20%

Readmission

Approximately 1 in 5 Medicare beneficiaries in the US are readmitted in the hospital within 30 days of discharge.

76%

Readmission

An efficient TCM program is estimated to prevent up to 76% of the readmission rates and in-turn uplift patient outcomes.

Halo TCM provides support to patients as they move between different healthcare settings or stages of care, promoting seamless transitions, enhancing results, and minimizing potential complications.

Our Medical Specialties

Routine Care

Our team provides physician directed bridge care in the 30 days following your release from a hospitalization.

Wound Care

IV Therapy

Pharmacy Services

Laboratory Testing

Dietary Counseling

Pain Management

Durable Medical Equipment (DME)

Therapies

We direct patients to skilled therapists that provide all-encompassing therapy services for those adjusting to home.

Physical Therapy

Occupational Therapy

Rehabilitative Therapy

Speech Therapy

Specialized Care

We provide focused care plans and follow up education for patients with specific needs, such as diabetes care, fall prevention, oxygen monitoring, and more.

Hemodialysis

Fall Prevention

Respiratory Care

High-Flow Oxygen Monitoring

Diabetes Care

Cardiac Health

Orthopedic Care

Key Features

Interactive Contact

We provide focused care and education for patients and families, such as diabetes care, fall prevention, oxygen monitoring, and more.

Discharge Summary

Reviewing the discharge summary and discharge instructions with the patient or caregiver.

Easy Care Transfer

Coordinating care with other health care professionals who may assume or resume care.

Care Coordination

Determining any needs that exist by coordinating care with community organizations and the patient's community physicians and specialists.

Medication Reconcillation

Reviewing and educating patients on current medication lists and determining plan for continuation and refill timelines.

Follow-up Reminder

Scheduling and automatically reminding the patient of required physician follow-ups or additional services.

We’re Leading Safe Transitions

Halo TCM offers a range of services as patients navigate the transition from hospital to community or home environment, including IV therapy, wound care, and respiratory care, as well as recommendations for comprehensive services such as physical therapy speech therapy, occupational therapy, rehabilitative therapy, DME supplies, and more. Patients living with diabetes and other chronic health conditions may also be treated by our transitional care team in the 30 days between hospitalization and return to a community primary care provider or specialist.

Our professionals are trained in various medical specialties, including nutrition, pain management, and nursing. Patients should consider Transitional Care to ensure a smooth and safe transition from the hospital or other medical facility to the home.

Why Choose Us?

Our patients and their loved ones can rest easy knowing that we are a local company led by physicians.

Coordination

Our team will help with the difficult process of coordinating your outpatient needs including physical and occupational therapies, dialysis, medical equipment, wound care and more.

Continuity of Care

Our team will help with the navigation of appointments and follow ups needed as you transition back to your primary care provider and specialist.

Restored Function

Our team of experts knows what you need to get back to your active lifestyle and we have the resources to help you. Our home evaluation will help you and your family determine what medical equipment and safety options will help you recover quickly.

Regained Independence

Our team provides resources and education to ensure that you are independently living as quickly and safely as possible.

Timely & Safe

We have several avenues for patients and families to connect with our team for resources, questions and education.

Low Re-Admission Rates

Our goal is to give patients and families hospital free days. We are experts in keeping you safe and anticipating problems in the critical 30 days when you are released from a facility.

Coordination

Our team will help with the difficult process of coordinating your outpatient needs including physical and occupational therapies, dialysis, medical equipment, wound care and more.

Continuity of Care

Our team will help with the navigation of appointments and follow ups needed as you transition back to your primary care provider and specialist.

Restored Function

Our team of experts knows what you need to get back to your active lifestyle and we have the resources to help you. Our home evaluation will help you and your family determine what medical equipment and safety options will help you recover quickly.

Regained Independence

Our team provides resources and education to ensure that you are independently living as quickly and safely as possible.

Timely & Safe

We have several avenues for patients and families to connect with our team for resources, questions and education.

Low Re-Admission Rates

Our goal is to give patients and families hospital free days. We are experts in keeping you safe and anticipating problems in the critical 30 days when you are released from a facility.

Frequently Asked Questions

What are some typical TCM services?

Transitional Care Management (TCM) involves identifying eligible patients, assessing their needs, coordinating care, managing medications, providing education and support, monitoring progress, and planning transitions. These stages aim to optimize patient outcomes and enhance care quality during healthcare transitions.

Who is eligible for TCM services?

Patients transitioning from an inpatient hospital stay, skilled nursing facility, or similar healthcare settings to their home or another community setting are typically eligible for Transitional Care Management (TCM) services.

What are the most prevalent forms of patient data gathered by TCM?

Transitional Care Management (TCM) collects patient data encompassing medical history, current health status, medications, care plans, contact details, appointments, and insurance/billing information. This data is crucial for seamless transitions between healthcare settings, minimizing complications, and optimizing health outcomes.

Do you have more questions?

How can HaloTCM help you?

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