Transitional Care Management Services Market - Global Industry Size, Share, Trends, Opportunity, and Forecast, Segmented By Service (Patient TCM Services {Interactive contact, Face-to-face visit, Non-face-to-face (telehealth)}, Healthcare TCM Services {Physicians, Non-Physician Practitioners},Billing TCM Services, Documenting TCM Services, Others), By End-use (Inpatient Settings, Community Settings), By Region and Competition, 2021-2031F

Forecast Period	2027-2031
Market Size (2025)	USD 1.89 Billion
CAGR (2026-2031)	13.73%
Fastest Growing Segment	Inpatient Settings
Largest Market	North America
Market Size (2031)	USD 4.09 Billion

Market Overview

The Global Transitional Care Management Services Market is projected to grow from USD 1.89 Billion in 2025 to USD 4.09 Billion by 2031 at a 13.73% CAGR. Transitional Care Management services comprise a comprehensive healthcare model designed to ensure the continuity of care as patients move from high-acuity settings, such as hospitals, to lower-acuity environments like homes or skilled nursing facilities. The primary drivers supporting this market include the global rise in geriatric populations and the increasing prevalence of long-term health issues which necessitate coordinated oversight to prevent hospital readmissions. According to the American Academy of Family Physicians, in 2024, nearly 95 percent of adults aged 60 years and older have at least one chronic condition. This high prevalence compels healthcare systems to adopt value-based care models that prioritize patient outcomes and reduce unnecessary medical expenditures.

Despite these strong growth indicators, the market faces a significant hurdle regarding the administrative complexity associated with reimbursement and billing processes. Healthcare providers often encounter stringent documentation requirements and intricate coding criteria that can lead to claim denials or delayed payments for these services. These administrative burdens may discourage smaller practices from implementing robust transitional care programs and potentially stifle the broader expansion of these essential coordination efforts across the healthcare continuum.

Key Market Drivers

The rising global geriatric population and the increasing prevalence of chronic diseases are fundamentally reshaping the demand for transitional care management services. As healthcare systems face a higher volume of patients requiring complex monitoring, the risk of costly readmissions increases, necessitating robust coordination models to manage patient health across different settings. According to the Centers for Disease Control and Prevention, February 2024, approximately 129 million people in the United States have at least one major chronic disease, creating a substantial need for continuous oversight. Providers rely on TCM to mitigate the financial risks associated with these complex conditions by ensuring safe discharges and reducing avoidable returns to acute care facilities. According to Dialog Health, October 2024, the average cost of hospital readmissions was 12.4 percent higher than index admissions, reaching $16,300 per patient, highlighting the economic necessity for effective care transitions.

The integration of telehealth and remote patient monitoring (RPM) technologies significantly accelerates market expansion by enabling real-time patient tracking outside clinical facilities. These tools allow care teams to monitor vital signs continuously, facilitating timely interventions that prevent post-discharge complications and support recovery in lower-acuity environments. This technological evolution supports the industry's shift toward home-based care, offering patients a convenient alternative to frequent hospital visits while providing clinicians with actionable health data. According to HealthArc, October 2024, the number of patients utilizing remote patient monitoring systems in the United States rose to 30 million in 2024, reflecting the rapid adoption of these solutions. By bridging the gap between hospital and home, these technologies enhance the scalability of coordination programs and improve overall patient engagement.

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Key Market Challenges

The administrative complexity associated with reimbursement and billing processes acts as a substantial restraint on the expansion of the Global Transitional Care Management Services Market. Healthcare providers face rigorous documentation standards and convoluted coding requirements that frequently result in claim denials or prolonged payment cycles. This operational friction creates a precarious financial environment, particularly for smaller independent practices that lack the administrative infrastructure to manage resource-intensive appeals. As a result, many potential market participants are deterred from adopting or expanding transitional care programs to avoid the risks of revenue loss and cash flow instability.

This challenge is quantified by recent findings regarding the intensifying struggle with payer reimbursement. According to the American Hospital Association, in September 2024, it was reported that claim denials for Medicare Advantage plans had surged by 55.7 percent between the compared reporting periods. Such a dramatic increase in uncompensated care efforts underscores the financial volatility providers face. This distinct upward trend in administrative hurdles directly disincentivizes the broad implementation of transitional care models, thereby stalling the overall growth potential of the market.

Key Market Trends

The integration of AI-driven predictive analytics is transforming patient risk stratification by shifting transitional care from a reactive model to a proactive, data-centric approach. By leveraging machine learning algorithms to analyze vast datasets within electronic health records, providers can now identify individuals with the highest probability of readmission before they leave the acute care setting. This capability allows care teams to allocate limited resources more efficiently, tailoring intensive intervention plans specifically for patients flagged as high-risk to prevent complications. According to Healthcare IT News, September 2025, in the 'Hospital Trends in the Use, Evaluation, and Governance of Predictive AI' report, approximately 71 percent of U.S. hospitals utilized predictive AI integrated into their systems in 2024, specifically to forecast inpatient risks and health trajectories.

