ASM
Ambulatory Specialty Model
The Ambulatory Specialty Model (ASM) aims to improve prevention and upstream management of chronic disease, which would lead to reductions in avoidable hospitalizations and unnecessary procedures. Participation in ASM will be mandatory for specialists who commonly treat people with Original Medicare for heart failure or low back pain in an outpatient setting across selected regions.
Innovation
ASM focuses on outpatient specialty care of chronic conditions rather than hospital-based alternative payment models. It holds participants accountable for screening and risk identification in addition to patient experience and health outcomes, rewarding specialists for effective upstream disease management and coordination with primary care.
The Problem
Delayed detection of chronic conditions, financial incentives that encourage unnecessary procedures, and the lack of care coordination among specialists and primary care providers all contribute to poor health outcomes for people who are at risk for or living with chronic disease. These include delayed diagnosis and poor disease management.
The Solution
ASM will promote preventive care and more effective upstream chronic disease management by rewarding specialists for improving patient health outcomes and coordination with primary care providers.
Expected Outcomes
ASM will reduce avoidable hospitalizations and unnecessary procedures, improve patient experience and outcomes, and lower costs to Original Medicare.
Strategy
ASM will help to Make America Healthy Again by promoting preventive care through interventions like screening, increasing transparency by making provider performance assessments more widely available, and protecting American taxpayers by holding specialists accountable for the cost of care.
Model Goals
- Improve prevention and upstream management of chronic disease
- Reduce avoidable hospitalizations and unnecessary procedures
- Improve patient experience and outcomes
- Lower costs to Original Medicare
Patient Eligibility
People with Original Medicare treated for heart failure or low back pain in an outpatient setting.
- Enrolled in Original Medicare
- Treated for heart failure or low back pain in an outpatient setting
Provider Eligibility
Individual physicians in selected mandatory geographic areas who bill under the Medicare Physician Fee Schedule for specific specialties related to heart failure or low back pain.
- Bill claims under the Medicare Physician Fee Schedule
- Have a selected specialty type related to an ASM targeted chronic condition (cardiology, anesthesiology, interventional pain management, neurosurgery, orthopedic surgery, pain management, or physical medicine and rehabilitation)
- Attributed to 20 or more episodes from the episode-based cost measure (EBCM) related to their specialty type and ASM targeted chronic condition
- Practice in one of the selected mandatory geographic areas
- Must not exclusively provide services billed under Rural Health Clinics (RHCs) or Federally Qualified Health Centers (FQHCs) payment systems
- Non-physician providers are not eligible
Care Categories
Chronic Disease Management
Program Benchmarks & Thresholds
eligibility
financial
operational
quality
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