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Transitional Care Management (TCM)

Just Left the Hospital? We've Got You.

The days right after a hospital stay are the most vulnerable — and the most important. Our TCM program makes sure you land safely at home with the support and follow-up you need.

Book Appointment
Who Transitional Care Management Is For
  • Recent Hospital Discharge
  • Skilled Nursing Discharge
  • Inpatient Rehab Discharge
  • High Readmission Risk
  • Complex Medication Regimens
  • Post-Surgical Recovery
How It Works
  1. Contact within 2 business days of discharge to check in and confirm you have what you need at home.
  2. Full medication review and reconciliation against everything prescribed at the hospital.
  3. Follow-up visit scheduled within 7–14 days, depending on complexity.
  4. Care coordination and specialist referrals so nothing falls through the cracks.
What You Get With Transitional Care Management
  • Immediate outreach after leaving the hospital or skilled nursing facility
  • Medication review so you know exactly what to take and when
  • Scheduled follow-up visit within 7–14 days
  • Coordination with all your doctors, specialists, and care facilities
  • Support for your family or caregiver throughout your recovery
Covered by Medicare

TCM is covered under Medicare Part B for patients discharged from hospitals, skilled nursing facilities, or inpatient rehab. Most patients have little to no out-of-pocket cost.