THE DIVERSITY OF HEALTH ACCESS IN THE US: A GEOSPATIAL ANALYSIS OF INTEGRATED DELIVERY NETWORKS AND AFFILIATED MEDICARE PROVIDERS
Author(s)
Halley Costantino, MS, Ashley Martin, PhD, Brian Duffant, BS, Matthew Gitlin, PharmD;
BluePath Solutions, Los Angeles, CA, USA
BluePath Solutions, Los Angeles, CA, USA
OBJECTIVES: Most US healthcare providers belong to larger health systems or Integrated Delivery Networks (IDNs), which can vary substantially in market consolidation, payer mix, and provider choice - factors which impact overall access and affordability to patients. This study examined the diversity, size, and socio-geographic variance of IDNs within the current US healthcare landscape.
METHODS: We conducted a secondary analysis of 2024 Medicare FFS claims to evaluate the diversity of IDN-affilated health facilities in the US. Medicare providers were identified via their unique CMS Certification Number and linked to their affiliated IDN using the AHRQ’s Compendium of U.S Health Systems - a consolidated list of US health systems and member facilities. IDNs were characterized based on size, geography, and market concentration (i.e., density of competing IDNs, as estimated by the Herfindahl-Hirschman Index (HHI)).
RESULTS: Most IDNs (n=870, 88.0%) included in this analysis operated within a single US state, with high rates of monopolization (HHI>1,800=97.9%) across a mean of 2.1 (SD=2.5, Range=1-24) providers and 393 (SD=634, Range 7-5,614) hospital beds. The remaining 12% of IDNs (n=119) were larger networks spanning a mean of 5.0 states (SD=6.1, Range=2-36), 20.8 (SD=27.7, Range=2-162) providers, and 2,915 beds (SD=4,759, Range=29-38,114). These multi-state IDNs managed a mean of 111,353 (SD=146,997) patients and 455,252 (SD=515,712) healthcare claims in 2024 - a rate over five-times the volume of single-state IDNs (mean patients=18,292; mean claims=81,701). Roughly 15% of the total volume of Medicare providers and affiliated patients/beds were managed by fewer than 10 (1%) individual IDNs, which generated 20% of the combined revenue.
CONCLUSIONS: While most hospitals in the US operate as part of an IDN, these IDNs differ considerably in their available infrastructure (providers/beds), patient/claim volume, and annual revenue. Further research is needed to understand how these inter-IDN differences shape healthcare access, costs, and strategy.
METHODS: We conducted a secondary analysis of 2024 Medicare FFS claims to evaluate the diversity of IDN-affilated health facilities in the US. Medicare providers were identified via their unique CMS Certification Number and linked to their affiliated IDN using the AHRQ’s Compendium of U.S Health Systems - a consolidated list of US health systems and member facilities. IDNs were characterized based on size, geography, and market concentration (i.e., density of competing IDNs, as estimated by the Herfindahl-Hirschman Index (HHI)).
RESULTS: Most IDNs (n=870, 88.0%) included in this analysis operated within a single US state, with high rates of monopolization (HHI>1,800=97.9%) across a mean of 2.1 (SD=2.5, Range=1-24) providers and 393 (SD=634, Range 7-5,614) hospital beds. The remaining 12% of IDNs (n=119) were larger networks spanning a mean of 5.0 states (SD=6.1, Range=2-36), 20.8 (SD=27.7, Range=2-162) providers, and 2,915 beds (SD=4,759, Range=29-38,114). These multi-state IDNs managed a mean of 111,353 (SD=146,997) patients and 455,252 (SD=515,712) healthcare claims in 2024 - a rate over five-times the volume of single-state IDNs (mean patients=18,292; mean claims=81,701). Roughly 15% of the total volume of Medicare providers and affiliated patients/beds were managed by fewer than 10 (1%) individual IDNs, which generated 20% of the combined revenue.
CONCLUSIONS: While most hospitals in the US operate as part of an IDN, these IDNs differ considerably in their available infrastructure (providers/beds), patient/claim volume, and annual revenue. Further research is needed to understand how these inter-IDN differences shape healthcare access, costs, and strategy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD124
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas