Atrium Health sets sights on entering Triangle with WakeMed acquisition; state treasuer asks fo delay

Atrium Health is aiming to transform the North Carolina healthcare marketplace for the second time in six years with plans to acquire WakeMed in a transaction unveiled Friday.

Atrium would enter the Raleigh and Triangle the same way - through acquisition - it did in Winston-Salem and Triad with Wake Forest Baptist Medical Center in October 2020.

The proposed deal requires the approval of the Wake County Board of Commissioners, which is scheduled to vote at its 5 p.m. Monday meeting on a transfer agreement necessary for Atrium to take over WakeMed.

The deal also requires state and federal regulatory approvals that include state Attorney General Jeff Jackson.

State Treasuer Brad Briner requested Sunday that Wake commissioners delay its vote, writing in a letter that he has serious concerns about the deal on behalf of the State Health Plan and its 750,000 members.

"As you know, the state of North Carolina and the Wake County Public School System are among the county's largest employers, and our constituents will feel the gravity of the decision you make," Briner said.

Atrium would own and operate WakeMed, but WakeMed would continue as the same legal entity without dissolving or reincorporating. WakeMed has three acute-care hospitals, a rehabilitation facility and a mental health hospital.

Atrium is owned by Advocate Health, already the nation's third-largest not-for-profit healthcare system.

Eugene Woods, Atrium's chief executive, said the $2 billion capital investment pledge is "one of the largest health care commitments this region has ever seen."

"But, the impact goes far beyond dollars. It means nationally recognized specialty care closer to home, more convenient and affordable care, including virtual visits, stronger mental health support, and 3,300 new health care jobs to help this community continue to thrive."

The Charlotte-based not-for-profit system gained the unanimous support of the WakeMed Board of Directors in large part because of pledging $2 billion in capital investment into the system, along with adding 3,300 new jobs.

Atrium pledged to make a $3.4 billion capital investment in Baptist, which included a $428 million critical care tower on the main Ardmore campus that debuted in July and was named after a retiring Baptist chief executive Dr. Julie Ann Freischlag.

By comparison, Risant Health Inc. made a $1.7 billion capital investment commitment to Cone Health as a pivotal component of its takeover of the Greensboro not-for-profit healthcare system in December 2024.

Cone Health is now part of a larger healthcare system with the closing of its acquisition by Risant Health Inc. with a capital investment pledge valued at $1.7 billion.

A key component of the Atrium-WakeMed deal could affect Winston-Salem with WakeMed gaining access to medical students at Wake Forest University School of Medicine's campus here and in Charlotte. That includes new residency and fellowship opportunities at WakeMed.

Atrium also has pledged to create a third life-science innovation district in Wake County similar to downtown Winston-Salem's Innovation Quarter and Charlotte's The Pearl.

Atrium also has committed to developing the state's largest nonprofit mental health network with 360 beds dedicated to behavioral health patients.

Donald Gintzig, WakeMed's president and chief executive, said that joining Atrium "represents a significant next step ... expanding our impact and ensuring a thriving nonprofit health care future for all we serve."

"WakeMed and Atrium Health are united in a shared commitment to serving our communities, and by building upon our complementary strengths, we can have an even greater impact on the health and well-being of Wake County and the entire state."

Atrium and WakeMed said part of the $2 billion capital investment commitment will go toward paying for redevelopment and expansion of WakeMed's main Raleigh campus that includes inpatient beds.

The systems said that "additional details about specific timelines will be shared as information is available in the coming months."

Also being expanded with new beds and services as part of the commitment are WakeMed's Cary and North Raleigh hospitals, along with inpatient and outpatient services at WakeMed's Garner Whole Health campus that is under development.

Also pledged is two new Healthplex locations offering stand-alone emergency departments and accessible outpatient services.

The 3,300 new health care jobs would be created in Wake County over five years, spanning clinical care, research, education, biosciences and support roles.

A likely tactic to win regulatory approval involves expanding financial assistance for WakeMed patients from 300% to 400% of the federal poverty level.

The systems would expand access to outpatient mental health services by growing behavioral health networks across the state and implementing advanced research and treatment methods through partnerships with national leaders in mental health care.

"WakeMed has a long history of stepping up to meet the needs of our community. It is in our DNA," Gintzig said.

