For years, Charlotte\u2019s health care market has been dominated by two names: Atrium Health and Novant Health. Between them, the two hospital systems hold a near lock on the region\u2019s hospitals, a growing share of its doctors and much of its specialty care.<\/p>\n
Now a third player is muscling into the market.<\/p>\n
In April, Duke Health paid $284 million to acquire Lake Norman Regional in Mooresville, rebranding it as Duke Health Lake Norman. It\u2019s the first Duke-branded hospital outside the Triangle.<\/p>\n
Around the same time, Duke announced a partnership with Novant to open joint campuses across North Carolina.<\/p>\n
Although details about the partnership are tightly guarded, Novant indicated at a recent regulatory hearing that the partnership would bring more of Duke\u2019s specialty expertise, such as advanced cancer care and gastrointestinal surgery, directly into the Charlotte market.<\/p>\n
\u201cThis is a big deal,\u201d said Bryan Blitstein, a Huntersville surgeon in private practice who is joining the Lake Norman hospital as a surgeon. \u201cFor my entire career, Charlotte has been teal (Atrium) versus purple (Novant). Duke coming in disrupts that and creates a third option. Healthy competition is good for everybody.\u201d<\/p>\n
For now, Atrium and Novant control nearly all hospital care in the Charlotte region. Atrium commands about half of the market, while Novant holds roughly 35 percent, according to national financial ratings agencies<\/a>.<\/p>\n Duke\u2019s moves won\u2019t transform Charlotte\u2019s health care landscape overnight. But the presence of a third provider could ultimately bring more choice and competition to the area\u2019s health care market and provide an alternative for the many patients who choose to drive to the Triangle for care, industry observers said.<\/p>\n \u201cThis is good news for Charlotte and for North Carolina,\u201d said Barak Richman, a health policy expert and George Washington University law professor who formerly taught at Duke. \u201cIt brings competition to a market dominated by Atrium, which is healthy for patients. For people in Charlotte, it might even lower some prices.\u201d<\/p>\n Duke pivots to expansion<\/p>\n Across North Carolina, hospital systems including Atrium, UNC Health and Novant have been aggressively growing <\/a>\u2014 buying up smaller hospitals and merging \u2014 to attract more patients, achieve economies of scale and boost their negotiating power with insurers. While the hospitals promise efficiencies and better care, critics point to research<\/a> that shows consolidation typically eliminates competition and drives up prices without improving quality.<\/p>\n Until now, Duke had largely resisted following its rivals in pursuing geographic expansion, Richman said, preferring to build its reputation as a national destination for complex care.<\/p>\n But that strategy is shifting. In a June 2025 bond prospectus<\/a>, Duke said it was transitioning \u201cto a regional health system.\u201d<\/p>\n In the financial document, Duke leadership also set an ambitious expansion goal: to \u201ctouch 25% of the lives in North Carolina,\u201d while nearly tripling revenue to more than $20 billion, up from $6.8 billion in fiscal 2024<\/a>.<\/p>\n Duke Health declined to answer questions about its plans, saying in an email: \u201cWe don\u2019t have updates to share beyond our Lake Norman announcement in April and Novant partnership announcement in March. We will include you on any related announcements moving forward.\u201d<\/p>\n \u201cDuke-itizing\u201d a hospital<\/p>\n Duke\u2019s purchase of the 123-bed Lake Norman hospital included nearby medical office buildings and physician offices, including nine primary care and seven specialty practices. It plans to add an imaging facility and more office space, according to its filing.<\/p>\n Blitstein, who will start his job at Duke Lake Norman Hospital in October, said Duke has already poured millions into the facility to upgrade its technology and infrastructure to Duke standards.<\/p>\n \u201cThey call it \u2018Duke-itizing\u2019 the hospital,\u201d he said. \u201cThey like that word.\u201d<\/p>\n Many Charlotte-area patients already drive to Durham to see Duke specialists, especially for cancer care, cardiology and complex surgeries, Blitstein said.<\/p>\n The idea now is to bring that care closer to home, he said, with the Mooresville hospital serving as \u201ca point of access\u201d where all Charlotte-area patients \u2014 not just those in Iredell County \u2014 can begin treatment, participate in clinical trials or get follow-up care if they are already being treated at Duke.<\/p>\n Duke is frequently ranked<\/a> as the top hospital in North Carolina and one of the best<\/a> in the country.<\/p>\n \u201cThe hope is to bring that level of excellence from Durham to the Charlotte market,\u201d Blitstein said. \u201cPatients shouldn\u2019t have to drive two hours for follow-ups or routine imaging. Those can be done here, with results sent seamlessly back to their doctors in Durham.\u201d<\/p>\n Still, not everyone is convinced the pivot is a good one for Duke. By chasing market share, Richman said, Duke risks diluting its academic mission.<\/p>\n \u201cIt\u2019s not surprising that they\u2019re finally starting to do what everybody else is doing,\u201d he said. \u201cBut this country already has way too much hospital expansion. \u2026 If I had my druthers, Duke would not be competing with Atrium for knee replacements. They would be competing with Mayo Clinic for the most complicated brain surgeries.