Following the return home after surgery, hospitalization, or spending time at an inpatient facility, a patient may require temporary medical care to transition back into everyday life and routine health care. Often, patients are facing medical recovery, a change in medication, or a new diagnosis and may have been advised by their attending physician to limit their activities or to minimize travel outside of their home prior to their release. These changes in medical status or physician-restrictions may hinder the patient’s access to traditional transitional care.

Transitional Care Management is a Medicare sponsored program that addresses the medical needs between an inpatient setting and return to daily activities for homebound patients.

ACT Health Solutions

We provide a means for patients in need of transitional care management to receive the necessary medical care necessary for recovery.

Care Components of TCM

During Transitional Care, we obtain and review the discharge instructions and information of our patients to develop a medicine administration management plan and facilitate the coordination of required follow up testing or treatments. Our practitioners also ensure patients receive the medical care and attention they need while homebound to minimize their risk of hospital readmission.