Description: On August 8, 2018, the Centers for Medicare and Medicaid Services (CMS) released a sweeping proposed rule that, if enacted, will significantly change the Medicare Shared Savings Program (MSSP). The proposed regulation, titled “Pathways to Success,” accelerates the path for accountable care organizations (ACOs) to participate in shared risk arrangements while simultaneously softening key provisions, allowing lower revenue ACOs to participate with reduced total financial risk. In addition, CMS has proposed numerous methodological and operational changes. In this presentation we share the most important details of the proposed regulation’s key provisions and briefly discuss how they might impact the Medicare Shared Savings Plan. Furthermore, we will discuss how changes to the Medicare ACO program are likely to have ripple effects in commercial ACOs, and how actuaries are poised to help both payers and providers navigate and succeed in these complex arrangements.