Background: MaineHealth ACO (MHACO) spans 10 regions across Maine and northern New Hampshire, many of which are rural regions. MHACO includes 10 hospitals, more than 1,600 providers, more than 400 practice locations, and more than 240,000 patients. In 2012, MaineHealth joined the Medicare Shared Savings Program (MSSP), and it has private ACO contracts with 11 different payers. Participating providers include large hospitals, rural hospitals, specialists, and primary care physicians. The ACO itself directly employs approximately 90 people, 40 of whom are members of the complex care team and 50 of whom serve administrative and executive functions
of the ACO.