2026 results

Outcomes by Specialty

Cardiology

63% → 80%

Controlled, under 140/90.

Nephrology

40% → 67%

Controlled, under 140/90.

Primary Care

52% → 81%

Controlled, under 140/90.

Based on aggregated, de-identified data from TOCA Health RPM and CCM programs, 2026 (data through October 2026).

Cardiology

Cardiology

Data across ~4,000 patient samples

Programs: 64% RPM + CCM · 34% RPM only · 1% CCM only

Controlled

63% → 80%

Hypertensive patients under 140/90.

Average systolic

−4.5mmHg

−11 mmHg for patients who started uncontrolled.

Severe readings

20%

of patients sent a reading ≥180/120, and every one was flagged and followed up.

Based on aggregated, de-identified data from TOCA Health RPM and CCM programs, 2026 (data through October 2026).

Patient Stories

Real patient, de-identified

~170/110 → ~125/85

A man who had been off blood-pressure medication for several months joined remote monitoring with home readings averaging about 170/110. His care manager made sure his cuff was working, escalated the high readings to the cardiology office, and checked in as he started a newly prescribed medication. Within about three months his monthly average had fallen to roughly 125/85, and it has stayed near that level for more than a year.

Real patient, de-identified

~165/100 → ~125/75

A man managing a long list of medications was taking only a handful of home readings a month, and those averaged about 165/100. His care manager coached him to check twice a day and keep to his medication schedule, and escalated each run of high readings to the cardiology office. He went from about 5 readings a month to about 30. Within three months his average came down to about 125/75, where it has held for six months.

Real patient, de-identified

~145/75 → ~110/60

A woman in her 80s saw her home readings climb into the 140s to 170s, along with some dizziness. Her care manager escalated the out-of-range readings to the cardiology office several times and followed up with her by phone. Her cardiologist changed her medication. Within about six weeks her monthly average dropped from roughly 145/75 to about 110/60, and it has stayed in the 110s to 120s since.

Things We See Everyday

Patterns the care team handles across the program, not one patient’s chart.

  1. 01

    A patient with heart failure gained several pounds over a few days and noticed ankle swelling. The care manager caught the trend in the daily weights and alerted the provider. The diuretic was adjusted, and the weight came back to baseline without an emergency visit.

  2. 02

    A patient with coronary disease called in reporting chest discomfort during a routine check-in. The care manager directed the patient to emergency care right away and documented the event for the cardiologist.

Conditions we manage

Share of patients with coded diagnoses, n≈1,800

Condition (ICD-10 group)Share
Hypertension (I10–I16)96%
Hyperlipidemia (E78)72%
Coronary artery disease (I20–I25)26%
Diabetes (E08–E13)23%
Heart failure (I50)10%
Atrial fibrillation (I48)8%
Chronic kidney disease (N18)7%
How care management helps

Drawn from care-manager notes. Keyword counts are approximate.

  • 841 readings escalated to the care team per 100 patient-years. 28% of patients had at least one reading escalated in 2026.
  • 20% of patients sent at least one severe home BP reading (≥180 systolic or ≥120 diastolic). Each one was flagged and followed up.
  • Care managers documented provider notifications for 30% of patients (532 per 100 patient-years). They covered symptom checks, medication questions and out-of-range trends.
  • When symptoms warranted it, patients were directed to urgent or emergency care (about 10 per 100 patient-years).

Nephrology

Nephrology

Data across ~2,400 patient samples

Programs: 70% RPM only · 26% RPM + CCM · 5% CCM only

Controlled

40% → 67%

Hypertensive patients under 140/90.

Average systolic

−7.2mmHg

−12.5 mmHg for patients who started uncontrolled.

Started uncontrolled

52%

reached under 140/90. 25% reached the CKD target of under 130/80.

Based on aggregated, de-identified data from TOCA Health RPM and CCM programs, 2026 (data through October 2026).

Patient Stories

Real patient, de-identified

~150/85 → ~120/75

An older man with kidney disease was sending home readings mostly in the 160s to 180s, with a few above 200, even though he felt fine. His care manager went over the trend with his family and escalated the readings to the nephrology office more than once in the same week. His doctor changed his blood-pressure medication. His monthly average went from about 150/85 to about 135/80 within two months, then to about 120/75 within four.

Real patient, de-identified

~100/60 → ~130/70

An older man with kidney disease, diabetes and high blood pressure had home readings averaging about 100/60, with occasional dizzy spells. His care manager flagged the low readings to the office several times over a few weeks. His doctor stopped one of his blood-pressure medications. Within about two months his average was back to a safer 130/70 range.

Things We See Everyday

Patterns the care team handles across the program, not one patient’s chart.

  1. 01

    A lab result showed elevated potassium. The care manager made sure the nephrologist saw it, reviewed high-potassium foods with the patient, and arranged a repeat lab. The follow-up result was back in range.

