Using Digital Therapeutics to Provide Comprehensive Hearing Healthcare



Author: Nancy Tye-Murray, Ph.D.

But how will Amptify help me make money?

An audiologist texted me this question during the Q&A that followed my Zoom presentation at the recent Hearing Technology Matters’ conference, Future of Hearing Health Care.

Amptify President Chris Cardinal and I had just presented about the first-ever clinically-validated digital therapeutic for hearing loss, which reduces the impact that hearing loss has on patients’ lives and allows audiologists to outsource aural rehabilitation to experts so they can concentrate on diagnostics and hearing aid fittings. As I’ll describe in this article, Amptify employs internal hearing health coaches who provide support as members engage in the Amptify auditory training games, the Amptify daily interactive curriculum, and the accompanying peer-support community.

I immediately “got” the attendee’s question. In 30-plus years of extolling the importance of aural rehabilitation, and the importance of supporting patients beyond the hearing aid fitting, I seemed to have always hit the proverbial brick wall of financial expediency. At the end of the day, audiologists in private practice or in hospital settings need to keep the lights on and the shingle hanging above their doors. Aural rehabilitation is time-consuming and labor-intensive, and admittedly, not a money maker.

So I agreed that the question, How will Amptify help me make money? was a legitimate one. Here’s the answer, by means of invoking a medical-model analogy:

When a patient has a knee problem, an orthopedic surgeon might diagnose that the knee be replaced. If so, the surgeon performs the implant surgery and then refers the patient to both a physical therapist for follow-up therapy and a pharmacist for a prescription of antibiotics. Although the orthopedic surgeon doesn’t generate income with these referrals, making them is all a part of implementing the best standard of care.

To extend this medical model to audiological care, like the orthopedic surgeon, the private practice or hospital audiologist diagnoses a patient’s condition (hearing loss) and if appropriate, selects and fits the patient with medical devices (hearing aids). Although in the “old days”, best practice might have been for the dispensing audiologist then to provide perceptual training or group aural rehabilitation as part of the treatment plan, it is now possible for the audiologist to make referrals for follow-up care. With the availability of Amptify, the audiologist can hand the patient a brochure (Figure 1) and prescribe a regime of aural rehabilitation. Not only does this not cost the audiologist anything but a couple of minutes added to the counseling session, but importantly, making the referral allows the audiologist to ensure comprehensive hearing healthcare.
Figure 1. The Amptify Patient Brochure


And this is the answer to the question of how audiologists profit by making referrals for aural rehabilitation. A downstream benefit of providing comprehensive hearing healthcare is that a clinical practice now distinguishes itself from big box stores such as Costco and Sam’s. Whereas these commercial entities truly exist for the sole purpose of generating profit, an audiological practice exists for the purpose of providing comprehensive healthcare services. Making referrals for necessary services that you are unable or unwilling to perform, may not generate income for the practice, but it is the right thing to do and patients are much more likely to leave an office thinking that they have been served by a healthcare provider and less likely to feel as if they have value-shopped at a “store” where one buys hearing aids.

What exactly is Amptify?
Amptify is the first-ever digital therapeutic designed for hearing health care. A digital therapeutic (DTx) is a software-based intervention for a disease and/or disorder that is clinically validated to drive a specific positive outcome, and is often coupled with a medical intervention such as a drug or medical device. DTxs in the areas of healthcare and education have proven to be highly effective for managing diabetes (Omada), asthma (Propeller Health), weight (Noom), and mental health (Headspace).

The Amptify DTx is a comprehensive tech-enabled hearing health DTx designed to treat hearing loss and its downstream effects. Amplify grew out of our experience with clEAR (customized learning Exercises for Aural Rehabilitation). clEAR was a first attempt to allow audiologists to outsource auditory training. Based on what we learned from the feedback of users and clinicians, we developed the next generation of online hearing healthcare, which we call Amptify. The comprehensive program includes the following:
  • Auditory training video games. The games are professionally crafted to ensure compliance and entertainment through animation and colorful graphic design (Figure 2). The instructional design underlying the games targets the development of speech discrimination skills and exercise for those cognitive skills necessary for discourse comprehension, including auditory attention, processing speed, and word memory. The auditory training games have also been shown to produce positive results in terms of maximizing users’ ability to use their residual hearing. Research focused on the games alone has shown that the instructional design that underlies the auditory training games leads to enhanced speech discrimination (Barcroft et al., 2016), reduced perceptual effort (Sommers et al., 2015), increased listening confidence (Tye-Murray et al., 2012), and improvements in those communication situations that patients deem challenging (Tye-Murray et al, 2017).
    Figure 2. Auditory Training Video Games


