placements so far2 B & W placements so far Indefinite placement and rotation about on 6 month basis.Indefinite placement and rotation about on 6 month basis. $Ad value = $16,000$Ad value = $16,000 –American Journal of Medicine –Medical Economics Free physician kit designed.Free physician kit designed. New BHI web/MDNew BHI web/MD

Medical PR – MD website

Physician Program Self-nominated direct mail physician kit.Self-nominated direct mail physician kit. –CME course by ENT Hearing LossHearing Loss Efficacy of hearing aidsEfficacy of hearing aids Hearing aids and quality of lifeHearing aids and quality of life –2 JAMA reprints on screening –Quick Hearing Check Pad 160 physician kits redeemed YTD.160 physician kits redeemed YTD.

Other Medical Initiatives Contacted key medical associations to make hearing screening part of a National best practice patient protocol. (DRF and HJ joined activity)Contacted key medical associations to make hearing screening part of a National best practice patient protocol. (DRF and HJ joined activity) AAFP contacted us and have referred the matter to their scientific committee.AAFP contacted us and have referred the matter to their scientific committee. Met with AAO-HNS executive staff to explore partnership.Met with AAO-HNS executive staff to explore partnership.

Research

Research Key element of PR initiatives and re- branding of BHI.Key element of PR initiatives and re- branding of BHI. Effectiveness of physician education efforts Effectiveness of physician education efforts Thin-tube BTE survey Thin-tube BTE survey MarkeTrak VIIIMarkeTrak VIII –planning summer 2008; will be seeking industry input. –Screening 11/2008 –Detailed survey 1/2009

Consumer Initiatives

Consumer Literature 1 print booklet Your Guide to Better Hearing1 print booklet Your Guide to Better Hearing –Distributed 42,000 program to date. 3 electronic eGuides3 electronic eGuides –Your Guide to Better Hearing –Guide to Your Childs Hearing –Your Guide to Hearing Aids –5,092 downloaded program to date.

Media

Media Critical as a means of elevating the problem of hearing loss in America.Critical as a means of elevating the problem of hearing loss in America. 501c3 status establishes opportunity for free or low cost ad placement.501c3 status establishes opportunity for free or low cost ad placement. Goal to manufacture more + news.Goal to manufacture more + news. Release more frequent, media- friendly research or articles.Release more frequent, media- friendly research or articles. Use of Strategy XXI April December 2006Use of Strategy XXI April December 2006

PBS Documentary Creative outcomes:Creative outcomes: –9.5 minute video brochure (8/06) –6 minute mini-PBS documentary (11/06) Funding by SonionFunding by Sonion Audience: Minimum 500 showings; 3-5 million viewersAudience: Minimum 500 showings; 3-5 million viewers Nielsen monitored (Jan, Apr 2007)Nielsen monitored (Jan, Apr 2007) –Sep-Dec 06 –45% sampling (9.5 min.) –204 showings –1 million people

Key PR Initiatives MarkeTrak VII demography and impact of hearing loss on income.MarkeTrak VII demography and impact of hearing loss on income. MarkeTrak VII – customer satisfaction in the digital age.MarkeTrak VII – customer satisfaction in the digital age. Leverage iPod media fixation.Leverage iPod media fixation. Introduction of BHI Childrens eGuide.Introduction of BHI Childrens eGuide. Support for the tax-credit bill.Support for the tax-credit bill. Ongoing – quality of life.Ongoing – quality of life. Dr. Cerf as spokesperson (minor effort)Dr. Cerf as spokesperson (minor effort) Physician PSAPhysician PSA PBS Documentary with 1 st BHI celebrity CerfPBS Documentary with 1 st BHI celebrity Cerf

BHI Getting Increased Media Attention Whats It Worth?

