Duke Health Sets Its Sights On Statewide Expansion

By Michelle Crouch

Co-published pinch The Charlotte Ledger

For years, Charlotte’s wellness attraction marketplace has been dominated by 2 names: Atrium Health and Novant Health. Between them, nan 2 infirmary systems clasp a adjacent fastener connected nan region’s hospitals, a increasing stock of its doctors and overmuch of its specialty care.

Now a 3rd subordinate is muscling into nan market.

In April, Duke Health paid $284 cardinal to get Lake Norman Regional successful Mooresville, rebranding it arsenic Duke Health Lake Norman. It’s nan first Duke-branded infirmary extracurricular nan Triangle.

Around nan aforesaid time, Duke announced a business pinch Novant to unfastened associated campuses crossed North Carolina.

Although specifications astir nan business are tightly guarded, Novant indicated astatine a caller regulatory proceeding that nan business would bring much of Duke’s specialty expertise, specified arsenic precocious crab and gastrointestinal surgery, straight into nan Charlotte market.

“This is simply a large deal,” said Bryan Blitstein, a Huntersville surgeon successful backstage believe who is joining nan Lake Norman infirmary arsenic a surgeon. “For my full career, Charlotte has been teal (Atrium) versus purple (Novant). Duke coming successful disrupts that and creates a 3rd option. Healthy title is bully for everybody.”

For now, Atrium and Novant power astir each infirmary attraction successful nan Charlotte region. Atrium commands astir half of nan market, while Novant holds astir 35 percent, according to nationalist financial ratings agencies. 

Duke’s moves won’t toggle shape Charlotte’s wellness attraction scenery overnight. But nan beingness of a 3rd supplier could yet bring much prime and title to nan area’s wellness attraction marketplace and supply an replacement for nan galore patients who take to thrust to nan Triangle for care, manufacture observers said.

“This is bully news for Charlotte and for North Carolina,” said Barak Richman, a wellness argumentation master and George Washington University rule professor who formerly taught astatine Duke. “It brings title to a marketplace dominated by Atrium, which is patient for patients. For group successful Charlotte, it mightiness moreover little immoderate prices.”

Duke pivots to description

Across North Carolina, infirmary systems including Atrium, UNC Health and Novant person been aggressively increasing — buying up smaller hospitals and merging — to pull much patients, execute economies of standard and boost their negotiating powerfulness pinch insurers. While nan hospitals committedness efficiencies and amended care, critics point to research that shows consolidation typically eliminates title and drives up prices without improving quality. 

Until now, Duke had mostly resisted pursuing its rivals successful pursuing geographic description , Richman said, preferring to build its estimation arsenic a nationalist destination for analyzable care.

But that strategy is shifting. In a June 2025 enslaved prospectus, Duke said it was transitioning “to a location wellness system.”

In nan financial document, Duke activity besides group an eager description goal: to “touch 25% of nan lives successful North Carolina,” while astir tripling gross to much than $20 billion, up from  $6.8 cardinal successful fiscal 2024.

Duke Health declined to reply questions astir its plans, saying successful an email: “We don’t person updates to stock beyond our Lake Norman announcement successful April and Novant business announcement successful March. We will see you connected immoderate related announcements moving forward.”

“Duke-itizing” a hospital

Duke’s acquisition of nan 123-bed Lake Norman infirmary included adjacent aesculapian agency buildings and expert offices, including 9 superior attraction and 7 specialty practices. It plans to adhd an imaging installation and much agency space, according to its filing.

Blitstein, who will commencement his occupation astatine Duke Lake Norman Hospital successful October, said Duke has already poured millions into nan installation to upgrade its exertion and infrastructure to Duke standards.

“They telephone it ‘Duke-itizing’ nan hospital,” he said. “They for illustration that word.”

Many Charlotte-area patients already thrust to Durham to spot Duke specialists, particularly for crab care, cardiology and analyzable surgeries, Blitstein said.

The thought now is to bring that attraction person to home, he said, pinch nan Mooresville infirmary serving arsenic “a constituent of access” wherever each Charlotte-area patients — not conscionable those successful Iredell County — tin statesman treatment, participate successful objective tests aliases get follow-up attraction if they are already being treated astatine Duke.

Duke is frequently ranked arsenic nan apical infirmary successful North Carolina and one of nan best successful nan country.

“The dream is to bring that level of excellence from Durham to nan Charlotte market,” Blitstein said. “Patients shouldn’t person to thrust 2 hours for follow-ups aliases regular imaging. Those tin beryllium done here, pinch results sent seamlessly backmost to their doctors successful Durham.”

Still, not everyone is convinced nan pivot is simply a bully 1 for Duke. By chasing marketplace share, Richman said, Duke risks diluting its world mission.

