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On August 30, the Centers for Medicare and Medicaid Services (CMS) released performance results for the ninth performance year (2021) of the Medicare Shared Savings Program (MSSP). The 2021 data represent the first full year of performance since the start of the COVID-19 pandemic, which continues to impact Medicare spending and cause a high degree of uncertainty in the Medicare program as noted in the 2021 Medicare Trustee’s Report. To that end, CMS maintained programmatic flexibilities, as detailed in our previous article detailing 2020 performance results, throughout the 2021 performance year to help accountable care organizations (ACOs) cope with the unprecedented situation. These flexibilities include removing COVID-19-episode costs from the benchmark and expenditure calculations and allowing ACOs to receive the higher of either their quality score or the national average. As such, this year’s results must continue to be interpreted with caution.