Navigating the Ambulatory Specialty Model: What ASM Signals for Value-Based Care and How Deacon Can Help
The Centers for Medicare and Medicaid Services is continuing its push to embed accountability deeper into healthcare delivery.
The Transforming Episode Accountability Model (TEAM) focuses on acute surgical episodes in hospital settings, and complements existing accountable care programs such as Medicare Shared Savings Program (MSSP) and ACO REACH.
The Ambulatory Specialty Model (ASM) builds on this foundation by extending mandatory value-based care into high-cost, high-volume specialty care.
Together, TEAM and ASM signal a consistent direction from the CMS Innovation Center: fewer carve-outs across inpatient, outpatient, and specialty settings, and greater accountability across the full continuum of care.
For organizations already preparing for TEAM, ASM should feel familiar in its structure and expectations, even if the clinical focus differs. Importantly, ASM allows participants to remain engaged in other CMMI models, reinforcing CMS’s intent to layer accountability rather than fragment it.
What Makes the Ambulatory Specialty Model Different
ASM holds specialists financially accountable for managing chronic conditions, specifically heart failure and low back pain, two areas of substantial Medicare spending with significant opportunity for improvement through earlier intervention and better coordination.
The model is scheduled to begin in 2027 and run for five performance years, supporting CMS’s broader goal of moving 100% of traditional Medicare beneficiaries into accountable care models by the end of the decade.
Under the final rule, CMS will select specialists from approximately 25% of metropolitan statistical areas based on historical claims data. Participation will be mandatory for clinicians who treat at least 20 Medicare patients annually for heart failure or low back pain. Performance will be evaluated across four domains: quality, cost, care improvement activities, and promoting interoperability, with payment adjustments of up to ±9% applied to future Medicare Part B claims (with the risk level increasing to ±12% by 2033).
What ultimately distinguishes ASM is its focus on ambulatory specialty care as a driver of downstream cost and outcomes.
Coordination Moves to the Center of Specialty Care
A defining feature of ASM is its requirement for closer collaboration between specialists and primary care providers.
Selected specialists must enter into at least one Collaborative Care Arrangement with a primary care provider, incorporating elements such as bi-directional data sharing, co-management of care, transitions planning, closed-loop referrals, and integrated care coordination activities. The model also places significant weight on certified electronic health record use and health information exchange to support seamless communication across settings.
Chronic disease management cannot succeed in silos. Specialists are expected to take a more proactive role in coordinating care, not just delivering episodic interventions.
How Deacon Helps You Prepare for ASM
Deacon Health’s deep understanding of TEAM is also applicable to ASM.
At its core, ASM requires three things: reliable coordination across providers, consistent execution of evidence-based care, and real-time visibility into patient risk and progress. Deacon supports all three.
Through high-touch coordination, Deacon helps ensure patients receive the right care, in the right setting, at the right time, while remaining connected to in-network specialists and primary care providers. This visibility across settings supports the collaborative care expectations embedded in ASM.
Deacon’s evidence-based approach also aligns with ASM’s performance requirements. By grounding care coordination in validated benchmarks and transparent measurement, organizations can better understand how quality, utilization, and cost intersect for chronic condition management.
Finally, Deacon’s data-driven platform supports the interoperability and decision-making ASM demands. Integrated clinical and social data enable earlier identification of risk, more informed referrals, and proactive intervention, helping specialists and care teams focus attention where it matters most.
Preparing Now for What Comes Next
Mandatory specialty participation in value-based care is coming, and preparation cannot wait until 2027.
Specialists and healthcare organizations should be evaluating referral patterns, care coordination workflows, data-sharing capabilities, and partnerships that support longitudinal management of chronic conditions. Those who act early will be better positioned to manage risk, improve outcomes, and capture the upside ASM offers.
ASM reinforces a broader truth about where healthcare is headed. Value-based care is no longer confined to specific settings or provider types. It is becoming the operating standard. Deacon is committed to supporting organizations as they navigate these models, bringing structure, consistency, and clarity to an increasingly accountable care environment.