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Nature 295 , 605607 (1982)

We will also require ACOs inexperienced with performance-based risk Medicare ACO initiatives to progress more rapidly to higher levels of risk and potential reward under a two-sided model by their second agreement period, by requiring them to participate under Level E of the BASIC track or the ENHANCED track

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6 On top of these biological changes, insulin resistance may increase around midlife, making it easier to gain weight and harder to lose it