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An ACO with assigned beneficiary expenditures and regional service area expenditures with little or no impact from the SAHS billing activity will receive a relatively higher benchmark update under the national-regional blended update factors used in performance year reconciliation, and therefore, may appear to perform better as a result of the national impact of the SAHS billing activity, resulting in higher earned performance payments or lower or no losses for the ACO

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Evidence on B12 and sleep is mixed: B12 helps regulate circadian rhythm in some contexts, yet high B12 status has been linked with shorter sleep in others