Integrated delivery networks (IDNs), or health systems, are organizations responsible for managing one or more healthcare facilities within a defined geographic area. These networks can vary in both size and service offerings and, because of this, may be affiliated with many different inpatient and outpatient provider types.

Some IDNs have hundreds of member facilities within their networks, and can leverage their size to exert industry influence and increase their purchasing power. This allows them to negotiate supply chain costs in much the same way that a group purchasing organization (GPO) would.

Below, we’ve compiled a list of the top 25 largest IDNs by net patient revenue.

Largest IDNs in the U.S. 2020

With 214 member hospitals and a total net patient revenue of almost $42.6 billion as of April 2020, Nashville-based HCA Healthcare is the largest IDN in the United States. Kaiser Permanente and CommonSpirit Health are the second and third largest health systems by net patient revenue—with $29.1 billion and $28.3 billion in net patient revenue reported as of April 2020, respectively.

We might expect that health systems with a greater number of member hospitals would report higher net patient revenues. However, 20 of the top 25 IDNs—or 80 percent—have fewer than 100 member hospitals. Fifteen of the top IDNs, or 60 percent, have fewer than 50 member facilities.

Based on this fact, it seems that there is little correlation between number of member hospitals and net patient revenue. It is more likely that the performance of these member hospitals is a stronger contributing factor to the financial success of the top 25 IDNs.

Top 25 IDNs by net patient revenue

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RankDefinitive IDIDN NameStateNumber of Member HospitalsNumber of DischargesNet Patient RevenueExplore This Dataset
1. 4710HCA HealthcareTN2141,923,773$42,673,974,296Explore This Profile
2. 4713Kaiser PermanenteCA43444,072$29,176,611,660Explore This Profile
3. 981465CommonSpirit HealthIL197959,084$28,358,722,418Explore This Profile
4. 4695Ascension HealthMO117679,089$18,788,901,219Explore This Profile
5. 4716Providence St Joseph HealthWA56463,500$16,286,062,476Explore This Profile
6. 845347Kaiser Permanente Northern CaliforniaCA21209,916$14,359,957,345Explore This Profile
7. 4685Tenet HealthcareTX87652,017$14,140,396,155Explore This Profile
8. 845346Kaiser Permanente Southern CaliforniaCA15185,367$14,011,636,037Explore This Profile
9. 4712Trinity HealthMI59574,749$13,737,577,562Explore This Profile
10. 560423University of California HealthCA21178,254$13,032,563,332Explore This Profile
11. 4698Dignity HealthCA48384,556$11,656,703,049Explore This Profile
12. 542233Community Health SystemsTN100496,596$10,823,928,332Explore This Profile
13. 7055Universal Health ServicesPA170719,554$9,471,725,806Explore This Profile
14. 4744Northwell HealthNY21287,889$8,970,564,399Explore This Profile
15. 6448University of Pittsburgh Medical CenterPA36274,760$8,796,223,659Explore This Profile
16. 274173Cleveland Clinic Health SystemOH18218,142$8,666,646,603Explore This Profile
17. 7066NewYork-Presbyterian Healthcare SystemNY13204,905$8,355,307,233Explore This Profile
18. 7004LifePoint HealthTN86312,900$8,269,550,749Explore This Profile
19. 7001Mass General BrighamMA17158,399$8,089,311,911Explore This Profile
20. 965729Advocate Aurora HealthIL29263,632$8,052,905,383Explore This Profile
21. 4694AdventHealthFL39325,832$8,016,967,163Explore This Profile
22. 975303Bon Secours Mercy HealthOH41309,455$7,741,285,587Explore This Profile
23. 4717Sutter HealthCA30159,758$7,639,862,131Explore This Profile
24. 938977Stanford MedicineCA347,288$7,158,753,641Explore This Profile
25. 577357Baylor Scott & White HealthTX53259,997$7,101,837,595Explore This Profile

Fig 1. Data is from Definitive Healthcare’s Hospitals & IDNs database. Net patient revenue is an aggregate of member hospital financial information from the July 2020 Medicare Cost Report release. The next scheduled Medicare Cost Report release is October 2020. Accessed July 2020.