Raleigh’s WakeMed hospital system is seeking approval to combine with Charlotte-based Atrium Health, but leaders of the two healthcare networks are adamant that the proposed $2 billion deal is not a sale.
The “planned strategic combination” sparked public controversy and pushback from state leaders when it was first announced last month. Now, WakeMed and Atrium are on a mission to convince skeptics that the partnership will benefit patients instead of raising costs and reducing competition, as some opponents suggest would be the case.
The first group of people WakeMed must win over in order to keep the deal alive is the Wake County Board of Commissioners. That’s because the commissioners must approve any changes to the legal documents that transformed WakeMed from a county hospital into a private nonprofit in 1997.
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On May 4, the commissioners postponed a vote that would have given Atrium governing power over WakeMed. They asked the hospitals to host listening sessions for members of the public to voice concerns about the deal.
Last week, the county hosted WakeMed’s leadership team and Gene Woods, the CEO of Atrium parent company Advocate Health, to make their case for the deal and answer commissioners’ questions in a special work session that lasted nearly four hours.
However, those sessions haven’t swayed the strongest opponents to the combination. That includes the State Employees Association of North Carolina, which warned that the deal would increase premiums for the 750,000 people covered by the State Health Plan, regardless of whether they receive services from WakeMed.
“When you have a hospital system that’s advancing its way across the state, consolidating everything, that always makes prices go up,” SEANC lobbyist Ardis Watkins told Carolina Public Press.
Déjà vu with independent takeovers
Watkins’ position mirrors that of NC Treasurer Brad Briner, who chairs the State Health Plan’s Board of Trustees. Briner sent a letter to the Wake commissioners urging them to reject the deal or at the very least require Atrium to pay for an endowment that would benefit Wake County residents.
Both Briner and Watkins cited other examples of independent hospitals in North Carolina that were absorbed by larger entities as reasons for Wake County to reconsider.
In 2018, for-profit HCA Healthcare purchased nonprofit Mission Health, whose flagship hospital in Asheville has since been racked by controversies. In 2021, Novant Health acquired Wilmington’s New Hanover Regional Medical Center and raised prices shortly thereafter.
“We’ve seen what’s happened in other places and most notably New Hanover County,” Watkins said.
“They had a wonderful community hospital, one of the top ranked in the country as far as community hospitals go, and Novant bought them. The county commissioners went along with it and the prices down there went up, and there are so many complaints over the quality of service.”
Atrium’s hunger for growth led to WakeMed deal
WakeMed and Atrium rejected the comparisons to what happened in Asheville and Wilmington, because they claim that the deal is not a sale at all. Instead, they framed the move as a partnership between like-minded nonprofit health systems.
“In our hearts, we believe a strategic combination with Atrium-Advocate Health is the best way to ensure that (WakeMed’s) mission stays alive,” WakeMed board chair Thad McDonald told commissioners.
The two began conversations in 2022 after Atrium was the sole respondent to a request by WakeMed for an oncology partner, McDonald said. Atrium first introduced the idea of a combination to WakeMed’s board of directors in 2024, and in November 2025 the board approved the proposal.
This isn’t the first time Atrium has gone after a big-time player in North Carolina’s hospital landscape. In 2020, it absorbed Wake Forest Baptist in Winston-Salem, which is affiliated with the Wake Forest School of Medicine.
In 2022, Atrium Health merged with another health system in Illinois to create Advocate Health, the nonprofit parent organization of Atrium. Advocate Health operates dozens of hospitals across the Carolinas, Georgia, Alabama, Illinois and Wisconsin.
So although WakeMed and Atrium have framed the deal as a partnership of relative equals, it remains true that Atrium is a much larger and more influential health system than WakeMed.
Small independents getting left behind
In making his pitch to the county commissioners, WakeMed board member Dan Blue III showed a chart illustrating the annual revenues of North Carolina health systems in 2011 versus 2024.
Fifteen years ago, the major health systems were all clustered together between just under $1 billion and $4 billion in annual revenue. Today, consolidation has led to a smaller group of large systems across North Carolina dominated primarily by Atrium, Novant, UNC Health and Duke Health.
“Independent health systems like WakeMed will find it difficult and they will struggle to survive in this climate,” Blue said, “so we look for a partner.”
“We’re able to do that because we’re operating from a very strong financial position today,” he continued.
WakeMed doesn’t have the revenue or borrowing ability needed to continue to make the investments it wants to, Blue said. Those investments include renovating WakeMed’s flagship Raleigh campus and continuing to expand across the county — things which Atrium said its $2 billion commitment will accomplish.
Woods said the best time for a partnership like this one is before a health system finds itself in financial straits. WakeMed CEO Donald Gintzig agreed.
“We were brave enough … to choose to do something that’s going to benefit people for a very long time in the future without having to,” Gintzig told commissioners in his closing comments.
“That would be my biggest heartbreak, is WakeMed having to do that in five or 10 years.”
WakeMed board: ‘Who we wanted to marry’
While the commissioners didn’t tip their hands when it came to their future vote to approve or reject the proposal, some questioned the due diligence by WakeMed and lack of a competitive process.
Commissioner Vickie Adamson asked why WakeMed didn’t seriously consider an unsolicited bid made by UNC Health shortly after the Atrium partnership was announced. A UNC Health spokesperson confirmed that the bid was worth $5 billion, more than twice what Atrium promised to invest.
In response, WakeMed board member Margaret Bratton pointed to the two system’s shared missions and likened the potential partnership with Atrium to a love story.
“We were in the process of finding a partner who had demonstrated commitment to the things that were the most important to us, and having that partner be someone who had a very similar origin story in Charlotte,” Bratton said.
“This is who we wanted to marry, so we were not out looking for bids.”
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