Evidence shows that heart disease management programs that include coordinated post-hospital care can improve patients' outcomes and reduce readmissions. Medicare, however, does not reimburse providers for services targeting the transition between hospital and home. Drawing from their previous research, faculty from the University of Pennsylvania, in collaboration with the International Heart Failure Consortium, will propose a new, post-discharge coordinated care benefit for Medicare beneficiaries with heart failure. Project staff will: a) highlight which specific interventions produce the greatest gain in health outcomes for different categories of patients; b) estimate the potential costs, benefits, and savings of such a benefit; and c) work with policymakers to develop a benefit prototype. This work could also inform similar efforts targeting other chronic conditions.