“…39,40 Such studies have had varied outcomes in measuring financial and health benefits to the implementation of ACOs, as well as measurements of the benefits in relation to the size and structure of the ACO. 45 Cigna Health, based in Connecticut, has implemented ACOs in several states, including Arizona, New Hampshire, and Texas. 44 Blue Cross Blue Shield of Massachusetts implemented a payment system paralleling an ACO payment organization in 2009, identified as an alternative quality contract, in which IDSs were measured for performance and financial benefit.…”