Top 10 Largest Health Systems in the U.S.

Updated July 2020

Health systems, also referred to as integrated delivery networks (IDNs), are networks of providers and care facilities that are formed with the goal of improving clinical and quality performance. IDNs help to ensure that patients receive the best care outcomes for the lowest costs, and usually offer a full range of healthcare services from preventative to post-acute care. 

Each health system is different in terms of size, specialty, and membership makeup. According to Definitive Healthcare data, approximately 78 percent of hospitals belong to an IDN—up from 75 percent in 2018.

Top 10 health systems by net patient revenue

1.  HCA Healthcare: $42,673,974,296
2.  Kaiser Permanente: $29,176,611,660
3.  CommonSpirit Health: $28,358,722,418
4.  Ascension Health: $18,788,901,219
5.  Providence St. Joseph Health: $16,286,062,476
6.  Kaiser Permanente Northern California: $14,359,957,345
7.  Tenet Healthcare: $14,140,396,155
8.  Kaiser Permanente Southern California: $14,011,636,037
9.  Trinity Health: $13,737,577,562
10. University of California Health: $13,032,563,332

Fig 1 Data 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.

The top health systems listed here reported a combined net patient revenue of over $204 billion as of July 2020—making these networks a lucrative sales and marketing opportunity for organizations selling into the healthcare market. 

Large IDNs like HCA Healthcare, Kaiser Permanente, and others often act as group purchasing organizations (GPOs) for their member hospitals. This means that the health systems negotiate with vendors to receive lower prices for supplies and services. According to Definitive Healthcare data, about 93 percent of U.S. hospitals are affiliated with a GPO—up from 84 percent in 2019. 

By understanding the pricing structures achieved by GPOs, an IDN may be able to further negotiate on behalf of its member facilities. Additionally, many IDNs service a local region, giving them a unique ability to identify the needs of a defined community and address pricing needs accordingly, in a way that nationwide IDNs or GPOs may be unable to match.

Collectively, the largest health systems manage more than 1,300 hospitals—nearly 20 percent of active hospitals in the United States. This could give these hospitals an advantage in lowering care costs. In addition to negotiating purchasing prices, health systems also help to keep patient referrals in-network. This improves care coordination, enhances the patient experience, and prevents revenue loss by referring outside of a hospital's network.

Top 10 largest health systems by member hospitals

1.  HCA Healthcare: 214
2.  CommonSpirit Health: 197
3.  Universal Health Services: 170
4.  Department of Veterans Affairs: 162
5.  Encompass Health Corporation: 123
6.  Ascension Health: 117
7.  Select Medical Corporation: 113
8.  Community Health Systems: 100
9.  Tenet Healthcare: 87
10. LifePoint Health: 86

Fig 2 Data from Definitive Healthcare's Hospitals & IDNs database. Health system data is sourced from proprietary Definitive Healthcare data and the July 2020 Medicare Cost Report Release. The next scheduled Medicare Cost Report release is October 2020. Accessed July 2020.

Health systems play a crucial role in bettering healthcare delivery throughout the United States. IDNs are able to manage dozens of hospitals and other care facilities—expanding service offerings and providing specialty physicians and clinics to ensure that patients are satisfied and treated properly. Because IDNs manage an entire network of facilities, they have the power to influence industry practices and set the bar for clinical and quality program performance.

Learn more

Interested in learning more about IDNs, and the ways in which you can leverage healthcare data to improve your conversations with health system executives? Take a look at our on-demand webinar, 10 Key Strategies for Selling to IDNs and GPOs. 

In this 60-minute discussion, attendees will gain a deep understanding of the 10 best strategies to employ when working with IDNs and GPOs and why these tactics have proven to be successful.