On December 21, CMS finalized the Medicare Shared Savings Program Pathways to Success rule. The final rule represents the most sweeping changes to the program since its inception. While accelerating the transition to risk, the rule's changes to the benchmarking methodology and expanded opportunities to use telehealth, beneficiary incentives, and skilled nursing facility waivers increase opportunities for ACOs to succeed financially in the program. However, like under prior program rules, for ACOs to successfully improve patient outcomes and reduce the total cost of care, they will need an aligned funds flow model, infrastructure to support care redesign and individualized care plans, and strong partnerships with post-acute networks.