  • A daily interactive, illustrated curriculum. The curriculum engages patients through quizzes, tutorials, balance exercises, and social diaries (Figure 3). The 12-to-16 week curriculum includes such topics as preventing and rectifying communication breakdowns, engineering the listening environment to potentiate successful communication, nutritional tips to promote hearing health, tinnitus management, balance exercises, and the link between hearing healthcare and cognitive health. The overall theme of the curriculum is empowerment. Patients are given the “tools” for ensuring successful conversations and the tools for mitigating against possible downstream effects of hearing loss, such as social isolation, falls, and cognitive decline. Results from our beta testing with a group of adults with hearing loss underscored the importance of emphasizing self-help content. The beta test results also led us to omit traditionally included content that emphasized managing possible negative correlates of hearing loss; e.g., self-stigmatization; unhelpful conversational behaviors such as aggressiveness or passivity (e.g., see Trychin, 1987; 2002; 2012, for this kind of approach). In finalizing the curriculum, we took to heart the sentiments of one beta tester, who told us (paraphrase): “I want to know what I CAN DO and not what I can’t do and I want to come away feeling ENHANCED by having taken proactive steps. My identity is that of someone who just happens to have hearing loss—the hearing loss doesn’t define who I am."
    Figure 3. Daily Interactive Curriculum


  • An online Amptify hearing health coach. Starting in the first week, users are paired with a hearing health coach, who provides support, encouragement, and hearing-related information. Over the first two weeks, the coach starts them off with introductory material that supplements the curriculum. In the third week, participants are placed in a group that is led by their coach. Before becoming an Amptify hearing health coach, candidate coaches undergo the in-house Amptify training program and must receive certification. Once they begin practicing as coaches, they are overseen by an in-house audiologist. The audiologist ensures quality-control and is available to answer questions or handle issues that might be technical in nature, as when a member might want to know the details of a hearing aid directional microphone. We discovered from our clEAR experience that the hearing health coach is an important “secret sauce” of any online aural rehabilitation program. Users respond to positive reinforcement and the accountability of knowing a professional is monitoring them.
  • An online customized social peer support community. We create communities of users so that each community includes members that are both homogeneous and heterogeneous, and who share the same hearing health coach. The coach leads discussions and promotes conversations. This aspect of the program relates back to traditional group aural rehabilitation and represents a “virtual answer” to the live group experience. Through their online interactions, members can share their experiences, find commonalities, and learn new ways to manage hearing loss through vicarious experiences. Over time, they create a friendship network and sense of empathy and support.
Does it work?
The short answer is, Yes. In addition to enhancing listening performance, as noted above, Amptify enhances the hearing health care experience and facilitates the adjustment to new hearing aids. Under the auspices of an NIH SBIR grant, we recently conducted a study with 28 new hearing-aid users to determine whether Amptify enhanced acclimation to their new devices. Results indicated a very positive response to the program overall and to the curriculum in particular, with the latter receiving a qualitative rating score of 6.1 out of a possible score of 7. Ninety-six percent of the participants reported a positive opinion and one half reported that the program helped them to adjust to their new hearing aids.

In summary, it is now possible to provide aural rehabilitation without incurring additional time or cost on the part of a patient’s audiologist. In addition, Amptify can reduce in-clinic time with patients because the online Amptify hearing health coach is able to answer simple questions about hearing aid use, such as those about battery life or device handling. Ultimately, the audiologist accrues profits by not only reducing in-clinic visits but also by creating patient loyalty through gold-star service.

Amptify was made available for general use on March 21, 2021. Enrollment is easy. Amptify provides brochures to clinics and a “cheat sheet” about how to describe the program. They can enroll patients either by referring them to www.Amptify.com so they can self-pay or they can sponsor their patients via their own clinic’s Amptify portal. The Amptify app can be accessed on iOS, Android, or at app.Amptify.com.

The future of hearing healthcare entails digital therapeutics for hearing loss—you can bet money on it.    
Nancy Tye-Murray, Ph.D. is CEO of Amtify and a professor at Washington University School of Medicine. She can be reached at nancy@clearforears.com.
References
Barcroft, J., Spehar, B., Tye-Murray, N., & Sommers, M. (2016). Task-and talker-specific gains in auditory training. Journal of Speech, Language, and Hearing Research, 59(4), 862-870.

Sommers, M. S., Tye-Murray, N., Barcroft, J., & Spehar, B. (2015). The effects of meaning-based auditory training on behavioral measures of perceptual effort in individuals with impaired hearing. Seminars in Hearing, 36(4), 263-272.

Tye-Murray, N., Sommers, M. S., Mauzé, E., Schroy, C., Barcroft, J., & Spehar, B. (2012). Using patient perceptions of relative benefit and enjoyment to assess auditory training. Journal of the American Academy of Audiology, 23(8), 623-634.

Tye-Murray, N., Spehar, B., Barcroft, J., & Sommers, M. (2017). Auditory training for adults who have hearing loss: A comparison of spaced versus massed practice schedules. Journal of Speech, Language, and Hearing Research, 60(8), 2337-2345.

Trychin, S. (1987). Did I Do That?. Gallaudet University.

Trychin, S. (2002). Living with hearing loss: Workbook. S. Trychin.

Trychin, S. (2012). Living with hearing loss presentations, workshops, and training programs. Retrieved March 29, 2021, from www.trychin.com/workshops.html#work