\u201d<\/p>\n Proposed Duke-Novant centers along I-77 corridor<\/p>\n Duke\u2019s partnership with Novant adds another layer to Duke\u2019s entrance into the Charlotte market.<\/p>\n In a March news release<\/a>, the two hospitals said they planned to \u201cjointly develop new campuses across North Carolina that will expand access to affordable, high-quality care,\u201d but they provided few details.<\/p>\n Novant and Duke declined to answer questions about the partnership, including what types of facilities they\u2019ll open or where they will be located.<\/p>\n However, the two hospital systems have already requested state approval<\/a> to build a jointly operated hospital in Mebane, a fast-growing city about halfway between Durham and Greensboro.<\/p>\n Duke\u2019s financial filing also outlines plans for the hospitals to jointly develop a network of outpatient centers across the state, including along Charlotte\u2019s I-77 corridor. The sites would offer primary care and such specialty services as cardiology, neurosciences and cancer, along with laboratory and imaging services \u2014 and potentially surgery, infusion and urgent care services, according to the filing.<\/p>\n The move comes as the North Carolina legislature has moved to loosen the state\u2019s certificate of need regulations for ambulatory surgical centers beginning this November, which would make it easier for hospitals to open them in urban areas.<\/p>\n At an August hearing where it requested state approval for more operating rooms, Novant also hinted that Duke specialists may perform surgeries and do other work in Novant hospitals.<\/p>\n Matthew Hanis, a Charlotte-based consultant and expert in the business of health care, said the partnership gives Novant a credibility boost by tying it to Duke\u2019s research and academic reputation. That could help Novant compete with Atrium, which partnered with the Wake Forest University School of Medicine to recently open Charlotte\u2019s first medical school<\/a>, Hanis said.<\/p>\n Steve Lawler, a former CEO of the North Carolina Health Care Association and now a health care consultant, said the deal should also make it easier for Novant to participate in advanced research and treatments and give its patients smoother access to Duke\u2019s specialized services and clinical trials.<\/p>\n \u201cNovant could act as a navigator to make it easy and seamless for people to access that type of high-end care,\u201d he said.<\/p>\n Just a partnership or a step toward a merger?<\/p>\n Joint ventures like Duke and Novant\u2019s are increasingly common in North Carolina and nationwide as hospitals look for ways to expand while avoiding the regulatory hurdles associated with mergers.<\/p>\n Such partnerships, which can include joint hospital ownership or operations, allow partners to share both the work and the risks of growth, Lawler said. He pointed to the recently announced children\u2019s hospital in Apex, a joint project between Duke and UNC Health, as another example.<\/p>\n Other hospitals, in their quest for expansion, have gone beyond shared ownership to fully integrated combinations. Atrium has perfected this approach, combining first with Navicent Health in Georgia, then with Wake Forest Baptist and finally with Advocate Aurora Health in 2022 to form the country\u2019s third-largest public health care system.<\/p>\n In its financial filing, Duke hinted at the possibility of deeper integration with Novant, saying the partnership \u201ccould serve as a launching point for future collaborative opportunities between the organizations.\u201d<\/p>\n Hanis said he doesn\u2019t have any inside information, but he wouldn\u2019t be surprised if the alliance was the first step in the systems coming together. \u201cBoth have the need to build scale\u201d to compete, he said.<\/p>\n He noted that Duke also partners with Tennessee-based Lifepoint Health, which owns nine smaller community hospitals in North Carolina. \u201cCombine Duke, Lifepoint and Novant and you have serious scale and brand,\u201d he said.<\/p>\n For now, many questions remain about the partnership: Will Duke doctors actually practice in Novant hospitals, or will Novant doctors collaborate with Duke specialists virtually? Could Duke alone, or the two systems together, open new hospitals in the Charlotte region? And how will Duke\u2019s debut in Charlotte affect health care costs and access to care?<\/p>\n For Marlene Tontodonato of Charlotte, the stakes are personal.<\/p>\n Tontodonato, 77, said she traveled to Duke for a third opinion after two local doctors disagreed about whether she should get spine surgery and a rod for her scoliosis \u2014 a curvature in her spine. Duke doctors suggested a more conservative approach, she said, and she still sees a spine specialist in Durham.<\/p>\n Tontadonato said she would welcome the chance to get that same level of care closer to home. But she said she hopes Duke brings its own doctors to Charlotte rather than absorbing local physicians.<\/p>\n \u201cI have more faith in Duke because it\u2019s a teaching hospital,\u201d she said, \u201cand they have expertise that I think we are lacking in Charlotte.\u201d<\/p>\n This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting<\/a>. You can support this effort with a tax-deductible donation.<\/a><\/p>\n This article<\/a> first appeared on North Carolina Health News<\/a> and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"For years, Charlotte\u2019s health care market has been dominated by two names: Atrium Health and Novant Health. 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