Graduate School of Business


Doctor of Business Administration (DBA)


Terrence Duncan


Health System, Accountable Care Organization, Complex Systems, System Dynamics Modeling, Feedback Loops, Nonlinearity


Business | Economics


The Patient Protection and Affordable Care Act of 2010 introduced accountable care organizations as a critical component in the transformation of the United States healthcare industry to a value-based care model. It also triggered an ongoing series of health system consolidations consistent with the theory of transaction cost economics. Consolidations included the alignment of health systems with accountable care organizations despite the assertions of some researchers that competing economic models rendered such partnerships financially unviable. The academic literature is silent on this issue, without any published studies of the effects of health system / accountable care organization interactions. The purpose of this qualitative study was to document the nature of health system / accountable care organization interactions to support the future construction of a system dynamics model. The research uncovered five themes demonstrating the absence of consideration for the effects of inter-organizational interactions among healthcare expert participants due to a lack of awareness of the presence of feedback loops and nonlinearity. The results of the research study demonstrated for the first time the presence of feedback loops in health system / accountable care organization interactions, the necessary presence of nonlinear behaviors governing those interactions, and the requirement to employ system dynamics models to accurately project future firm performance in health system / accountable care organization partnerships.