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Integrated Delivery Networks and their Growing Influence on Regional Healthcare in the US

Over the past several years, the push by providers and payers toward higher quality, lower cost care has gained momentum. Policy, increased incentives buying behaviors and other factors have prompted regional health networks to offer care in a more coordinated setting, fundamentally changing how the delivery of health is provided and managed. These changes makes this one of the most dynamic eras in the evolution of US healthcare.

 

Of these changes, one of the most noticeable is the growth and proliferation of Integrated Delivery Networks, or IDNs. An IDN is set of physicians working with hospitals to form a healthcare ecosystem where a person can receive any type of care it needs from one single ‘brand’ of healthcare provider. Ultimately, the goal is holistic care; as a patient, you can receive preventable care, physical therapy, and everything in between. Through electronic health records (EHRs,) patient information can be stored, tracked and shared within the network providing comprehensive view of a patient’s health.

 

     How are IDNs transforming the healthcare landscape?

"Every market in the nation is coalescing around a handful of healthcare ecosystems. IDNs are the cornerstones of these ecosystems"

Mark Cherry, Principal Analyst, Market Access Insights, Decision Resources Group

IDNs come in all shapes in sizes – Some can be a collection of hospitals or focus on a specific therapy area. Through acquisitions and mergers, major IDNs have come to dominate major markets to create a truly holistic source for healthcare by offering a true continuum of care. In doing so, these major IDNs can exert a lot of leverage among their physician groups as well as with payers and can even blur the lines between provider and payer as they grow and leverage their influence. For instance, they can create collaborative plans with payers but can also work directly with employers to provide healthcare plans via their own formularies, protocols and reimbursement processes.

How did IDNs get started

The Affordable Care Act helped to accelerate the formation of integrated delivery networks due to the emphasis placed on accountable care and clinical integration. Hospitals had to learn to adapt as Accountable Care Organizations (ACOs) started to form due to the shift from volume to value in healthcare delivery. As ACOs focused on contracting between payers and providers to help control costs and ultimately keep patients out of hospitals, these hospital-based groups began to adjust their business models to help control patient populations and offer holistic care.

 

IDNs began to emerge as hospitals began leveraging their capital and regional branding to naturally evolve into these large networks and use ACOs as part of their ‘toolbox’ to deliver care. Some of the earliest IDNs include Kaiser Permanente, UPMC and BS&W (an HMO-style IDN).


What do the most prominent IDNs have in common?

Although there are many attributes to consider when identifying an IDN, there are 5 main criteria that major IDNs share:

 

Provider Alignment  Development  Stage  and  Physician  Data

This is really the DNA of an IDN. Within these large systems, large IDNs have centralized control of physicians through employment and/or clinical integration, and common branding across facilities in the region.

Continuum of Care

Essentially, large IDNs are able to offer more services, from preventative care and primary/urgent level care to post-acute care and various therapies and treatments. If there is a large breadth of services, there is more patient containment.

Clinical Integration

Large IDNs can efficiently communicate within an established and unified EHR system which is shared and actively monitored to gauge protocol adherence and patient outcomes. The largest IDNs will often have their own formularies.

Regional Presence

IDNs that cater to the broadest set of patient needs typically control large portions of the market. They can use this as leverage when negotiating with payers and drug manufacturers as a way to further drive down cost.

Reimbursement

In increasing numbers, large IDNs have contracts where they accept some sort of risk with payers to push for better patient outcomes. They can also influence physician and patient behavior by pushing specific protocols and treatments.

 

Life science companies can rely on the strength of our healthcare affiliations data and market analysis to understand IDN control, enhance their market access strategy and optimize their sales force, all within a single intuitive platform.

  • Gain a deep understanding of provider and vertically integrated healthcare systems, from the macro-level down to the individual physician-level, to properly align home office strategy and field force teams.
  • Gauge the rising influence of IDNs within local markets and address them in an effective way.
  • Engage your most significant customer groups efficiently and intelligently with specific data on the strength of their affiliations.