Turning Remote Patient Monitoring into Proactive Chronic Care for Ohio’s Medically Complex Patients

Patient Demographic

The Neighborhood Health Association (NHA) serves a population of medically complex patients in Ohio who require ongoing monitoring for chronic conditions such as hypertension and cardiovascular disease.

The Challenge

Neighborhood Health Association (NHA) serves a population of medically complex patients in Ohio who require ongoing monitoring for chronic conditions such as hypertension and cardiovascular disease. Traditional care models made it difficult to maintain visibility into patient health between appointments, creating the risk that worsening conditions would go unnoticed until they resulted in emergency department visits or hospitalizations.

NHA needed a scalable way to monitor patients remotely, identify health concerns earlier, and empower care teams to intervene before problems escalated.

The Solution

NHA deployed Claris Healthcare’s Remote Patient Monitoring (RPM) platform across its chronic care program, equipping patients with connected monitoring devices and providing care teams with real-time visibility into vital sign data.

Through Claris Companion, NHA established a continuous monitoring model that enabled:

• Automated collection of blood pressure and pulse readings
• Real-time alerts when readings exceeded clinical thresholds
• Centralized care coordination workflows
• Structured clinical documentation and follow-up
• Ongoing oversight without requiring frequent in-person visits

The result was a technology-enabled care model that extended clinical visibility into patients’ homes while allowing staff to focus attention on individuals who needed intervention most. 

The Impact

Monitoring 22 High-Risk Patients Around the Clock

Over a 17-month period, NHA actively monitored 22 patients through Claris Companion’s RPM platform.

This level of monitoring would be virtually impossible through traditional in-person care models alone.

Early Identification of Health Risks

The platform generated more than 8,000 out-of-range vital sign alerts, automatically notifying care teams when readings suggested a potential health concern.

The most common alerts involved:

• Elevated systolic blood pressure
• Elevated diastolic blood pressure
• Irregular pulse readings

These alerts provided NHA clinicians with hundreds of opportunities every month to identify emerging issues and engage patients before conditions worsened. 

Consistent Clinical Engagement

NHA’s care team documented more than 1,400 clinical interactions and follow-ups, ensuring that patients were not only monitored but actively managed.

Clinical notes captured:

• Patient stability assessments
• Medication changes
• Phone outreach
• Hospitalization events
• Emergency department visits
• Care plan modifications

Every active patient had documented clinical engagement, demonstrating that RPM data was being translated into meaningful care actions.

Proven Operational Performance

For more than a year, NHA maintained a 100% alert acknowledgment rate, ensuring every alert generated by the platform was reviewed by the care team.

This level of responsiveness demonstrates how RPM can be integrated into day-to-day clinical workflows rather than functioning as a passive data collection tool.

Why It Matters

For patients, Claris Companion provided continuous oversight while allowing them to remain safely at home.

For clinicians, it delivered real-time insights into patient health status and helped prioritize outreach based on actual clinical risk.

For NHA, the program demonstrated that remote patient monitoring can:

• Expand care capacity without expanding facility space
• Improve visibility into chronic disease management
• Support proactive interventions
• Enable continuous care between appointments
• Scale monitoring programs across larger patient populations

NHA successfully managed 85 patients over the life of the program, with 22 actively monitored at the time of reporting, demonstrating both sustained adoption and operational scalability.