The annual cost of hospital care in the US has surpassed $1 trillion, despite relatively poor health outcomes compared to similar nations. This has highlighted the need for innovative care delivery models that reduce costs and improve outcomes. The Hospital at Home (HaH) program, which provides acute-level hospital care at home, has seen significant progress over the past two decades, driven by technological advancements in remote patient monitoring, wearable sensors, and health information technology. The COVID-19 pandemic further accelerated the adoption of HaH, with reimbursement waivers making it financially viable for hospitals and payors. However, HaH still faces challenges, including the need for more compelling evidence, addressing structural and incentive conflicts, and ensuring privacy and scalability. Despite these challenges, HaH has demonstrated feasibility, efficacy, and effectiveness, and there is a growing interest in its potential as a permanent alternative form of acute care management. The review evaluates the current status and future prospects of HaH, highlighting the promises and challenges it faces in becoming a mainstream alternative for acute care delivery.The annual cost of hospital care in the US has surpassed $1 trillion, despite relatively poor health outcomes compared to similar nations. This has highlighted the need for innovative care delivery models that reduce costs and improve outcomes. The Hospital at Home (HaH) program, which provides acute-level hospital care at home, has seen significant progress over the past two decades, driven by technological advancements in remote patient monitoring, wearable sensors, and health information technology. The COVID-19 pandemic further accelerated the adoption of HaH, with reimbursement waivers making it financially viable for hospitals and payors. However, HaH still faces challenges, including the need for more compelling evidence, addressing structural and incentive conflicts, and ensuring privacy and scalability. Despite these challenges, HaH has demonstrated feasibility, efficacy, and effectiveness, and there is a growing interest in its potential as a permanent alternative form of acute care management. The review evaluates the current status and future prospects of HaH, highlighting the promises and challenges it faces in becoming a mainstream alternative for acute care delivery.