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In late July, the Center for Medicare and Medicaid Innovation (CMMI) announced updates to the ACO Realizing Equity, Access, and Community Health (REACH) model beginning in performance year (PY) 2025.1 This announcement coincided with the recent publication by CMMI of the Global and Professional Direct Contracting (GPDC) Model PY2022 Evaluation Report, which cites some of the early findings of the GPDC model, REACH’s predecessor. Specifically, the report states that “as of PY2022, gross Medicare spending increased for Standard DCEs” (DCEs are Direct Contracting Entities which are similar to the ACOs in REACH). Using a statistical method known as difference in differences, the authors of the aforementioned report estimated an overall $193.3 million2 increase in net Medicare spending for DCE participants in Standard Accountable Care Organizations (ACOs). Perhaps to respond to this report’s citation of the increased costs as well as to improve overall model sustainability, CMS introduced the following changes that will reduce expected financial shared savings in PY2025 and PY2026 for many REACH ACOs.