Transitional Care Management (TCM)
Transitional Care Management (TCM) by CCMS offers critical support for patients transitioning between care settings, ensuring continuity and quality from hospital discharge to home or other facilities. TCM is a core component of CCMS’s commitment to population health, helping to reduce readmissions, improve patient outcomes, and streamline processes for healthcare providers.
Our TCM services benefit both payers and risk-bearing organizations by proactively lowering readmission risks and healthcare costs. By reconnecting discharged patients with their primary care physicians (PCPs) within 7 to 14 days, TCM ensures timely follow-up to address any changes in the care plan, review medications, and reduce the potential for complications. This essential follow-up care helps PCPs stay informed about their patients’ health and reduces gaps in care, leading to better health outcomes and cost savings.
Eligibility for TCM Services
CCMS’s TCM services are available to a broad range of healthcare professionals, ensuring comprehensive support during critical patient transitions:
Physicians
Nurse Practitioners (NPs)
Physician Assistants (PAs)
Non-Physician Practitioners (NPPs)
Clinical NurseSpecialists (CNSs)
To learn more about how TCM can enhance population health management, explore this article by Mario Espino.