  2. 02

    A patient noticed swelling and a few pounds of weight gain. The care manager reinforced fluid and salt limits and notified the provider, who adjusted the treatment plan before the patient needed urgent care.

Conditions we manage

Share of patients with coded diagnoses, n≈720

Condition (ICD-10 group)Share
Chronic kidney disease (N18)94%
Hypertension (I10–I16)84%
Diabetes (E08–E13)44%
Hyperlipidemia (E78)11%
Anemia, COPD/asthma, heart failureeach <3% (n ≥11)
Obesity, coronary disease, atrial fibrillation<11 patients each
How care management helps

Drawn from care-manager notes. Keyword counts are approximate.

  • 1,128 readings escalated to the care team per 100 patient-years. 46% of patients had at least one reading escalated.
  • Care managers documented provider notifications for 60% of patients (≈1,000 per 100 patient-years).
  • About 1 in 10 patients had potassium follow-up documented, and 18% had lab follow-up. 41% received diet or fluid counseling (low-sodium, renal diet, fluid intake).
  • Low-blood-pressure episodes were flagged for one in three patients. This matters for CKD patients on several BP medications.

Primary Care

Primary Care

Data across ~760 patient samples

Programs: 65% RPM only · 32% RPM + CCM · 3% CCM only

Controlled

52% → 81%

Hypertensive patients under 140/90.

Average systolic

−8.1mmHg

−14.6 mmHg for patients who started uncontrolled.

Started uncontrolled

69%

of patients who started uncontrolled reached under 140/90.

Based on aggregated, de-identified data from TOCA Health RPM and CCM programs, 2026 (data through October 2026).

Patient Stories

Real patient, de-identified

~160/95 → ~120/80

After a hospital stay, an older man's home readings averaged about 160/95, with peaks near 200/110. His care manager tracked the spikes, checked for warning symptoms, and kept his physician's office updated through the program's regular reading reports. His doctor doubled one blood-pressure medication and added another a few weeks later. Within about three months his average was close to 120/80, and it has mostly stayed in the 120s to 130s since.

Real patient, de-identified

~160/80 → ~120/65

A woman's home readings averaged about 160/80, with highs above 180, and her care manager escalated them to her doctor's office several times in one month. The care manager also worked with her family on the basics: a pill organizer and less salt in home cooking. After her follow-up visit with her physician, her average fell to about 135/75 within a month and to about 120/65 within three months. It has held there for about eight months.

Things We See Everyday

Patterns the care team handles across the program, not one patient’s chart.

  1. 01

    A patient with diabetes reported several high fingerstick readings. The care manager notified the physician, and the treatment plan was updated. Diet education continued on later calls.

  2. 02

    During a check-in, a patient described new shortness of breath. The care manager directed them to urgent care the same day and documented it for the primary care physician.

Conditions we manage

Share of patients with coded diagnoses, n≈260

Condition (ICD-10 group)Share
Hypertension (I10–I16)>99%
Hyperlipidemia (E78)74%
Diabetes (E08–E13)44%
Depression / anxiety (F32, F33, F41)28%
Peripheral arterial disease (I70, I73)18%
Coronary artery disease (I20–I25)16%
Hypothyroidism (E03)13%
COPD / asthma (J44–J45)13%
Sleep apnea (G47.3)12%
Obesity (E66)11%
Chronic kidney disease (N18)11%
How care management helps

Drawn from care-manager notes. Keyword counts are approximate.

  • Care managers documented provider notifications for 47% of patients (≈920 per 100 patient-years).
  • 39% of patients had at least one reading escalated to the care team.
  • Medication adherence was addressed with 57% of patients, and lifestyle and diet education with 42%.
  • When symptoms warranted it, patients were directed to urgent or emergency care (about 9 per 100 patient-years).

Methods

†Hypertensive = hypertension diagnosis on file or baseline home BP averaging ≥140/90. We included patients with ≥2 months of home BP readings, at least 3 readings in their first 30 days and in their most recent 30 days, and active monitoring in 2026. Readings are home cuff readings (not office BP) after plausibility filtering. Average follow-up was about 1–1.5 years. There is no control group. Patients selected for high starting BP tend to read lower later anyway (regression to the mean), and medication changes come from the care team and physicians, not from monitoring alone.

Figures are aggregated across multiple TOCA client practices; no practice or patient is identified. Blood pressure results compare each patient’s home readings in their first 30 days with their most recent 30 days; there is no control group, and medication changes are made by each patient’s physician. Patient stories are real TOCA patients, de-identified, with ages, timeframes and readings generalized and other details changed. Stories labeled "Composite" combine patterns across many patients and do not describe real individuals. Counts under 11 are not shown. Individual results vary and are not guaranteed.

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