Paid BHI PR Placements Audience and Value CampaignPlacementsImpressions $ ad Value NAPS - Income 40419,990,000$74,200 NAPS HL Prevention 3247,300,000$23,800 ARA Content Tax Credit Bill 2301,998,000$39,900 Total94829,288,000$137,900 Cost: $11,000 for 3 placements Rate=.04 cents

Free BHI PR Print/web Placements Audience and Value CampaignPlacementsImpressionsValue Google Ads Continuous web 35,000 (click through) $27,000 Burrelle-Luce Report of all print/web placements on MarkeTrak, childrens eGuide, Income study, HL prevention ,453,000$543,004

TVAppearances or mentions AppearancePlacementsImpressionsValue Retirement Living Network 2 East coast cable 12 pm 9,500,000$3,000,000 PBS documentary (9/06-11/06) 204 placements 71 stations Nielsen monitoring 45% response 1,049,300?? ABC news – NY 1 – 15 seconds 8,246,000$24,264 CNBC squawkbox 1 – 2 minutes 97,000$2,526 TOTAL20818,892,000$3,027,000

Radio appearances AppearancePlacementsImpressionsValue Radio Health Journal 400 local -12 minutes 1,200,000$288,000 Martha Stewart Living radio 1 Sirius – 12 minutes ???? Local radio appearances 3113,800$4,172 KGAM radio Palm Springs PSA 50 – 1 minute PSA ??$3,000 Project health radio 106 local – 10 minutes 1,600,000$238,000 TOTAL5602,913,800$544,172

Impression Summary PR campaign garnered: PR campaign garnered: –Approximately: 1884 placements1884 placements 111 million impressions111 million impressions –Various intensities – examples: Simple mention of 31.5 million HL populationSimple mention of 31.5 million HL population BHI as sole or key reference on hearing loss by AARP and Womens DayBHI as sole or key reference on hearing loss by AARP and Womens Day Feature article on income and hearing loss (Gannett news service)Feature article on income and hearing loss (Gannett news service) Feature article (2) on hearing loss in the courtroom (ABA).Feature article (2) on hearing loss in the courtroom (ABA). 12 minute segment on 400 radio stations12 minute segment on 400 radio stations 12 minutes on Retirement Living Network (RLN) on directional digital hearing aids.12 minutes on Retirement Living Network (RLN) on directional digital hearing aids. 9.5 minutes on PBS9.5 minutes on PBS –Ad value - $4.26 million not all inclusive

Celebrity & Notable American Outreach

Celebrity & Success Story Outreach Based on MarkeTrak VII satisfaction ratings there are 3.9 million hearing aid success stories over the last 4 years.Based on MarkeTrak VII satisfaction ratings there are 3.9 million hearing aid success stories over the last 4 years. Important to gather stories of famous and average American for media program.Important to gather stories of famous and average American for media program. Unable to secure referrals from HHP (only 1) despite:Unable to secure referrals from HHP (only 1) despite: –PSA to HH industry –Personal letters by mail – all HHP –Journal cooperation –Personal meetings in about 10 speeches

New Celebrities BHI Spokespeople Vinton Cerf – Co-founder of Internet and Google Executive. Used in our PBS documentaryVinton Cerf – Co-founder of Internet and Google Executive. Used in our PBS documentary Duke Fakir (4 Tops) Only HHP referralDuke Fakir (4 Tops) Only HHP referral Not household names.Not household names. PSA program is hampered without new celebrities.PSA program is hampered without new celebrities. Better Hearing Month weakened without new celebrities.Better Hearing Month weakened without new celebrities.

Notable American Program Supplement to the celebrity program.Supplement to the celebrity program. Gather success stories from Notable Americans from all walks of life:Gather success stories from Notable Americans from all walks of life: –Lives changed due to: hearing aids, cochlear implants, surgery (otosclerosis) –Teachers, writers, physicians, psychologists, athletes, local politicians, journalists, lawyers, pilots, etc. Use in PR initiatives to counter negative image of hearing healthcare in America. Many times the press asks me for contacts for success stories.Use in PR initiatives to counter negative image of hearing healthcare in America. Many times the press asks me for contacts for success stories. Use to penetrate the social networks of key occupations.Use to penetrate the social networks of key occupations. People will listen to their peers perhaps more so than celebrities.People will listen to their peers perhaps more so than celebrities.

