Online Hearing Testing: Listen Lively and Patient Engagement

Nancy M. Williams
July 21, 2020

Hearing Healthcare Market Development Column


Online hearing testing at Listen Lively (Lively) is mission-critical because it marks the first step in the company’s direct-to-consumer (D2C) model of care that is completely home-based. Two executives at Lively, during a Zoom interview in June, revealed that during the first wave of the coronavirus pandemic this past spring, the company’s D2C model accelerated its usual growth.

Lively’s online assessment is also important because it demonstrates a patient engagement best practice of presenting meaningful test results, a key element in Auditory Insight’s “Patient Engagement Framework for Online Hearing Testing.” (The framework focuses on patient engagement best practices rather than clinical best practices or a hearing aid’s underlying technology.)  

Based in New York City, Lively launched in early 2019, supported by a $16M Series A investment from Declaration Capital.  The company offers the “Lively Bundle,” of a pair of behind-the-ear, Bluetooth enabled hearing aids (using product from GN Resound) and three years of follow-up care with a Lively audiologist, per the company website. The Rechargeable bundle option retails for $2,250; the battery-powered option $1,850. 


Patient Engagement Best Practice with Test Results


Auditory Insight has analyzed close to 20 online hearing tests offered by D2C hearing aid companies and global hearing aid brands. Auditory Insight defines an online hearing test as an assessment which consumer-patients take using their own PC or smartphone.

Some online tests require headphones, others permit use of device speakers. (In last month’s HHTM Market Development Column, for example, Shoebox Online was reviewed.) 

The research shows that Lively demonstrates a patient engagement best practice by presenting meaningful test results. During a recent interview, Harvey Abrams, PhD, Head of Audiology Research at Lively, was quick to caution that the company’s online assessment is not a diagnostic exam.

“We don’t display the results as an audiogram,” said Abrams. The purpose of the test is to “create a personal sound profile so that we can appropriately program hearing aids.”

In a sense, the necessity of distinguishing the results from the audiogram has freed the company from the audiogram’s chief constraints: its opacity and complexity.

In contrast, Lively’s test results:

  • Relay the information in everyday language
  • Describe specific voices and sounds challenging for the patient given their hearing profile
  • Couple the written explanation with an engaging visual representation of the patient’s hearing profile.

The graphic below shows Lively’s presentation of test results when Auditory Insight’s test taker (i.e., adult male with a moderate, downward sloping hearing loss) completed the assessment in May of this year.


Christina Callahan, AuD, Head of Clinical Audiology at Lively, explained that the company put considerable thought into how to communicate the test results. Rather than embracing a practice simply because “that’s how we’ve always done it,” the approach was, “let’s get users and see what they think and what would resonate with them.”

Test results that explain the nature of persons’ hearing loss in vivid terms are an important contributing factor to consumer-patients’ coming to terms with their loss. “MarketTrak reports consistently have indicated that what people want from their hearing healthcare provider is a test that truly measures the problems that they’re having,” Abrams added. “We wanted something that might be more intuitive to an individual, rather than X’s and O’s and the graph.”


Lively’s D2C Audiologist-Based Model of Care


After consumer-patients complete the online hearing test, ordering a Lively bundle triggers a model of care which “emulates the journey in a best-practice” brick and mortar clinic, says Abrams. Before scheduling an orientation call with an audiologist, patients must complete the Consumer Ear Disease Risk Assessment (CEDRA) questionnaire; those patients who create a flag on the CEDRA or earlier during the online hearing test must speak with an audiologist on a video call to determine whether a full hearing exam is needed.

During the orientation, also a video call, Lively audiologists work with patients to optimize fit, teach patients how to operate and care for their hearing aids, and, perhaps most impressively, administer the Client Oriented Scale of Improvement (COSI), a clinical tool developed by the National Acoustics Laboratories (NAL) to document patients’ needs and measure improvements in hearing ability. 

“We do a two-week check-in, a one-month check, and a three-month and a six-month, very similar to the clinic.” Callahan explained. During each interaction, Lively audiologists follow up on the patient goals and track any changes. 

“It’s a company goal that we must acquire these COSI goals to make sure we’re being personalized, make sure that we’re actually doing what we should for each person,” Callahan added. She reported that Lively has COSI goals on file for 98% of people who completed the orientation call. 

However, Lively’s D2C model lacks two aspects of the ideal patient journey in a brick-and-mortar clinic. The first is in-person interactions, helpful for sensitive discussions, particularly relevant for those outstanding audiologists who make the time to help their patients overcome stigma and integrate hearing aids into their personal and professional lives. The second is real-ear-measurement, which verify a hearing aid’s prescription by placing a probe microphone into the ear canal while the patient is wearing their hearing aids.


Strong Business Performance During the Pandemic’s Spring Wave


Yet Lively’s online hearing test and its home-based model of care translated into solid performance during the pandemic’s spring wave. Callahan reported that she increased her staff required to support the Lively base of consumer-patients from five audiologists in late January to eight by the end of May.

Assuming that the audiology staff was fully utilized during both of these points in time, that increase in staff translates into roughly a 60% increase in monthly sales during the period beginning February 1, 2020 and ending May 31, 2020.

According to Callahan, many existing hearing aid users whom Lively fitted during the pandemic did not want to put themselves at risk by visiting their clinic in-person or could not because their clinic was closed. In addition, Lively-fitted consumer-patients whose budgets had tightened as a result of hardship from the pandemic or who were lowering spending given economic uncertainty.

The Lively model appears to appeal disproportionately to a younger demographic than who traditionally frequented brick-and-mortar clinics. Abrams noted that about 43% of the company’s consumer-patients are aged 35 to 64.

Despite the ongoing pandemic in the US, innovation continues at Lively. The company is currently developing an improved online hearing test. “Once we get that, we will have a better idea of what transducers individuals are wearing,” Abrams said. “We may also be able to measure the background noise levels in the environment in which they’re taking the test.”

As the U.S. continues to combat the coronavirus pandemic, the Lively model addresses consumer-patients’ demand for social distancing. The company remains committed to its home-based, D2C model. “It’s the primary motivation for every audiologist’s that’s joined us. They feel they can really make a difference and contribute to bringing their services to a model that people want,” concluded Callahan.

**Disclosure: The author discloses that her company consults with hearing device manufacturers and pharmaceutical hearing healthcare companies.


Nancy M. Williams is President of Auditory Insight, a boutique consultancy advising leaders on transforming hearing healthcare. Nancy partners with senior leaders of pharma and device companies to develop successful commercialization strategies based on deep insight into patient needs, practical understanding of clinical behaviors of audiologists and ENTs, and unique viewpoints on how hearing healthcare is evolving. She holds an MBA from Harvard Business School and a B.A. from Stanford University in Quantitative Economics, both with distinction.


*featured image courtesy Lively

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