"We are confident that this combination will further our commitment to our patients and their families and help us deliver on our mission and more for decades to come."

Briner told the Wake commissioners he has three primary concerns.

The first is that recent consolidation of non-profit hospitals and hospital systems in N.C. over the last decade has produced :the same results over and over - either higher costs or lower quality of care in the acquired hospital's service area - and in some cases, both."

"I am not aware of any example where these types of transactions have resulted in patients being better off, and it is highly unlikely that this one will be the first. "

The second was Briner's belief that WakeMed would be in a position to meet the Atrium jobs and capital investment pledge over several years.

"I can attest that WakeMed has substantial borrowing capacity," Briner said.

"The combination of WakeMed's strong finances, ample borrowing capacity, the favorable demographics of WakeMed's service territory, and the continued growth of Wake County, ensure these investments will almost certainly be made whether this consolidation is authorized or not.:

The third is that "the effective sales price of WakeMed is ZERO," Briner wrote.

"A promise of new capital investments and jobs that will most-certainly be created anyway means that authorizing this consolidation is selling WakeMed for no real upside - and a lot of downside for Wake County residents already feeling the pain of skyrocketing cost-of-living increases."

Briner said if the commissioners choose to accept Atrium's offer for WakeMed, "then please at least demand consideration from the acquiror in the way that New Hanover and Buncombe Counties have in the past."

"Using those as comparables, Wake County should be able to set up an endowment of well over $1.5 billion from funds paid by Atrium, for allowing this acquisition."

Briner separately said that "I look forward to the attorney general (Jackson) and Federal Trade Commission carefully scrutinizing this proposal and what it could mean for the people across our stat.

The state attorney general's office conducts anti-trust reviews of hospital merger applications.

"If history is any guide, this merger will not benefit the public," Briner said.

Jackson spokesperson Bailey Aldridge said Jackson "plans to review the proposal carefully," according to a statement sent to Raleigh TV station WRAL.

"Our focus is on ensuring patients can continue to get high-quality healthcare they can afford, no matter where in the state they seek care."

When Gov. Josh Stein served as attorney general, he said that "I have real concerns about this trend ... wave of hospital consolidations. Bigger doesn't always mean better."

"In fact, it often means worse and more expensive."

He cited at that time HCA and Mission in Asheville, Novant Health Inc. and New Hanover Regional in Wilmington, and Wake Forest and Atrium - all of which he ultimately approved from an antitrust review.

Yet, Stein ultimately signed off Atrium's acquisition of Baptist, the merger of Advocate Health and Atrium Health, HCA and Mission in Asheville, and Novant Health Inc. and New Hanover Regional in Wilmington.

Dale Folwell, Briner's predecessor as treasurer, was vocally opposed to not-for-profit healthcare system acquisitions in his two terms in office, calling them "anti-consumer."

Folwell's main concerns focused on how those acquisitions could affect State Health Plan members in terms of higher costs.

When discussing the Advocate-Atrium merger, Folwell said that "Research consistently shows mergers and acquisitions do not deliver on hospital executives' promises, but instead trigger higher costs, reduced access and the same or lower level of care."

Some analysts said part of WakeMed's incentive for being acquired by Atrium is a defensive move to gain access to financing that helps it fending off encroaching competition from Duke Health and UNC Health.

With Atrium and WakeMed not having overlapping healthcare market, the potential for job cuts and reduced competition within the Triangle is not likely to be a major concern to regulators, said Zagros Madjd-Sadjadi, an economics professor at Winston-Salem State University.

"To what extent is this going to provide new services and to what extent is it going to take from existing service providers" will be pivotal considerations, Madjd-Sadjadi said.

"Such ventures will typically lower costs due to synergies, and that often means job losses at the industry level even as it expands access or otherwise reduces its own costs.

"Such cost reductions and expanded access, if it goes toward, padding managerial salaries or increasing endowments as opposed to lowering patient costs, may be unwelcome in the current inflationary environment as consumers are increasingly squeezed from all sides."

On the other hand, Madjd-Sadjadi said, if Atrium and WakeMed "can commit to reductions in costs paid by patients and their employers, and approval for this project is made contingent upon that, this endeavor could be very beneficial for the Triangle region."

"This should not be a major ask for these entities because both are non-profits and thus are supposed to be patients first in their respective missions."

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This story was originally published May 2, 2026 at 8:49 PM.