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Banner Health’s acquisition of the University of Arizona Health Network has completely transformed the latter health system and integrated it into the greater Banner system. Tenet Healthcare’s joint venture acquisition of Carondelet Health Network ushered CHN toward value-based care through its new Physician Performance Network of Arizona ACO. Though Banner employs a moderate number of physicians through its employed physician groups, the majority of physicians in Tucson are in small, independent groups, and they have eschewed health system employment and control and instead gotten involved in networks like Arizona Connected Care, a CIN that has five ACOs. Arizona’s new managed Medicaid contract will lead to enrollment shifts. The state’s request to add work and community engagement requirements to its Medicaid program, if approved, will lead to enrollment losses for participating carriers and could have a chilling effect on both future enrollment and patient access to branded prescription drugs.