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Healthcare Insights

How many accountable care organizations (ACOs) are in each state?

An accountable care organization (ACO) is a healthcare delivery model that aims to improve the quality and coordination of care for patients while reducing costs. It is a network of healthcare providers, including doctors, hospitals, and other healthcare professionals, who voluntarily come together to provide coordinated care to a specific population of patients.

The primary goal of an ACO is to promote collaboration and integration among different healthcare providers to deliver more effective and efficient care. By working together, ACO members strive to improve patient outcomes, enhance patient satisfaction, and achieve cost savings by avoiding unnecessary duplication of services or hospital admissions.

Using data from our ConnectedCareView product, the heatmap below shows how many ACOs are in each state across the U.S. to date. It’s important to note that not all states report how many ACOs they have and may use different terminology when referring to their ACO initiatives.

The number of ACOs by state

Fig 1. Heatmap shows the number of ACOs by state. Data is from the Definitive Healthcare’s ConnectedCareView product. Data accessed in May 2024.

How many states have ACOs?

Definitive Healthcare tracks more than 1,800 active ACOs across the U.S. Our list of accountable care organizations by state highlights the states with the most and fewest ACOs.

List of ACOs by state

RankStateNumber of ACOsExplore dataset
1California151Explore
2Maryland128Explore
3Massachusetts120Explore
4Florida119Explore
5Texas119Explore
6New York106Explore
7Tennessee86Explore
8Colorado78Explore
9Illinois65Explore
10Pennsylvania65Explore
11Arizona64Explore
12Washington64Explore
13Ohio59Explore
14New Jersey58Explore
15Michigan51Explore
16North Carolina49Explore
17Virginia48Explore
18Connecticut45Explore
19Oregon40Explore
20Minnesota35Explore
21Georgia32Explore
22Missouri32Explore
23Maine25Explore
24Iowa23Explore
25Indiana20Explore
26Nebraska17Explore
27Wisconsin17Explore
28Kansas15Explore
29Idaho13Explore
30Louisiana13Explore
31New Hampshire13Explore
32South Carolina13Explore
33Utah12Explore
34Kentucky11Explore
35Nevada11Explore
36Oklahoma8Explore
37Rhode Island8Explore
38Vermont8Explore
39Delaware6Explore
40Montana5Explore
41Arkansas4Explore
42Alabama3Explore
43Hawaii3Explore
44Mississippi3Explore
45District of Columbia2Explore
46South Dakota2Explore
47West Virginia2Explore
48Alaska1Explore
49North Dakota1Explore
50New Mexico1Explore

Fig. 2. Data is from Definitive Healthcare’s ConnectedCareView product. Data accessed May 2024.

California has the highest number of ACOs with 151, and Maryland follows closely with 128 ACOs. Massachusetts, Florida, and Texas have 120, 119, and 119 ACOs respectively. New York has 106 ACOs. The numbers gradually decrease across other states, with North Dakota, New Mexico, and Alaska having the lowest count with only one ACO each.

In general, as the population of a state increases, the number of ACOs also tends to increase, but the relationship is not extremely strong. While states with larger populations might be expected to have more ACOs due to greater healthcare demand, other factors such as state regulations, healthcare delivery models, and provider participation rates can also influence ACO formation.

For a deeper understanding of ACOs, consider checking out the top 25 ACOs ranked by gross savings and the top 25 ACOs ranked by patient population.

Are ACOs only for Medicare?

No. While ACOs were originally established as a payment model for Medicare, many private sector health plans have launched their own ACO networks. These ACOs are usually offered as distinct insurance product options available to individuals and employers. Often, they are offered through a health maintenance organization or a preferred provider organization.

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