Champions Clinical Services

Patient guide / TCM

Medical follow-up as you return to the community.

After discharge, patients may have new medications, appointments, and questions. Transitional care management, or TCM, helps coordinate this period as patients return to the community.

Understanding the setting

A TCM visit is a medical appointment to review the discharge plan, reconcile medications, assess ongoing needs, and arrange appropriate follow-up.

Taking part in the plan

Have discharge instructions, a current medication list, questions, and your primary care provider’s information available. Tell the team about appointments already scheduled.

Planning the next transition

Transitional care supports the return to ongoing primary care. Coverage and patient responsibility depend on the insurance plan; ask about expected costs when arranging the visit.

Questions worth asking

Which medications changed?

Bring this question to the care team. Ask how the answer applies to your condition, goals, and available support.

Who is arranging follow-up?

Bring this question to the care team. Ask how the answer applies to your condition, goals, and available support.

Who should I call before my next appointment?

Bring this question to the care team. Ask how the answer applies to your condition, goals, and available support.

General information, not an individual treatment or coverage recommendation. Your care team can explain what applies to you.

Medicare information about this care