The Pivotal Role of Healthcare IDNs in Purchasing and Population Health
CMS is putting increasing pressure on healthcare providers to deliver high-quality care to patients at the lowest possible cost while simultaneously reducing preventable readmissions. Some care providers have joined accountable care organizations (ACOs) to meet these expectations. However, though ACOs are capable of providing coordinated, timely care, they have limitations as a group of individual providers, care centers, and health plans.
Integrated delivery networks (IDNs) are similar to ACOs in that they are systems of providers and care sites that aim to improve patient experience and care while reducing cost. Unlike an ACO, a healthcare IDN is a cohesive group that offers a full range of preventative and acute care services, as well as health insurance plans, rather than a collection of individual providers and payors. Definitive Healthcare currently tracks more than 960 IDNs across the United States.
Top GPOs Affiliated with IDNs
|GPO Name||# Affiliated IDNs|
|HealthTrust Purchasing Group||134|
|The Resource Group||24|
Fig 1 Data from Definitive Healthcare
In order to improve on quality metrics and clinical performance, both IDNs and ACOs must monitor patient population health. As regional organizations, IDNs are in a unique position to assess the particular needs of the local population. These insights allow IDNs to focus on the most prevalent health issues in their communities. IDNs in particular are able to address social determinants of health. Because many IDNs own or manage specialty and home care services, they are able to send paramedics and nurses to patients’ homes for treatment of mental health or substance abuse issues.
Texas alone has 80 IDNs, according to Definitive Healthcare data, and each of these would likely emphasize different care needs. Austin, for example, would likely have a younger population and healthcare that targets mental health and preventative medicine. In a more rural area, where patient populations are likely to be older, healthcare focus might be on diabetes, obesity, and chronic pain.
For IDNs and ACOs to be successful in delivering quality and cost-effective care, they must utilize convenient and comprehensive data sharing. Some IDNs are beginning to assume risk in terms of bundled payments and population health management. In order to assess this risk, IDNs rely on payor claims data through health information systems (HIEs). For both ACOs and IDNs, HIEs are integral in sharing patient data across the care continuum, allowing providers to coordinate care and ensure that there are no lapses in treatment. These organizations can also engage providers by giving them data on key metrics, as well as feedback on their own patients in terms of experience and overall health.
Another incentive for being part of a coordinated care organization is the ability to reduce care costs for patients and care providers. Where ACOs themselves cannot be part of group purchasing organizations (GPOs), their member hospitals often are. However, many IDNs are able to leverage their size to negotiate prices on their own. Approximately 80 percent of IDNs are associated with at least one GPO, according to Definitive Healthcare data, with the most popular being Vizient. In comparison, only about 36 percent of hospitals are part of both an ACO and a GPO.
One of the largest healthcare costs is that of providing employee health benefits. Many employers cannot afford to use traditional channels to offer health insurance, and some are turning to individual IDNs. Because IDNs can offer their own health plans, they are increasingly attractive to employers requiring employee benefit plans. Both ACOs and IDNs are being asked by employers to take on greater risks for managing their employees’ health through bundled payments and networks. This puts both types of organizations in a unique place in terms of coordinating affordable care while simultaneously reducing purchasing costs.
Healthcare IDNs are in a pivotal place on the healthcare continuum. They are able to offer their own healthcare plans, while managing and operating their own primary, specialty, and acute care centers and physicians. Because IDNs control every aspect of their network, it is easier to reap the benefits of group purchasing, direct contracts with employers, and data sharing through HIEs. These factors suggest that IDNs could be able to shape healthcare practices and trends moving forward.
Fig 2 Data from Definitive Healthcare
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