For years, the healthcare industry broadly and Centers for Medicare & Medicaid (CMS) specifically have been looking for ways to manage ever increasing healthcare costs without compromising quality. In an effort to achieve this goal, CMS has been considering options for shifting financial risk to providers as a way to incentivize practitioners to provide efficient, lower-cost care. The Medicare Access and CHIP Reauthorization Act, or (MACRA) is a sweeping reform designed to, change how providers are reimbursed for Medicare FFS beneficiaries and encourage providers to enter into financial risk sharing agreements for the care of their patients. Although the goal is simple, the details of the program and associated alternative payment models are quite complex. Actuaries are poised to help both payers and providers of all types manage this transfer of insurance risk and create approaches to achieve desired outcomes.