Transitional Care Management (TCM)

Care 24/7’s TCM program helps ease the patient transition between different care providers. Services include scheduling and confirming TCM appointments, reviewing discharge instructions and medication lists, and reiterating provider recommendations. Care 24/7 staff assists in the coordination and communication of preventative care and wellness services as well as referrals and ordered health tests, as requested by the patient’s provider. Care 24/7 staff assists with community services that can help meet the patient’s health care needs such as: transportation, medical payment assistance, and access to medical equipment or home repair.

Care 24/7 TCM Services:

  • Provide virtual care coordination services to patients transitioning to community setting following inpatient discharge
  • Licensed Clinical staff provides the services and are directed by a physician or other qualified health care professional to eliminate gaps in care post-discharge
  • The 30-day TCM period begins on the date the patient is discharged and continues for the next 29 days