Notable American Program Self nomination on front of BHI web.Self nomination on front of BHI web. Dispenser incentive (Free BHI material)Dispenser incentive (Free BHI material) Only 3 success stories submitted.Only 3 success stories submitted. Only 1 referral from HHP – which we rejected.Only 1 referral from HHP – which we rejected. One success story (attorney) led to 2 publications by American Bar Association: Untreated Hearing Loss: Risky Business in the Courtroom.One success story (attorney) led to 2 publications by American Bar Association: Untreated Hearing Loss: Risky Business in the Courtroom.

Corporate Partnerships Seeking partners or corporate sponsors or grants from foundations to expand our programs.Seeking partners or corporate sponsors or grants from foundations to expand our programs.

Corporate Sponsorships & Foundations Personal meetings with Apple and phone contact with Sony, CES.Personal meetings with Apple and phone contact with Sony, CES. Grant requests to all small players in hearing health industry including non-HIA members.Grant requests to all small players in hearing health industry including non-HIA members. Grant requests:Grant requests: –Physicians Foundation on Practice Excellence. (Wide scale direct mail distribution of BHI physician kit). –CVS Pharmacy (children) –Midas Muffler (We make the world quieter) –United Airlines (Matching grant PBS documentary) –Previous HH personal contacts in industry including Delta Zeta Sorority Foundation. Small individual & corporate donations ($6,603 CY2006).Small individual & corporate donations ($6,603 CY2006).

Google Ads Free program since 11/2005.Free program since 11/2005. Dozen ads associated with key search terms (e.g. hearing loss, hearing aids).Dozen ads associated with key search terms (e.g. hearing loss, hearing aids). Examples:Examples: Most popular:Most popular: –MarkeTrak VII customer satisfaction –Celebrities who overcame hearing loss Surpassed 40,000 referrals to BHI website in Jan 07.Surpassed 40,000 referrals to BHI website in Jan 07.

HHP Partnering with the Better Hearing Institute Integrating local and National promotion

Partnering Summary We need the assistance of HHP:We need the assistance of HHP: –Celebrity & success story referral. –Get our National media messages to the local level. –Translate national research into friendly media at local level. –Ideas for promoting hearing health. –Desired tools for local level promotion.

Dispenser Partnering Redesigned HHP website

Dispenser Partnering Redesigned HHP website

Partnering with HHP Instituted more frequent communication with members of PRDP and continue to add to our contacts from State meetings.Instituted more frequent communication with members of PRDP and continue to add to our contacts from State meetings. New 4 hour CEU seminar:New 4 hour CEU seminar: –MarkeTrak VII: New Opportunities for Promoting Hearing Solutions. –Part 2: Integrating National and Local Promotion. CY 2006 paid talks:CY 2006 paid talks: –Mfg: Unitron, Beltone, ReSound –State Associations: Arkansas, Maine/NH, Texas

Looking Forward

Public Relations Strategy XXI hired in 3/2005 on a retainer.Strategy XXI hired in 3/2005 on a retainer. Solicited proposals from 2 other firms including Strategy XXI going forward:Solicited proposals from 2 other firms including Strategy XXI going forward: –APCO Worldwide (DC) –Van Vechten & Associates (FL) Decision to retain PR team on special project basis as a means of avoiding high overhead of typical PR firm.Decision to retain PR team on special project basis as a means of avoiding high overhead of typical PR firm.

New PR team Wayne PinesWayne Pines –APCO President, 10 years VP Burson-Marsteller, Chief of consumer education & press relations FDA; worked with HIA (Hearing on the Hill) and BHI in past (PRDP program). Fabia DArienzoFabia DArienzo –20 year broad-based communication experience in health communications, PR and advertising. (GCG communications, Sciens Worldwide, APCO, Phizer, The New Yorker) Sharon NatanblutSharon Natanblut –20+ PR veteran on health and social issues. Known for developing anti-smoking and substance abuse campaigns. (Deputy Director FDA, VP Burson-Marsteller)