Simultaneously, the incorporation of Social Determinants of Health (SDOH) in discharge planning represents a critical evolution in how providers address the root causes of hospital readmissions. Healthcare organizations are increasingly acknowledging that non-clinical factors—such as housing instability, food insecurity, and lack of transportation—often dictate patient outcomes more significantly than medical treatments alone. This trend drives the adoption of holistic discharge protocols that link patients with community-based support services to ensure sustainable recovery outside clinical facilities. According to the National Institutes of Health, August 2025, in the study 'Social Determinants of Health and 30-Day Readmission for Heart Failure Patients in U.S. Hospitals', patients with two or more documented social risk indicators demonstrated a significantly elevated probability of 30-day readmission, validating the necessity of addressing these socioeconomic variables in care plans.

Segmental Insights

The Inpatient Settings segment is identified as the fastest-growing category within the Global Transitional Care Management Services Market due to stringent mandates aimed at lowering hospital readmission rates. Regulatory bodies like the Centers for Medicare & Medicaid Services impose financial penalties for preventable readmissions, incentivizing hospitals to strengthen their discharge protocols. This pressure compels healthcare institutions to integrate comprehensive management services directly into the inpatient workflow to ensure continuity of care. Such strategic investments in pre-discharge planning and coordination are essential for mitigating financial risks, thereby driving the rapid expansion of this market segment.

Regional Insights

North America commands a dominant position in the Global Transitional Care Management Services Market due to favorable reimbursement structures and a strong regulatory emphasis on value-based care. In the United States, the Centers for Medicare & Medicaid Services (CMS) actively drives market adoption by offering financial incentives for reducing hospital readmissions and establishing specific billing codes for care coordination. This regulatory environment compels healthcare providers to implement structured transition programs for the rising geriatric population. Additionally, the region benefits from a mature healthcare infrastructure that supports the seamless integration of technology essential for managing patient transitions between care settings.

Recent Developments

• In December 2024, Surgical Information Systems announced a partnership with Nexus Health Resources to launch a new survey solution for ambulatory surgery centers and hospital outpatient departments. This collaboration leveraged Nexus Health Resources' expertise as a provider of transitional care software and patient engagement services to help facilities meet regulatory requirements. The partnership integrated Nexus’s capabilities to assist providers in ensuring coordinated, quality healthcare during the transition from a facility to the home, thereby supporting efforts to reduce unnecessary readmissions and manage total medical spend.
• In November 2024, Interwell Health launched Acumen Rounder, a nephrology-specific mobile application featuring dedicated capabilities for Transitional Care Management. The new tool was designed to alert nephrologists when dialysis patients are discharged from the hospital, triggering a streamlined workflow to outreach, document, and bill for transitional care visits. This functionality aimed to ensure follow-up care is scheduled within the critical 14-day post-discharge window, a practice directly linked to reducing hospital readmissions and improving coordination for patients navigating complex kidney care journeys.
• In July 2024, MD Revolution partnered with PatchRx to integrate a medication adherence platform into its remote care management suite, which supports Transitional Care Management and Chronic Care Management programs. This collaboration allowed clinicians to track patient medication-taking patterns directly within their existing remote care workflows. By combining medication adherence data with dynamic care management and automated billing capabilities, the partnership aimed to empower providers to personalize interventions, improve health outcomes, and ensure patients receive timely support during critical care periods.
• In February 2024, Tango and WellSky announced a strategic partnership to introduce a fully integrated post-acute care episode management program designed for health plans and risk-bearing entities. This collaboration combined Tango’s value-based home health enablement platform with WellSky’s acute and post-acute technology and analytics. The initiative aimed to address market challenges such as fragmented incentives and delayed access to optimized care transitions. By enabling a unified model for care coordination across home health, skilled nursing, and long-term acute care facilities, the program sought to improve patient outcomes and reduce the total cost of care.

Key Market Players

• Humworld Inc.
• Rijuven Corp.
• Pharmerica Corporation
• Carevitality Inc.
• Act Health Solutions
• Medsien Inc.
• Wellsky Corp.
• Nextgen Healthcare Inc.
• ManipalCigna Health Insurance Company Limited
• Fi-Med Management, Inc.

By Service	By End-use	By Region
Patient TCM Services {Interactive contact Face-to-face visit Non-face-to-face (telehealth)} Healthcare TCM Services {Physicians Non-Physician Practitioners} Billing TCM Services Documenting TCM Services Others	Inpatient Settings Community Settings	North America Europe Asia Pacific South America Middle East & Africa

Report Scope:

In this report, the Global Transitional Care Management Services Market has been segmented into the following categories, in addition to the industry trends which have also been detailed below:

• Transitional Care Management Services Market, By Service:

• Patient TCM Services {Interactive contact
• Face-to-face visit
• Non-face-to-face (telehealth)}
• Healthcare TCM Services {Physicians
• Non-Physician Practitioners}
• Billing TCM Services
• Documenting TCM Services
• Others

• Transitional Care Management Services Market, By End-use:

• Inpatient Settings
• Community Settings

• Transitional Care Management Services Market, By Region:

• North America
• United States
• Canada
• Mexico
• Europe
• France
• United Kingdom
• Italy
• Germany
• Spain
• Asia Pacific
• China
• India
• Japan
• Australia
• South Korea
• South America
• Brazil
• Argentina
• Colombia
• Middle East & Africa
• South Africa
• Saudi Arabia
• UAE