Ambulatory Specialty Model (ASM)
CMS Ambulatory Specialty Model (ASM) — Starting 2027
The Ambulatory Specialty Model (ASM) is a new CMS model that builds on existing value-based care frameworks, designed to improve outcomes and reduce costs in outpatient specialty care. Beginning January 1, 2027, the model will run for five performance years through 2031, with payment adjustments extending beyond that period.
CMS has already released participants for the 2027 performance year.
ASM represents a shift in how specialists are held directly accountable for performance, building on existing value-based care models
A Mandatory Model for Select Specialists
Participation in ASM is required for selected providers, with no opt-out option. If a provider is in an ACO, that does not exempt them from ASM, they would need to do both. CMS will identify eligible specialists based on:
Clinical focus areas
Patient volume thresholds (e.g., treating Medicare patients with targeted conditions)
Geographic selection (CBSAs and metropolitan areas)
The model applies to specialists treating heart failure and low back pain, two high-cost, high-impact conditions in the Medicare population.
ASM Replaces MIPS for Selected Participants
For participating providers, ASM replaces MIPS during the years they are in the model. However, this applies only to selected participants. Providers may still be required to participate in other value-based care models, such as MSSP, at the same time.
Performance in MIPS is directly tied to reimbursement as well.
Performance Driven Payment Adjustments
Under ASM, Medicare payments will be adjusted based on provider performance.
These adjustments:
Are evaluated at a condition-specific level (e.g., heart failure and low back pain)
Are benchmarked against peer specialists treating similar patient populations
Apply directly to specialists across all Medicare Part B services
Include both upside and downside risk, consistent with other value-based care models
Value-based care programs have long tied performance to revenue. With ASM, accountability is applied directly to specialists and at a condition-specific level.
Focus on Upstream Management and Care Coordination
ASM emphasizes proactive, upstream management of chronic conditions through condition-specific measures and episode-based accountability, encouraging specialists to:
Identify and address risks earlier in condition-specific episodes of care
Manage heart failure and low back pain populations to prevent avoidable hospitalizations
Reduce unnecessary procedures within defined specialty care pathways
Collaborate more directly with primary care providers under increased coordination expectations
The model also requires stronger care coordination, data sharing, and patient engagement, with clearer expectations for specialist involvement in longitudinal patient management.
Driving Measurable Outcomes in Specialty Care
By aligning incentives with outcomes, ASM is designed to:
Improve chronic disease management
Enhance patient experience and functional outcomes
Reduce the total cost of care
Increase accountability across specialty providers
Ultimately, ASM represents an extension of value-based care into specialty practice, extending performance-based reimbursement deeper into specialty care.