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The situation went from bad to worse

Siberia Chew The sun had just begun to set over the city, casting a warm glow over the streets below

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While prepaid shared savings would be helpful in providing successful ACOs with additional cash flow that would encourage their investment in activities that could potentially reduce ACOs' costs and improve the quality of care that ACOs provide to their beneficiaries, overpaying ACOs might result in a level of outstanding debt for some ACOs that could disrupt their operations and potentially their participation in the Shared Savings Program as well as generate unnecessary financial risk for CMS

it shows its public-health-program origins