What is an IDN in Healthcare?
An IDN in healthcare is an Integrated Delivery Network – an umbrella term for any type of arrangement in which healthcare providers (and sometimes payers) work together to provide collaborative and coordinated care. Depending on the type of arrangement, an IDN in healthcare can consist of entities under common ownership or can be an affiliation of independent entities.
IDNs in healthcare range in size from small provider networks offering localized healthcare services in a specific area of medicine, to huge healthcare delivery systems offering a full range of healthcare services across most of the country. Some consist solely of healthcare services (i.e., HCA Healthcare). Others (i.e., Optum) are owned by payers (in this case, UnitedHealth).
Where an IDN is not directly affiliated with – or owned by – a payer, there may be an arrangement with a payer to provide in-network services. When this happens, the healthcare IDN may be regarded as a preferred partner or as part of a health maintenance organization (HMO) depending on the type of arrangement. In the former case, healthcare providers remain employees of the IDN (or an entity within the IDN). In the latter case, healthcare providers work for the HMO.
Common Components of an IDN in Healthcare
The objective of an IDN in healthcare is to coordinate services between providers (or healthcare units) in order to increase efficiency, enhance the quality of service, and improve patient outcomes. IDNs aim to achieve this objective by integrating various types of providers and services into a single healthcare package. For this reason, an IDN in healthcare commonly includes some or all of the following components:
- Hospitals and other medical facilities that provide acute care services, emergency treatment, specialized treatments, and/or inpatient care.
- Physician practices, primary care clinics, and/or outpatient facilities staffed by doctors, nurse practitioners, and other healthcare professionals.
- Post-acute care settings such as nursing homes, rehabilitation centers, and other care facilities to provide continuity of care from acute care settings.
- Health management centers that proactively manage the health of certain patient types through preventative care, chronic disease management, and wellness programs.
- Healthcare support services such as diagnostic imaging, laboratory testing, rehabilitation therapy, home health services, and durable medical equipment.
As well as having benefits for patients, healthcare IDNs can also reduce the cost of delivering healthcare by negotiating better prices with pharmaceutical companies, equipment providers, and software providers. Subject to IDNs achieving the objective of improved patient outcomes, they can also benefit from higher scores in the Hospital Readmissions Reductions Program and other Merit-based Incentive Payment System metrics.
Compliance Challenges for IDNs in Healthcare
The compliance challenges for IDNs in healthcare can also vary according to the nature of the business arrangement. For example, components of an IDN that qualifies as an Organized Health Care Arrangement under HIPAA can share Protected Health Information with other components within the IDN without a Business Associate Agreement being in place – provided patients are notified of the arrangement in the Notice of Privacy Practices.
However, IDNs in healthcare that are not under common ownership will independently be responsible for complying with the conditions of participation for Medicare, HHS OIG compliance, and OSHA compliance. This can create compliance challenges if a key component within the healthcare IDN is not complying with regulatory requirements and it affects the compliance capabilities of other components.
It can also be the case that healthcare IDNs who operate across state borders may have to comply with one set of regulations in one state, and a different set of regulations in a neighboring state. This not only occurs when one state adopts legislation with (for example) more stringent privacy protections than HIPAA, but also when professional licensing or certification requirements differ. Organizations with concerns about the compliance challenges for IDNs in healthcare should seek advice from a compliance professional.