Public Relations Core activities Research and develop new hearing pitches (e.g. hearing loss & intimacy)Research and develop new hearing pitches (e.g. hearing loss & intimacy) Extensive media outreach targeting baby boomer print, TV and radioExtensive media outreach targeting baby boomer print, TV and radio Ghost-writing opinion columnsGhost-writing opinion columns Syndicated columns on consequences of hearing lossSyndicated columns on consequences of hearing loss Celebrity and success story outreachCelebrity and success story outreach As needed editing for webAs needed editing for web Outreach for new partnershipsOutreach for new partnerships

Core Activities 2007 Updates to website:Updates to website: –Press articles, expanded write-ups, hearing loss simulator. –Enhancing external links to BHI website Development of new eGuides – which may lead to press releases:Development of new eGuides – which may lead to press releases: –Financial assistance –Possible Tinnitus solution with hearing aids– given consumer interest (3 x hearing loss) –Hearing Loss prevention MarkeTrakMarkeTrak –Final publications (unamplified pediatric/dependent and adult populations) –Binding and distribution of all 5 parts to HIA members.

Core Activities HHP Partnering Personal meetings with audiologists and dispensers building on developmental work in 2006 and new talk: New Opportunities for Promoting Hearing Health.Personal meetings with audiologists and dispensers building on developmental work in 2006 and new talk: New Opportunities for Promoting Hearing Health. –AAA (2007) and IHS presentations (2008) –State Associations accepted so far: Illinois, Ohio, Mid-Atlantic, Wisconsin Alliance, CAA (Canada). Continue celebrity and notable outreach effort:Continue celebrity and notable outreach effort: –New Board members (Jones and Erickson) could help with their captive HHP networks. Develop generic hearing health professional community talk. Scripted PowerPoint (CY07)Develop generic hearing health professional community talk. Scripted PowerPoint (CY07) Develop generic physician outreach talk which could be given at State Medical Associations or to Physician Groups (CY08).Develop generic physician outreach talk which could be given at State Medical Associations or to Physician Groups (CY08).

Core Activities (2007) Pediatric/Dependent MarkeTrak MarkeTrak analysis of 1.2 million children. Evidence of:MarkeTrak analysis of 1.2 million children. Evidence of: –Neglect –Misinformation –Minimization of HL –Financial barriers Public relations efforts will be contingent on findings. Currently in peer review:Public relations efforts will be contingent on findings. Currently in peer review: –Will join with other hearing health organizations interested in children and hearing loss. (ASHA, AAA, AG Bell) –May join with other organizations reporting underserved children population to get larger exposure: American Optometric Association (vision loss – 10 million children).American Optometric Association (vision loss – 10 million children). American Dental Association (recent NBC news release)American Dental Association (recent NBC news release)

Core Activities (2007) Pediatric MarkeTrak Influence Pediatrician practices.Influence Pediatrician practices. –reported to ignore 59% of hearing loss screenings (Washington University study) Call for greater child advocacy after infant screening.Call for greater child advocacy after infant screening. –Estimate only 50% follow-up with children failing infant screening. –Many parents do not come back until child age 3 after failed screening. –What is the audiologists role when the child is not brought back after HL screening failure? Support for tax credit bill.Support for tax credit bill.

Core Activities (2007) Possible Corporate Sponsors Continue to write grants as they opportunistically become available.Continue to write grants as they opportunistically become available. Targeted attempt to secure place of sale promotion/partnering on hearing loss:Targeted attempt to secure place of sale promotion/partnering on hearing loss: –Mfgs/retailers who sell products requiring use of hearing (Sony, Apple) –Mfgs/retailers who sell products that potentially contribute to HL (Harley Davidson) –Mfgs/retailers who make the world quieter (Midas Muffler) –Mfgs/retailers/service organizations that have tangential relationship to outcome of better hearing (e.g. intimacy, relationships, emotional health, physical health, job effectiveness, etc)

Core Activities (2007) Corporate Will begin exploring possibilities of promoting better hearing in corporations.Will begin exploring possibilities of promoting better hearing in corporations. Start with discussions with personnel directors and marketing/PR executives among HIA members.Start with discussions with personnel directors and marketing/PR executives among HIA members.

