Specialty Care Was Never Designed for What Happens Between Visits
Learn how ASM creates a structured framework for executing specialty care plans consistently between appointments.
Read Article →ASM Resource Center
Ambulatory Specialty Model
Educational resources to help healthcare organizations understand, evaluate, and implement CMS’s Ambulatory Specialty Model (ASM); a care delivery model for heart failure patients, built for what happens between visits.
Featured ASM Resources
Featured ASM Resources
Explore the foundational resources that explain the Ambulatory Specialty Model, answer common implementation questions, and provide practical guidance for healthcare organizations.
CMS Ambulatory Specialty Model FAQ for Cardiology Practices
Answers to common questions about implementation, staffing, workflows, technology, and outcomes.
Read Article →Practice Readiness Assessment
A practical tool to help organizations evaluate readiness for implementing ASM across specialty populations.
Explore Resource Center →ASM Framework
How ASM helps practices execute care between visits
The Ambulatory Specialty Model combines clinical oversight, multidisciplinary care teams, monitoring, structured workflows, and patient engagement into a coordinated model for continuous specialty care.
Specialty Clinical Oversight encloses a continuous cycle of four activities that repeat between visits: Technology-Enabled Monitoring, then Structured Clinical Workflows, then Multidisciplinary Care Teams, then Continuous Patient Engagement, and back to Technology-Enabled Monitoring.
The patientbetween every visit
Specialty Clinical Oversight
Technology-Enabled MonitoringStructured Clinical WorkflowsMultidisciplinary Care TeamsContinuous Patient EngagementSpecialty Clinical Oversight
Physicians maintain clinical decision-making while extending their reach beyond the office.
Technology-Enabled Monitoring
Patient data is transformed into actionable clinical insight.
Structured Clinical Workflows
Evidence-based protocols support consistent intervention, escalation, and follow-up.
Multidisciplinary Care Teams
Nurses, pharmacists, APPs, and care coordinators help execute care plans at scale.
Continuous Patient Engagement
Patients remain connected to their care team between visits, not just during them.
What ASM Helps Solve
Closing the execution gap in specialty care
ASM is designed for the gap between clinical intent and clinical reality, where treatment plans often stall, patients disengage, and care teams struggle to keep up.
Patients fall through the cracks between visits.
Medication titration is delayed. Symptoms go unaddressed. Patients disengage. Care remains episodic rather than proactive.
Care plans are actively executed.
ASM brings together monitoring, care teams, protocols, and clinical oversight to help ensure treatment plans are carried out consistently.
Specialty care extends beyond the clinic.
Practices can support complex patients more proactively without relying solely on in-person encounters or already constrained care teams.
Clinical Evidence
ASM in Heart Failure Care
ISHI applies the Ambulatory Specialty Model to heart failure care by combining heart failure clinical expertise, remote monitoring, patient engagement, structured clinical workflows and care coordination.
Executing Heart Failure Care Between Visits
Review real-world outcomes from 747 heart failure patients supported through ISHI's protocol-driven care model.
Read More →Transforming Heart Failure Care Through Active Clinical Management Between Visits
Explore the clinical problem, the care model, and the operational framework behind active management between visits.
Read More →Explore Outcomes and Resources
Review evidence, outcomes, and practical resources supporting active specialty care management.
Explore Evidence →Related Resources
Continue exploring specialty care execution
Explore additional thought leadership, clinical evidence, and practical resources supporting the future of specialty care.
Ready to See ASM in Practice?
Explore the clinical evidence and real-world outcomes demonstrating how the Ambulatory Specialty Model supports active heart failure management between visits.
View Clinical Evidence