Value-Based Care Has Arrived in Cardiology. Practices Need to Be Ready.
Prakash Patel, M.D., is CEO and Chairman of Cardiac Care Alliance (CCA), a market-leading, national physician-led value-based cardiology network supporting cardiologists, health systems, patients, and payers. Learn more at CardiacCareAlliance.com.
For years, cardiologists have heard that value-based care is coming. For some practices, that conversation is now a requirement.
Medicare’s Ambulatory Specialty Model will make selected cardiologists financially accountable for the quality and cost of heart failure care beginning in 2027. Its reach is limited to eligible physicians in designated markets, but its implications extend well beyond those participants. It signals a growing expectation that specialists demonstrate not only the care they provide, but the outcomes and spending that follow.
For cardiologists, the immediate challenge is practical: how to prepare for that accountability without overwhelming the practice or compromising clinical autonomy.
The Medicare deadline
The CMS Innovation Center’s Ambulatory Specialty Model, or ASM, is a mandatory model designed to improve chronic disease management and reduce avoidable hospitalizations and unnecessary procedures. In cardiology, it focuses on heart failure and includes eligible general cardiologists in selected geographic areas.
Three features deserve particular attention:
- Performance measurement begins January 1, 2027, and continues through December 31, 2031.
- Payment adjustments begin in 2029, based on 2027 performance. The two-year lag gives practices time before the financial impact arrives—not before the measurement starts.
- Adjustments range from minus 9% to plus 9% in the first two payment years, increasing to minus 12% to plus 12% in the final payment year. They apply to Medicare Part B payments for covered professional services.
CMS will assess participating physicians across quality, cost, improvement activities, and interoperability, with payment adjustments based on performance relative to peers. This is individual physician accountability, even when the infrastructure needed to succeed sits at the practice or network level.
CMS has proposed additional changes and clarifications in the 2027 Medicare Physician Fee Schedule proposed rule. Practices should follow those developments, but uncertainty over individual provisions is not a reason to postpone preparation. The model’s start date and underlying purpose are already established.
Building readiness without losing independence
“The difficult part is not persuading cardiologists that outcomes matter. It is building the systems that make those outcomes visible, support consistent follow-through, and connect clinical decisions with financial performance.”
In our view, most practices should not have to build that infrastructure on their own. Our physician-led network can spread the investment across practices, share best practices, and prepare the practices for additional value-based opportunities, while preserving local clinical decision-making. At Cardiac Care Alliance (CCA), our approach combines analytics, deep value-based experience producing outcomes, and support for physician-led, coordinated care—all without purchasing providers.
What Cardiologists Should Do Now
For ASM readiness, I would focus that work on five areas.
- Understand Your Patient Population: Ensure physicians have a deep understanding of their patient population, especially if they are subject to ASM today. Regardless, a practice should know which patients have heart failure, where they receive care, and what happens between visits. Data should help physicians identify gaps and act on them—not simply produce another dashboard.
- Optimize Care Transitions: Make sure care transitions are tracked and optimized. Who knows when a patient leaves the hospital? Who arranges follow-up? Who reconciles medications and communicates with primary care? Practices typically need support on these tasks, rather than relying on individual staff members to close every gap.
- Follow Physician-Led Clinical Pathways: Use physician-led widely accepted pathways to support consistent care. Heart failure management should reflect evidence-based treatment, including guideline-directed medical therapy where appropriate, while allowing physicians to account for comorbidities, tolerability, and patient preferences. The aim is to reduce unwarranted variation, not replace judgment.
- Address Patient Access: Address access as an operational and best practice issue. Preparation should include a close look at appointment availability, referral delays, virtual care options, home care services, and the timeliness for symptomatic patients to be seen in the practice.
- Understand Financial Exposure: Model what a payment adjustment would mean for the practice, identify where performance can improve, and make deliberate investments before penalties or lost revenue force the decision.
