The Ambulatory Specialty Model: Prioritizing Chronic Disease Management and Value-Based Contracting

Value-based care is no longer just for primary care. With the planned Ambulatory Specialty Model (ASM), CMS is taking direct aim at specialty care—starting with heart failure and low back pain management. For cardiology practices, particularly those managing heart failure, this marks a fundamental shift in how chronic disease management will be delivered, coordinated, and reimbursed.

The ASM, announced in July 2025, is set to begin on January 1, 2027, but the time to prepare is now.

What Is the Ambulatory Specialty Model?

The Ambulatory Specialty Model (ASM) is a new CMS Innovation Center initiative designed to bring specialists into the center of value-based care. Historically, most population health and cost-control efforts focused on primary care physicians and ACOs. The ASM changes that by holding specialists directly accountable for both quality and cost outcomes related to chronic disease management.

For cardiologists, the ASM will initially focus on heart failure—a condition responsible for billions in Medicare spending each year due to hospitalizations, ER visits, and disease progression. Under the new model, cardiology practices will be expected to:

• Proactively manage heart failure patients across care settings
• Integrate remote monitoring and preventive strategies into daily practice
• Coordinate more closely with primary care providers and social services
• Participate in shared savings and risk-based payment models.
  

Why Heart Failure—and Why Now?

Heart failure is one of the costliest and most complex conditions to manage. It affects more than 6 million Americans and accounts for nearly 1 in 4 hospital readmissions. CMS sees an opportunity to improve care and reduce spending by shifting the focus to:

• Preventing decompensation and hospitalizations
• Enhancing medication adherence and lifestyle management
• Using remote patient monitoring (RPM) and data to drive earlier interventions
• Closing care gaps through better communication between specialists and primary care
  

Who Will Participate—and How?

The ASM will apply to cardiology practices with at least 20 Original Medicare heart failure patients annually in designated regions. Importantly, participation will be mandatory in selected geographic areas, as outlined in the CMS ASM announcement.

Cardiology practices best suited to begin preparing now include:

• High-volume outpatient cardiology clinics treating complex heart failure patients
• Independent practices aiming to remain competitive as Medicare shifts to value-based specialty care
• Clinics already using RPM tools, such as connected weight scales, blood pressure cuffs, or implantable monitoring devices
• Specialty groups practicing in regions with high Medicare Advantage or ACO penetration
  

How Will CMS Incentivize Cardiology Clinics?

The ASM introduces performance-based payment adjustments, beginning with a potential ±9% adjustment on Medicare Part B claims in Year 1. The model aligns with CMS’s broader strategy to move away from fee-for-service volume and toward value and outcomes.

Specialty practices like Cardiology will be evaluated based on:

• Quality Measures – including blood pressure control, medication adherence, and functional status
• Cost Performance – focusing on reducing hospitalizations and total cost of care
• Improvement Activities – such as patient engagement, health-related social needs screening, and shared care planning
• Interoperability – the ability to exchange data and coordinate care across settings

Additionally, CMS will provide enhanced data feedback and require them to implement Collaborative Care Arrangements, encouraging formalized partnerships between specialists and primary care providers to ensure seamless, team-based management of chronic disease.

This approach goes well beyond traditional RPM reimbursement (99453, 99454, 99457/8), embedding value-based expectations into the entire cardiology care model.

Challenges for Independent Cardiology Clinics

For independent cardiology practices not currently in a Clinically Integrated Network (CIN) or ACO, the ASM presents unique challenges:

1. Data Integration Gaps

Standalone practices may lack full access to hospitalization data, emergency visits, and medication changes happening outside their office. Participation in the ASM will require investment in interoperable technology platforms, or connections to Health Information Exchanges (HIEs). 

2. Care Coordination Requirements

The ASM will require routine collaboration with primary care providers, something not all specialty practices are currently set up to do. Building structured workflows for communication, shared decision-making, and care transitions will be critical.

3. Administrative and Financial Risk

Taking on performance-based payment models means building new reporting processes, quality dashboards, and compliance workflows. Practices will also face financial risk if they underperform against benchmarks.

How Can Clinics Prepare?

Here are actionable steps cardiology clinics can take now to get ready for 2027:

Invest in Interoperable Technology

Adopt platforms that integrate RPM data, EHR information, and claims data to ensure comprehensive care management.

Formalize Collaboration with Primary Care

Set up Collaborative Care Agreements that define roles, responsibilities, and shared goals for managing heart failure patients. This includes creating shared care plans and communication workflows.

Expand Remote Monitoring Today

Use current RPM billing codes (99454, 99457, 99458) to establish a foundation for proactive monitoring. For heart failure, this may involve weight scales or other devices to help identify fluid retention in between clinic visits. This builds the infrastructure and team-based care model needed for the ASM.

Begin Tracking Key Metrics

Start collecting baseline data on heart failure readmissions, blood pressure control, medication adherence, and social needs screenings. This will make it easier to demonstrate improvement once performance periods begin.

Engage Patients in Self-Management

Empower patients through education, remote check-ins, and lifestyle coaching to reduce the risk of hospitalization and complications.

Looking Ahead: A New Era of Specialty Value-Based Care

The Ambulatory Specialty Model is more than just a new payment structure—it represents a shift in how cardiology and other specialties will operate in a value-based system. For heart failure management, this means moving beyond episodic care to longitudinal, data-driven, patient-centered care.

Cardiology practices that start preparing now will not only be ready for ASM’s go-live in 2027—they’ll be ahead of the curve as the entire healthcare system continues to shift toward outcomes-based reimbursement.