Transitional Care Management

Transitional Care Management (TCM) supports patients as they move from hospital or facility care back to their home or community. This Medicare-approved service focuses on preventing hospital readmissions by ensuring seamless continuity of care during this critical period.

Our providers engage with patients within two business days of discharge and schedule a timely in-person visit—within 7 days for high complexity cases or 14 days for moderate complexity—to address care needs. We also coordinate follow-up appointments, reconcile medications, and connect patients with necessary community resources, all to promote a smooth and safe recovery at home.