Hospital to Home

The Hospital to Home (H2H) Initiative is a resource for hospitals and cardiovascular care providers committed to improving transitions from hospital to "home" and reduce their risk of federal penalties associated with high readmission rates.


Self-contained improvement projects that include a goal statement, success metrics, a tool kit, an assessment, and 3 webinars (evidence, tools, lessons learned) that provide participants with recommended strategies and tools to achieve small, attainable goals in their organization.

  • See You in 7

    The goal of the H2H SY7 Challenge is for all patients discharged with a diagnosis of HF/AMI to have a follow-up appointment scheduled/cardiac rehab referral made within 7 days of hospital discharge.

  • Mind Your Meds

    The goal of the H2H MM Challenge is for clinicians and patients discharged with a diagnosis of HF/MI to work together and ensure optimal medication management.

  • Signs and Symptoms

    The goal of the H2H S&S Challenge is to activate patients to recognize early warning signs and have a plan to address them.

Getting Started

Kick-start H2H at your hospital by utilizing the ”Getting Started Checklist.
Get Started

News And Research

  • 561 ACOs participating in Medicare Shared Savings Program

    According to the CMS, 561 accountable care organizations will participate in the Medicare Shared Savings Program this year -- 124 new participants, 372 continuing participants and 65 organizations that renewed agreements -- covering 10.5 million lives. The majority of ACOs will be in the upside-only Track 1, but 55 will be in Track 1+, which transitions participants toward accepting some downside risk, eight will be in Track 2 and 38 will be in Track 3, both of which carry downside risk. RevCycle Intelligence (1/10) Learn More

  • Group issues updated guidance on recommendations for contact precautions

    The Society for Healthcare Epidemiology of America has released updated guidance regarding recommendations on contact precautions to prevent the transmission of multidrug-resistant infections such as methicillin-resistant Staphylococcus aureus and Clostridium difficile in hospitals. The recommendations, published in the journal Infection Control & Hospital Epidemiology, say clinicians should consider the amount of time elapsed since the last positive sample. Medscape (free registration) (1/12) Learn More

  • Focused health care facilities are prime targets for bundled care

    The concept of the focused factory has been proved effective in transplant, trauma and cancer centers, and a focused-factory-style health care provider is an attractive partner for accountable care organizations, write Suzanne Delbanco and Roslyn Murray. However, many highly specialized practices and facilities are paid through conventional models that offer no incentive to reduce costs and eliminate unneeded services, making them ripe for bundled care arrangements, Delbanco and Murray write. Health Affairs Blog (1/10) Learn More