Partnering with entities like CCA that bring deep experience in commercial and Medicare Advantage value-based arrangements can provide a useful foundation that can be applied to perform under ASM’s specific measures, attribution rules, and reporting requirements.
Beyond Medicare
I expect Medicare Advantage and commercial payers to place greater weight on cardiology performance as they refine networks, benefit designs, and contracting strategies. The pace will vary by market, but the business question is straightforward: which cardiologists can demonstrate high-quality care at a sustainable total cost?
That may translate into preferred network status, lower member cost sharing, more active referral steering, or contracts that tie compensation to measured performance. In some markets, it may also mean narrower networks.
For cardiologists, the potential opportunities are substantial, including incremental revenue and preferred status that can affect referrals, patient access, and negotiating leverage. A practice may deliver excellent care, but if it cannot substantiate that performance, it leaves others to define its value. CCA supports cardiologists in capturing these opportunities.
Employer pressure adds another reason to prepare. As purchasers seek better control over cardiovascular spending, I expect greater interest in arrangements that connect specialty care with measurable outcomes and a clearer account of total cost.
None of this means every payer will adopt the same model. It means practices should build the ability to demonstrate performance before a contract or network decision makes it urgent—and even better, proactively seek market differentiation and upside-only opportunities like CCA offers.
What payer contracting requires
Preparing for measurement and securing a payer agreement are related, but they are not the same task.
My advice is to approach contracting with a realistic understanding of what each side needs.
- Bring meaningful scale. A payer needs a large enough patient population to evaluate results and justify the operational investment. A network can make that conversation more viable for independent practices.
- Make the data defensible. Be prepared to reconcile practice-level findings with payer claims and explain differences in attribution, outcomes, costs, measurement periods, and patient mix.
- Allow time for implementation. An agreement in principle is only the beginning. Contracting, data exchange, clinical workflows, and payment operations all need to be resolved before launch.
- Negotiate the mechanics carefully. Attribution, benchmarks, exclusions, risk adjustment, quality thresholds, and reconciliation terms can matter as much as the headline savings opportunity.
- Start with manageable exposure. A focused arrangement around a defined population can establish credibility before a practice takes on broader financial risk.
A good value-based contract should give physicians a fair opportunity to influence the results for which they are accountable. That requires careful design and execution—not simply an attractive shared-savings percentage.
The work starts now
Independent cardiology practices do not need to abandon their identity to participate in value-based care. They do need a clearer view of their performance and reliable systems for managing care beyond the office visit.
ASM puts a date on that work for selected physicians. Commercial and Medicare Advantage payers may create a different timetable for others. Either way, I believe practices will be better positioned if they can explain their results, identify where improvement is needed, and gain incremental upside from outcomes.
The first payment adjustment may arrive in 2029. The performance that determines it begins in January 2027. That is the deadline practices should plan around.
Where CCA Comes In
Cardiac Care Alliance helps cardiology practices prepare for the shift to value-based care while preserving their underlying fee-for-service contracts and clinical autonomy. Through a physician-led network, actionable data, coordinated care support, and deep experience in value-based payer arrangements, CCA helps practices build the infrastructure to demonstrate performance and pursue new opportunities—all without purchasing practices.
Is your practice affected by the 2027 Ambulatory Specialty Model?
Explore ASM readiness and connect with our team: connect.cardiaccarealliance.com/asm
To learn more about Cardiac Care Alliance, visit CardiacCareAlliance.com or contact network@cardiaccarealliance.com.
Sources
- Centers for Medicare & Medicaid Services. Ambulatory Specialty Model (ASM) Overview. Supports the model’s purpose, participation criteria, performance periods, and payment adjustments.
- Centers for Medicare & Medicaid Services. Ambulatory Specialty Model Frequently Asked Questions. Supports physician-level accountability, reporting requirements, and payment timing.
- Centers for Medicare & Medicaid Services. CY 2027 Medicare Physician Fee Schedule Proposed Rule. Supports Prakash’s discussion of proposed regulatory changes.
