Healthcare Insights
Top IDNs by net patient revenue
Net patient revenue (NPR) is a metric used to identify financially successful healthcare organizations. To gain a bigger picture of how financially strong a network of facilities is, the NPR of an integrated delivery network (IDN), or health system, can be a key indicator.
What is an IDN in healthcare?
An integrated delivery network (IDN), also referred to as a health system, is an organization that owns and operates a network of healthcare facilities. An IDN may include facilities such as hospitals, physician groups, clinics, ambulatory surgery centers, and imaging centers, to name a few.
Using the Definitive Healthcare HospitalView product, we have created a list of the top IDNs in the U.S. by their net patient revenue. The data is aggregated from affiliated facilities based on data from the Medicare Cost Report and is according to the most recent 12-month interval tracked in our database.
| Rank | IDN name | Definitive ID | HQ state | NPR | Explore dataset |
|---|---|---|---|---|---|
| 1 | HCA Healthcare (FKA Hospital Corporation of America) | 4710 | TN | $ 60,343,640,684 | Explore |
| 2 | Kaiser Permanente | 4713 | CA | $ 32,563,488,111 | Explore |
| 3 | CommonSpirit Health | 981465 | IL | $ 32,509,931,129 | Explore |
| 4 | Advocate Health | 1057655 | NC | $ 25,785,142,257 | Explore |
| 5 | University of California Health (AKA UC Health-CA) | 560423 | CA | $ 25,105,164,284 | Explore |
| 6 | Providence St Joseph Health (AKA Providence) | 4716 | WA | $ 21,637,452,810 | Explore |
| 7 | Trinity Health (FKA CHE Trinity Health) | 4712 | MI | $ 19,415,366,749 | Explore |
| 8 | AdventHealth (FKA Adventist Health System) | 4694 | FL | $ 19,258,731,508 | Explore |
| 9 | Ascension Health | 4695 | MO | $ 17,805,369,564 | Explore |
| 10 | Northwell Health (AKA North Shore Long Island Jewish Health System) | 4744 | NY | $ 16,096,967,312 | Explore |
Fig. 1 Data is from the Definitive Healthcare HospitalView product. Data is aggregated from affiliated facilities based on data from the Medicare Cost Report and is displayed according to the most recent 12-month interval tracked in our database. Data accessed October 2026.
What is the largest health system in the U.S. by net patient revenue?
The leading IDN in the U.S. by net patient revenue is HCA Healthcare, generating $60.3 billion during the most recent 12-month interval tracked in our database.
Kaiser Permanente and CommonSpirit Health nearly tie for second place, with each health system generating about $32.5 billion.
As some of the biggest providers of healthcare in the U.S. the IDNs on our list similarly rank high on our lists of the largest health systems ranked by number of hospitals and discharges, and our list of top healthcare systems by operating expenses.
The average net patient revenue for all IDNs tracked in the most recent 12-month interval is $2.1 billion. The average NPR for the top 10 IDNs listed above is $27 billion.
Definitive Healthcare looked at more than 800 reporting IDNs for this analysis.
Hospital metrics beyond net patient revenue
Net patient revenue (NPR) is a key indicator of an IDN’s financial performance, but it doesn’t tell the whole story. To fully understand the financial health and operational efficiency of a health system, it’s important to consider other metrics related to costs and expenses.
Operating expenses provide critical insight into how much it costs an IDN to deliver care across its network. A high NPR paired with equally high operating expenses could indicate tight profit margins or operational inefficiencies. Conversely, lower operating costs relative to revenue suggest better financial management and resource utilization.
Other important financial metrics to consider include operating margin, average daily census, debt service coverage ratio, supply chain costs, capital investment, bad debt and charity care expenses, and return on assets—each of which provides insight into an IDN’s profitability, financial stability, operational efficiency, and ability to reinvest in growth and quality care.
By examining these financial metrics alongside NPR, healthcare stakeholders can gain a more balanced view of an IDN’s financial stability and capacity for growth. This deeper understanding supports more strategic marketing, partnership decisions, and sales engagements tailored to each health system’s unique financial profile.
Keys to marketing and selling to IDNs
Marketing or selling to a health system offers a strategic opportunity to engage with key decision makers who influence clinical and operational practices across a wide range of healthcare facilities. Because IDNs manage multiple hospitals, outpatient centers, physician groups, and other care sites, successfully partnering with an IDN can help you reach a larger patient population more efficiently than targeting individual providers or facilities alone.
Engaging IDN leadership requires understanding their priorities, such as improving patient outcomes, reducing costs, and optimizing care coordination. Tailoring your product or therapy messaging to address these goals can increase receptivity and open doors for deeper collaboration.
Moreover, IDNs often have centralized purchasing and standardized protocols, meaning that a single approval can lead to widespread adoption across their network. This scale effect not only accelerates market penetration but also strengthens long-term partnerships, providing sustained growth opportunities.
Finally, demonstrating how your solution integrates with existing workflows and supports value-based care initiatives can further position your offering as an essential tool for IDNs aiming to enhance quality while controlling expenses.
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Healthcare Insights are developed with data from the Definitive Healthcare product portfolio and from CMS. Want even more insights? Start a free trial now and get access to the latest intelligence on hospitals, physicians, and other healthcare providers.
