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5 Key Strategies for Improving Transitional Care Management in ACOs

by Aledade

Primary care providers (PCPs) participating in accountable care organizations (ACOs) are responsible for much more than the services they provide during any specific encounter.

As an important component of Aledade's Core 4 services, transitional care management (TCM) is designed to bridge the gap and ensure that primary care providers follow up with their patients in a structured, reimbursable manner after discharge from a hospital, skilled nursing facility, inpatient rehab facility, or certain other settings.

In this white paper, you will learn about:

  • Laying the groundwork for success with accountable care strategies
  • Working closely with other providers in the community
  • Closing the loop with community-based organizations, caregivers, and patients
  • Reviewing your existing processes and workflows and start thinking about how to make positive, data-driven changes