Transitional Care Program

Our Transitional Care Program (TCP) reduces the need for frequent Hospital services by providing comprehensive and compassionate care on an outpatient basis. Our goal is to help patients achieve medical stability so they can return to the care of their Primary Care Physician, and to live their lives to the fullest.

Our physicians specialize in the care of patients with multiple complex chronic conditions.  Patients have 24 hour access to their TCP provider and spend extended time with the physician during clinic visits. With the help of the TCP care team, patients work toward achieving their healthcare and quality of life goals. 

Reduced medical costs of 25%

The Transitional Care Program combines best practices from chronic care management and medical home initiatives, as well as geriatric and palliative medicine. Following evidence-based protocols, experienced physicians offer consistent, quality care, resulting in a drop unnecessary hospital admissions and readmissions.


Multiple clinics and growing

The TCP operates a large network of clinics in Texas, with the majority in the greater Houston area, in the greater Dallas/Fort Worth area, one in Beaumont, and one in Port Arthur – and we are continually growing. Contact us to discuss how we can develop a clinic system for your Medicare Advantage plan or physician organization.

No Copays or Fees

It will not cost patients anything, and visits are a part of the benefits offered by their insurance company.

Removing barriers to quality outpatient care. To serve the patient’s full set of needs, we provide:

+ Monthly one- hour clinic visits

+ Assistance with transportation to clinic, lab and imaging appointments

+ 24/7 physician access for each patient

+ Coordination of all health care services

+ Physician-directed telemanagement between clinic visits

+ A home visit program for limited mobility patients