Analyzing Determinants of Hospitals' Accountable Care Organizations Participation

Valerie Yeager, Yongkang Zhang, Mark L. Diana

Research output: Contribution to journalArticle

16 Scopus citations


Accountable care organizations (ACOs) are rapidly being implemented across the United States, but little is known about what environmental and organizational factors are associated with hospital participation in ACOs. Using resource dependency theory, this study examines external environmental characteristics and organizational characteristics that relate to hospital participation in Medicare ACOs. Results indicate hospitals operating in more munificent environments (as measured by income per capita: β = 0.00002, p <.05) and more competitive environments (as measured by Health Maintenance Organization penetration: β = 1.86, p <.01) are more likely to participate in ACOs. Organizational characteristics including hospital ownership, health care system membership, electronic health records implementation, hospital type, percentage of Medicaid inpatient discharge, and number of nursing home beds per 1,000 population over 65 are also related to ACO participation. Should the anticipated benefits of ACOs be realized, findings from this study can guide strategies to encourage hospitals that have not gotten involved in ACOs.

Original languageEnglish (US)
Pages (from-to)687-706
Number of pages20
JournalMedical Care Research and Review
Issue number6
StatePublished - Jan 1 2015
Externally publishedYes


  • Accountable Care Organization (ACO)
  • environment
  • health care quality
  • resource dependency theory

ASJC Scopus subject areas

  • Health Policy

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