Core Activity (2007) Develop Medical Council –Addition of Dr. Luxford from the House Ear Institute serves to expand the external credibility of the Board to the Press. –Recruit other prominent physicians to the BHI Medical Council. –Use Medical Council to influence inclusion of hearing loss screening as part of a best practice medical protocol. –Serve as medical experts on hearing loss in the media. –Author medical opinions/papers on behalf of BHI. –Seek to achieve celebrity referrals from House Ear Institute. The majority of famous BHI celebrities came from House Ear Institute in the 1970s-1990s.

Core Activity (2007) BHI Media Council Our technical advisory council has resulted in:Our technical advisory council has resulted in: –Credible BHI literature –Ready panel for answering tough questions. –Audiological experts available for press Propose development of media council of individuals who could review media concepts on an ongoing basis.Propose development of media council of individuals who could review media concepts on an ongoing basis. –Worked well with PBS documentary –Need such a council to bounce ideas off –Review new projects, articles, PSAs, etc. Meet with marketing and PR departments of key hearing aid manufacturers + their PR firms if possible.Meet with marketing and PR departments of key hearing aid manufacturers + their PR firms if possible. Share new talk New Opportunities for Promoting Hearing Health.Share new talk New Opportunities for Promoting Hearing Health.

Core Activity (2008) BHI Presence in Pharmacy Have not yet approached pharmacies.Have not yet approached pharmacies. Will approach the key pharmacies as well as their charitable foundations (e.g. CVS Foundation).Will approach the key pharmacies as well as their charitable foundations (e.g. CVS Foundation). –Drug store web page ads –PSAs on prescriptions –Messaging on pharmacy bags –Pharmacy foundations for donation of Guides to Better Hearing for pharmacy counters.

Special Projects

Funding Do not anticipate need for fund raising for special projects in CY2007.Do not anticipate need for fund raising for special projects in CY2007.

2007 Print PSA Campaign

2007 Print PSA Program Thematic in nature (7 ads)Thematic in nature (7 ads) –Vision and hearing (2) –Quality of life – fractured relationships (2) –Quality of life – relationships (2) –Romance (1) Similar call to actionSimilar call to action –Visit HHP –Visit or call BHI for Guide to Better Hearing

2007 Print PSA Program 4 sizes4 sizes Distributed by Goodwill Communications, specialist in non-profit marketing.Distributed by Goodwill Communications, specialist in non-profit marketing. 7,000 newspapers and magazines7,000 newspapers and magazines –Known to accept PSAs Monitored for placement and $$ valueMonitored for placement and $$ value

Vision & Hearing

Fractured Relationships

Quality of Life/Relationships

Romance

Special Project Educational Videos/Audios Developing videos for website:Developing videos for website: –Science & manufacturing of hearing aids –Hearing healthcare process –Footage for both videos shot or existing from PBS documentary. –Anticipate minute videos –Given time involved will defer for the future. Video or professional write-up on effective methods for families to break down denial.Video or professional write-up on effective methods for families to break down denial. –Dr. Phil or other prominent psychologist on shooting a educational program on breaking through hearing loss denial. (Cost unknown)

Special Project Electronic PSA Most likely for consideration for CY Most likely for consideration for CY –Radio PSA to 3,600 radio stations: $35,000 –TV PSA to 1,100 stations: $59,000 - $89,000 Without tier 1 celebrity it is unlikely though PSA could be effective.Without tier 1 celebrity it is unlikely though PSA could be effective. But may consider earlier if tier 1 celebrity becomes available.But may consider earlier if tier 1 celebrity becomes available.

Special Project Movie Theatre PSA (Closure) PR firm unable to find free PSA in a movie theater.PR firm unable to find free PSA in a movie theater. The best deal available is from National Cinemedia (Cinemark USA, AMC Theatres and Regal Entertainment Group) at reduced rate.The best deal available is from National Cinemedia (Cinemark USA, AMC Theatres and Regal Entertainment Group) at reduced rate. Slides are on for seconds and are seen an average of three times before each movie.Slides are on for seconds and are seen an average of three times before each movie. Audience = 23 million impressionsAudience = 23 million impressions Not-for-profit rate including creative = $85,000.Not-for-profit rate including creative = $85,000. Impression rate a reasonable =.4 centsImpression rate a reasonable =.4 cents

Special Project Movie Theatre PSA (Closure) Current PR firm against paid movie PSAs.Current PR firm against paid movie PSAs. –People go to movie for entertainment and not for health or social issues. –Challenged to find a message in one slide which would be sufficiently motivating. –PSA on hearing screening or hearing aids felt to lower professional status of HHP.

