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Healthcare Insights

How many IDNs are in the U.S.?  

The rise of integrated delivery networks (IDNs) is a defining trend in U.S. healthcare. These powerful organizations bring together a diverse network of healthcare facilities and providers–hospitals, physician groups, and clinics–under one umbrella.

This integrated approach aims to streamline care delivery by providing patients with a seamless experience across a broad spectrum of services, from routine checkups to complex surgical care.

As of April 2024, Definitive Healthcare tracked over 1,100 active IDNs across the U.S. Their distribution varies by state, with some states boasting nearly 100 headquartered IDNs, while others have only a handful.

Using Definitive Healthcare’s HospitalView data, we ranked the U.S. states where the most IDNs are headquartered as of April 2024. Data on these systems is updated daily and based on proprietary research.

States with the most IDN headquarters

Rank State Number of IDNSExplore dataset
Texas 103 Explore
California 90 Explore
New York 57 Explore
Florida 54 Explore
Tennessee 52 Explore
Pennsylvania 49 Explore
Illinois 47 Explore
Georgia 38 Explore
10 Louisiana 34 Explore

Fig. 1. Data is from the Definitive Healthcare HospitalView product. Data accessed April 2024.

Which states have the most health systems/IDNs?

Texas has the most IDN headquarters with 103. Texas has a total population of 30 million people and is one of the largest states in the country by both size and population. It is also home to some of the largest IDNs in the country, including Tenet Healthcare, Baylor Scott & White, and Steward Healthcare System.

California follows closely behind with 90 IDNs. As the most populous state in the U.S., California likely has a high demand for a comprehensive network of healthcare facilities, making IDNs a valuable model. Some of the most notable IDNs headquartered in California include Dignity Health, Prime Healthcare Services, and Kaiser Permanente. Discover the largest California IDNs.

New York takes the third spot with 57 IDNs. Similar to California and Texas, New York's large population might explain the significant number of IDNs headquartered there. Some of the most notable IDNs headquartered there include Northwell Health, New York-Presbyterian Healthcare System, and Mount Sinai Health System.

States with the fewest IDN headquarters

Rank State Number of IDNs Explore dataset
Vermont Explore
Delaware Explore
North Dakota  Explore
Wyoming Explore
Rhode Island Explore
South Dakota Explore
Alaska Explore
Nevada Explore
District of Columbia Explore
Hawaii  Explore

Fig. 2.  Data is from Definitive Healthcare’s HospitalView database. Data accessed in April 2024.

Which states have the fewest IDNs?

With only two IDNs, Vermont has the lowest number of headquartered integrated delivery networks, including the University of Vermont Health Network and North Star Health. This could be due to its small population size and rural nature, potentially leading to less demand for a complex network of healthcare facilities.

Three states share the second position with just three IDNs each: Delaware, North Dakota, and Wyoming. These states also tend to be smaller in population and geographically spread out, which might influence the number of established IDNs.

The third-place spot is also a tie between South Dakota and Rhode Island, with four IDNs headquartered within each. These states are all either geographically small or have a relatively low population density. This could mean a smaller overall need for healthcare systems.

It's important to consider that "fewest" is relative. Even with only two or three IDNs, these states might still have adequate healthcare coverage for their residents, or have population density that’s situated close to bordering states, with residents traveling to the border state for their care.

What is the difference between an IDN and a health system?

While IDNs are considered health systems, not all health systems may be classified as IDNs. An IDN is a form of health system, but traditional health systems differ in that they are typically independent organizations that work together through contractual agreements and share financial and medical responsibilities rather than through direct ownership or control.

An IDN, on the other hand, oversees all the facilities, physicians, hospitals, technologies, and administrations under them. Within an IDN, there is often a high level of integration and coordination among facilities, physicians, and other providers. IDNs may have agreements with specific health plans and may even own a health insurance entity, allowing for greater control over care delivery and payment.

Why are IDNs important to healthcare?

Integrated delivery networks are important to healthcare for several reasons. IDNs bring together various healthcare providers and organizations under one umbrella, facilitating better coordination of care for patients. This coordination can help patients receive seamless transitions between different levels of care and can reduce the likelihood of medical errors or duplicative services.

By integrating diverse healthcare services and providers, IDNs can also standardize clinical practices, implement evidence-based guidelines, and promote best practices across the network. This standardization can promote consistent care for patients regardless of where they receive treatment within the network.

IDNs can also pool resources, including medical equipment, technology, and personnel, across their network of facilities. This may allow for better allocation of resources to meet patient needs, reduced waste, and economies of scale.

IDNs, particularly larger ones, have increased negotiating power with payors, pharmaceutical companies, medical device manufacturers, and other healthcare stakeholders. This leverage can allow them to secure favorable contracts, pricing arrangements, and reimbursement rates.

Finally, IDNs offer a continuum of care that spans primary care, specialty care, acute care, post-acute care, and sometimes even health insurance coverage. This comprehensive approach means patients can usually receive care at every stage of life, from infancy to old age, without leaving the IDN.

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