Delaware is the only state in the U.S. without an ACO. Conversely, California has 46, Florida has 42 and Texas has 33 ACOs. Those are the three states with the highest number of ACOs, according to Mr. Muhlestein.
States with higher populations are more likely to have more ACOs, according to Mr. Muhlestein. However, there is also a geographic pattern to the spread of ACOs. The Midwest and the West Coast have seen the most extensive growth, while the Deep South, the Great Plains and the Mountain West have seen the least.
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