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++ Whether accounting for improper payments would cause a change in the ACO's financial performance compared to its performance under the initial determination, including: -- Causing an ACO to meet or exceed its MSR/MLR when it did not do so under its initial determination, or no longer meet or exceed the relevant threshold when it did so under its initial determination

Of the five studies that did report at least one significant association, four showed the association to be tenuous and variable across different models, while only one showed it to be robust

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