Special Project Reinvigorate Better Hearing Month Better hearing & speech month most effective in the 1980s.Better hearing & speech month most effective in the 1980s. Tremendous media exposure.Tremendous media exposure. Key components:Key components: Tier 1 celebrity (e.g. Reagan). Tier 1 celebrity (e.g. Reagan). Poster child Poster child Collaboration at that time 20 not-for-profit organizations Collaboration at that time 20 not-for-profit organizations Press and media exposure including PSAs. Press and media exposure including PSAs. Local press kit for hearing health professionals. Local press kit for hearing health professionals.

Special Project Reinvigorate Better Hearing Month Modest program in 2007 building to full collaborative program in 2008, Modest program in 2007 building to full collaborative program in 2008, Select theme: hearing loss among baby boomers. Select theme: hearing loss among baby boomers. Media advisory (March) Media advisory (March) National press release (April) National press release (April) Target health reporters Target health reporters Sunday newspaper magazine Sunday newspaper magazine CNN accent health CNN accent health National Press Club (Screening & Income study) National Press Club (Screening & Income study) Video News release (May) on baby boomers and lost income. (Paul Pessis practice & BHI) Video News release (May) on baby boomers and lost income. (Paul Pessis practice & BHI) Local press kit for hearing health professionals. Local press kit for hearing health professionals.

Special Project Medical Education American Geriatrics SocietyAmerican Geriatrics Society –10,000 specialists in geriatrics including: MD, nurses, psychiatrists, psychologists, social workers. 2,700 at conference. –May 2007 – Seattle. –Place BHI in front of eyeballs of this influential group. Variation of our Medical PSA in conference bulletin with offer to get our literature/physician kit via our website.Variation of our Medical PSA in conference bulletin with offer to get our literature/physician kit via our website. BHI Booth (generic)BHI Booth (generic) Evaluate for plenary session in CY08 on hearing loss.Evaluate for plenary session in CY08 on hearing loss.

Summary of Priorities Build on PRDP program by establishing grass roots dispenser affiliates of BHI capable of translating national media message down to their local community:Build on PRDP program by establishing grass roots dispenser affiliates of BHI capable of translating national media message down to their local community: –Face to face meetings –Recruit celebrity and average American database –Develop local media angles –Build scripted PowerPoint speech for local outreach Supplement public relations with public service announcements (PSA) as a means of increasing positive impressions.Supplement public relations with public service announcements (PSA) as a means of increasing positive impressions.

Summary of Priorities Begin targeting key professional (e.g. American Geriatrics Society, AAFP) and consumer associations (e.g. AARP) as a means of elevating importance of hearing health.Begin targeting key professional (e.g. American Geriatrics Society, AAFP) and consumer associations (e.g. AARP) as a means of elevating importance of hearing health. Opportunistically search for PR angles:Opportunistically search for PR angles: –e.g. Tinnitus & hearing aids, Intimacy, financial assistance, happiness, etc.

Summary of Priorities Continue to enhance website and new consumer literature including building traffic to website.Continue to enhance website and new consumer literature including building traffic to website. Rebuild Better Hearing Month (May) as a key industry event (realistically will be done in steps)Rebuild Better Hearing Month (May) as a key industry event (realistically will be done in steps) Explore a solution to denial of hearing loss.Explore a solution to denial of hearing loss. Explore hearing health promotion in corporations.Explore hearing health promotion in corporations. Leverage MarkeTrak non-owner research in the press – adults + dependents.Leverage MarkeTrak non-owner research in the press – adults + dependents. Develop medical and media councils.Develop medical and media councils.