NAPA partners with Numo Health to provide quality, tech-enabled care.
“I sang like a bird,” recalled Grobsmith, an alto who has sung with Master Chorale for 21 years. “I’m singing better than I have in decades. It’s really been life altering for me.”
Her singing triumph was made possible by the progress she has made in controlling her pulmonary problems, especially chronic coughing.
For Grobsmith, 77, being able to breathe easily, cough little and sing clearly has never been something she could take for granted. “I was raised in a home with two smokers, and I’ve always suffered from a lot of bronchitis,” she said. “When friends were playing outside, I was in the infirmary. I’ve always had chronic coughing.”
For decades, she was coughing, which led to having to drop out of concerts, such as her Nebraska choir’s performance of the Brahms Requiem some decades ago. “I was hoarse and couldn’t sing,” she said. “I’m a singer; choral music has always been an important part of my life. When you can’t sing, you can’t live.”
Coughing fits were not just during performances. “I often had to leave a concert or movie or play,” she said. “I always had to sit on the aisle to make a quick exit.”
Allergy testing indicated serious issues. “They found out I was allergic to practically everything. I took medications for at least 30 years for all the things I was allergic to – trees and grasses, and dogs and cats, and horses.”
Grobsmith’s ties to Flagstaff are strong. She is a retired professional who served as provost and vice president for academic affairs at NAU for 10 years. She left that post in 2012 and worked with the Center for International Education until her retirement in 2017.
She finally found real help for her condition when she located Dr. Elijah Poulos, a pulmonologist in Flagstaff who is affiliated with Flagstaff Medical Center and has hospital privileges with FMC.
Since 2016, Dr. Poulos also has been a full partner and part owner of Northern Arizona Pulmonary Associates (NAPA), on North Rim Drive in Flagstaff. He has been managing Grobsmith’s pulmonary disease since 2019.
Because of a critical shortage of pulmonologists in the Flagstaff area, Poulos was one of the few specialists available to help Grobsmith with her lifetime of health struggles.
“He’s a dream,” she said. “His goal was to get my asthma under control.”
The doctor examined her a number of times and prescribed advanced therapies. “Finally, this last year, he said I was a candidate for Tezspire [a treatment for severe asthma], which is a monthly injection. In addition, he put me on a nebulizer with a steroid vapor that gets inhaled.”
Unfortunately, a problem in her care arose when Northern Arizona Healthcare (NAH) ended its contract with NAPA in July of 2023. This change meant that the already critical shortage of pulmonologists would probably get worse.
“Our group was the only pulmonary practice in Flagstaff at the time, and we had seven pulmonologists in our group,” said Dr. Poulos. “We serviced an area from east to west borders, and northern border down to Phoenix and Prescott. We lost two pulmonologists shortly after NAH canceled our contract. Across the country, following the stress on pulmonary critical care physicians after COVID, many retired early, leaving a national shortage. Our state had (and still has) a significant shortage.”
The NAPA group also has been assisting pulmonary patients in the Verde Valley.
“Our group had also been graciously covering Verde Valley Medical Center inpatient pulmonary consults without any contract with NAH, out of compassion for the community, since the passing of their community pulmonologist,” Poulos added.
In March 2023, a lifeline was thrown to the pulmonary care crisis when NAPA was able to partner with Numo Health, a virtual pulmonary clinic that leverages cutting-edge technology to transform the delivery of health care.
This collaboration meant Poulos was able to continue to treat Grobsmith. “Patients who live at Flagstaff altitude and are unfortunate enough to have underlying lung diseases often suffer tremendously,” he said. “It takes significant time and effort to bring their pulmonary disease under control and keep it controlled. Liz is an amazing woman with a great spirit. She has been a trouper, and we have managed to keep her well controlled, out of the hospital ER, and stabilized with an improved quality of life.”
Although not part of the launching of Numo Health, Poulos has been involved since the beginning in creating NAPA’s partnership with Numo.
Navya Davuluri, Ph.D., a resident of Sunnyvale, California, is founder and CEO of Numo Health. Davuluri approached the NAPA group, Poulos said.
“She had been visiting sites around Northern Arizona and had heard the concerns of many primary care physicians that our practice was closing,” he said. “She approached us as a partnership to help ‘off-load’ some of our overhead, while simultaneously improving access to care and improving in-home management of complex pulmonary diseases.”
According to the Numo Health website, the inspiration for Numo started when Davuluri helped care for her grandfather, who suffered from COPD. His final two years of life were challenging and compounded by the glaring shortcomings present in the traditional pulmonary care model. Telehealth was not available and communicating and transmitting critical information was a considerable burden as a caregiver.
She knew there must be a better way to help him. Davuluri was able to help her grandfather by relaying his treatment plan and prescriptions by phone to a care team that was tasked with passing that information on to a specialist.
Davuluri is considered an expert in the application of bioengineering techniques to the monitoring of chronic health conditions. She explained the meaning of the company name. “Numo is a play on two words: ‘Nu’ comes from pneumo, which means relating to lungs, and ‘Mo’ comes from monitoring,” Davuluri said. “It is a reference to monitoring lung health.”
She has spent the majority of her academic and professional careers working on technology that captures and quantifies a patient’s day-to-day condition outside of the hospital or clinic, as well as facilitating improved communication between doctors and patients regarding this crucial information.
The mission of Numo Health is to provide revolutionary pulmonary care from the comfort of a patient’s home, which includes features such as easy appointment booking, ability to speak directly to doctors and easy access through a secure portal to questions about care plans, billing and medications. Existing patients are also provided with a Numo electronic tablet that helps patients and doctors track their health from a distance.
In addition, in-house pulmonary function tests (PFT) are important tools in recovery. “The collaboration with Numo has also enabled NAPA to purchase two new PFT machines and now offers full PFTs in the office, at a fraction of the cost as a hospital-based PFT,” Poulos explained.
“We have 25 staff members that include pulmonologists, internists, nurses, care coordinators, medical receptionists, healthcare operations personnel, AI engineers, sales and marketing personnel,” said Davuluri.
Grobsmith says she continues to have a great response to treatment. She is using telehealth for most of her appointments, which provides added flexibility without compromising care. She will soon start remote patient monitoring to track her respiratory needs.
“I see Dr. Poulos at Numo now,” Grobsmith said. “They provide every patient with an iPad, so we can do interactive meetings. We spend 45 minutes on the phone or the iPad. We talk about my symptoms and what’s happening or not happening. I have full access. I can see him in person, but I haven’t needed to yet. I am doing well. It’s a great story.”
Today, doing well for Grobsmith includes coughing only about 10% of the time. This has enabled her to continue her work in the community, where she serves on the board of Master Chorale and the NAU College of Arts and Letters.
“I’m doing a lot more singing than I used to,” she said.
In July, she will be one of 38 singers from Master Chorale and various community members who will be traveling to Paris on a Music Celebrations International choir tour to mark the 80th anniversary of D-Day.
Perhaps most importantly, Grobsmith, who is widowed, wants to be healthy enough to enjoy her family life with her twin children and her four grandchildren.
“I am very blessed,” she said. “I will be taking my 12-year-old granddaughter to Paris with me.” FBN
By Betsey Bruner, FBN
Photo by V. Ronnie Tierney, Fresh Focuses Photography: Long-time Flagstaff resident Liz Grobsmith finds her singing voice and improved quality of life with support from pulmonary doctors and their partnership with Numo Health.