Top 25 IDNs by Net Patient Revenue

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.