Continuity of care is at the heart of MPAC’s Transitional Care Management (TCM) program. This program was designed on the premise that the NP who cared for the patient at the facility is the best person to provide on-going high-level medical care for the patient as they transition from the facility to home. The NP works in conjunction with a dedicated MPAC Care Manager to provide:
There is an important distinction between home health care and MPAC’s TCM program. The goal of home health is to provide nursing care such as changing bandages and monitoring medications. Conversely, the NP will assess a patient's clinical stability, make adjustments to the treatment regimen, and write orders or prescriptions as needed.