Healthcare Insights

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 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.

25 largest IDNs in the U.S. in 2021

IDN NameDefinitive IDStateNet Patient Revenue# of Hospitals# of DischargesExplore Dataset
HCA Healthcare4710TN$42,945,358,828 2111,857,196Explore
CommonSpirit Health981465IL$29,813,296,010 198895,823Explore
Ascension Health4695MO$22,587,431,574 133753,721Explore
Providence St Joseph Health4716WA$16,232,451,121 58407,267Explore
Trinity Health4712MI$15,118,643,048 69557,467Explore
University of California Health560423CA$14,875,522,334 22166,227Explore
Tenet Healthcare4685TX$13,214,321,067 83525,445Explore
Dignity Health4698CA$12,991,195,170 50373,166Explore
Community Health Systems542233TN$9,909,230,808 90420,393Explore
LifePoint Health7004TN$9,553,925,272 151291,429Explore
AdventHealth4694FL$9,044,810,859 43320,888Explore
Northwell Health4744NY$8,937,459,144 20228,051Explore
University of Pittsburgh Medical Center6448PA$8,928,278,852 36252,220Explore
Cleveland Clinic Health System274173OH$8,808,677,158 21224,692Explore
Atrium Health4697NC$8,725,276,358 39255,039Explore
Universal Health Services7055PA$8,696,950,743 179675,582Explore
Advocate Aurora Health965729IL$8,211,691,653 30246,144Explore
NYU Langone Health579801NY$8,208,565,651 8151,738Explore
NewYork-Presbyterian Healthcare System7066NY$7,964,971,495 13182,437Explore
Baylor Scott & White Health577357TX$7,923,033,422 50208,844Explore
Sutter Health4717CA$7,712,003,148 29167,312Explore
Mass General Brigham7001MA$7,690,293,965 16147,300Explore
Mayo Clinic7104MN$7,643,977,864 21110,658Explore
Bon Secours Mercy Health975303OH$7,604,910,882 39273,008Explore
BHSH System1044485MI$7,275,008,167 22222,728Explore

Fig. 1 – Data from the Definitive Healthcare HospitalView product. Net patient revenue is an aggregate of member hospital financial information from the January 2022 Medicare Cost Report release. The next scheduled Medicare Cost Report release is April 2022. Data is accurate as of March 2022. 

Which IDNs have the highest net patient revenue?

With 211 member hospitals and a total net patient revenue of $42.9 billion, Nashville-based HCA Healthcare is the largest IDN in the United States. CommonSpirit Health and Ascension Health are the second and third largest health systems by net patient revenue—with $29.8 billion and $22.5 billion in net patient revenue reported as of the January 2022 Medicare Cost Report.

We might expect that health systems with more member hospitals would report higher net patient revenues. However, 20 of the top 25 IDNs—or 80%—have fewer than 100 member hospitals. Fourteen of the top IDNs, or 56%, have fewer than 50 member facilities.

There is little correlation between the 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.

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