Aledade’s Director of Transitions of Care, Dr. Kim Hodge, joins Josh (@DrJIsrael) to talk about Transitional Care Management (TCM) visits and the challenge of providing consistent care to patients as they move through different levels of care in a health system. She covers how to conduct an effective TCM visit and what Aledade is doing to encourage and support this work for vulnerable patient populations and how use telehealth to do this work during the time of COVID-19.