All ETDs from UAB

Advisory Committee Chair

Thomas L Powers

Advisory Committee Members

Andres Azuero

Stephen J O'Connor

Jose B Quintana

Robert Weech-Maldonado

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


The purpose of this dissertation was to study market and organizational drivers associated with inter-organizational network participation. Inter-organizational networks are increasingly emerging across industries as a strategy for adapting to fundamental changes in competitive market environments. Specifically, this study empirically examined the association between market and organizational drivers for a sample of U.S. hospitals relative to their participation or non-participation in Medicare ACOs as a newly emergent inter-organizational network in the healthcare sector. This was a cross-sectional study of U.S. hospitals participating in Centers for Medicare and Medicaid Services (CMS) designated ACOs as of January 1, 2014 and hospitals not participating as of that date. There were nTotal = 3757 cases in the analysis with nParticipating = 538 ACO participating hospitals and nNonparticipating = 3219 non-participating hospitals. Data were complete for 2793 cases. Binary logistic regression was used to predict hospital ACO participation. The findings indicated that the market and organizational drivers, acting jointly, were significantly associated with inter-organizational network participation. Seven out of twelve hypotheses were accepted in the joint model. The findings indicated that market related drivers were significantly associated with participation in inter-organizational networks with five of seven hypotheses accepted. The study supported an association between Environmental Complexity (i.e., Herfindahl-Hirschman Index and Location), Environmental Munificence (i.e., standardized Per Capita Income and Primary Care Physician Supply/1000 population), and Market Demand (i.e., Medicare Mortality rate) with inter-organizational network participation (i.e., hospital ACO participation). Organizational drivers were significant with two out of five hypotheses accepted in the joint model. Slack Resources (i.e., Hospital Occupancy) and Quality (i.e., hospital HCAHPS score) were significant and positively associated with inter-organizational network participation (i.e., hospital ACO participation). These results suggested that organizational characteristics were a modest driver of participation decisions. Findings from this study have both theoretical and practical implications.



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