CMS Announces Model to Improve Prevention, Management of High-Cost Chronic Conditions

CMS is proposing the new Ambulatory Specialty Model (ASM), a mandatory payment model focused on specialty care for people with heart failure and low back pain – significant areas of Medicare spending. The model aims to enhance the quality of care and reduce low-value care by improving upstream chronic condition management and coordination between primary care providers and specialists.

The proposed ASM, one of the newest CMS Innovation Center models, is designed to incentivize preventive care and increase financial accountability for specialists. ASM rewards specialists who detect signs of worsening chronic conditions early, enhance patients’ function, reduce avoidable procedures and hospitalizations, and use technology that allows them to communicate and share data electronically with patients and their primary care providers. Participants will be held accountable for their performance, generating savings.

If finalized, the model will begin in January 2027 and run for five performance years through December 2031.

Find more information on the ASM webpage, as well as the press release and fact sheet.

ASM is proposed in the Calendar Year 2026 Physician Fee Schedule Proposed Rule.

Send questions about the model to AmbulatorySpecialtyModel@cms.hhs.gov.

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