“It’s not astonishing that they’re yet starting to do what everybody other is doing,” he said. “But this state already has measurement excessively overmuch infirmary description . … If I had my druthers, Duke would not beryllium competing pinch Atrium for knee replacements. They would beryllium competing pinch Mayo Clinic for nan astir analyzable encephalon surgeries.”  

Proposed Duke-Novant centers on I-77 corridor

Duke’s business pinch Novant adds different furniture to Duke’s entranceway into nan Charlotte market.

In a March news release, nan 2 hospitals said they planned to “jointly create caller campuses crossed North Carolina that will grow entree to affordable, high-quality care,” but they provided fewer details.

Novant and Duke declined to reply questions astir nan partnership, including what types of accommodation they’ll unfastened aliases wherever they will beryllium located.

However, nan 2 infirmary systems person already requested authorities approval to build a jointly operated infirmary successful Mebane, a fast-growing metropolis astir halfway betwixt Durham and Greensboro.

Duke’s financial filing besides outlines plans for nan hospitals to jointly create a web of outpatient centers crossed nan state, including on Charlotte’s I-77 corridor. The sites would connection superior attraction and specified specialty services arsenic cardiology, neurosciences and cancer, on pinch laboratory and imaging services — and perchance surgery, infusion and urgent attraction services, according to nan filing.

The move comes arsenic nan North Carolina legislature has moved to loosen nan state’s certificate of request regulations for ambulatory surgical centers opening this November, which would make it easier for hospitals to unfastened them successful municipality areas.

At an August proceeding wherever it requested authorities support for much operating rooms, Novant besides hinted that Duke specialists whitethorn execute surgeries and do different activity successful Novant hospitals.

Matthew Hanis, a Charlotte-based advisor and master successful nan business of wellness care, said nan business gives Novant a credibility boost by tying it to Duke’s investigation and world reputation. That could thief Novant compete pinch Atrium, which collaborated pinch nan Wake Forest University School of Medicine to precocious open Charlotte’s first aesculapian school, Hanis said.

Steve Lawler, a erstwhile CEO of nan North Carolina Health Care Association and now a wellness attraction consultant, said nan woody should besides make it easier for Novant to participate successful precocious investigation and treatments and springiness its patients smoother entree to Duke’s specialized services and objective trials.

“Novant could enactment arsenic a navigator to make it easy and seamless for group to entree that type of high-end care,” he said.

Just a business aliases a measurement toward a merger?

Joint ventures for illustration Duke and Novant’s are progressively communal successful North Carolina and nationwide arsenic hospitals look for ways to grow while avoiding nan regulatory hurdles associated pinch mergers.

Such partnerships, which tin see associated infirmary ownership aliases operations, let partners to stock some nan activity and nan risks of growth, Lawler said. He pointed to nan precocious announced children’s infirmary successful Apex, a associated task betwixt Duke and UNC Health, arsenic different example.

Other hospitals, successful their quest for description , person gone beyond shared ownership to afloat integrated combinations. Atrium has perfected this approach, combining first pinch Navicent Health successful Georgia, past pinch Wake Forest Baptist and yet pinch Advocate Aurora Health successful 2022 to shape nan country’s third-largest nationalist wellness attraction system.

In its financial filing, Duke hinted astatine nan anticipation of deeper integration pinch Novant, saying nan business “could service arsenic a launching constituent for early collaborative opportunities betwixt nan organizations.”

Hanis said he doesn’t person immoderate wrong information, but he wouldn’t beryllium amazed if nan confederation was nan first measurement successful nan systems coming together. “Both person nan request to build scale” to compete, he said.

He noted that Duke besides partners pinch Tennessee-based Lifepoint Health, which owns 9 smaller organization hospitals successful North Carolina. “Combine Duke, Lifepoint and Novant and you person superior standard and brand,” he said.

For now, galore questions stay astir nan partnership: Will Duke doctors really believe successful Novant hospitals, aliases will Novant doctors collaborate pinch Duke specialists virtually? Could Duke alone, aliases nan 2 systems together, unfastened caller hospitals successful nan Charlotte region? And really will Duke’s debut successful Charlotte impact wellness attraction costs and entree to care?

For Marlene Tontodonato of Charlotte, nan stakes are personal.

Tontodonato, 77, said she traveled to Duke for a 3rd sentiment aft 2 section doctors disagreed astir whether she should get spine room and a rod for her scoliosis — a curvature successful her spine. Duke doctors suggested a much blimpish approach, she said, and she still sees a spine master successful Durham.

Tontadonato said she would invited nan chance to get that aforesaid level of attraction person to home. But she said she hopes Duke brings its ain doctors to Charlotte alternatively than absorbing section physicians.

“I person much religion successful Duke because it’s a school hospital,” she said, “and they person expertise that I deliberation we are lacking successful Charlotte.”

This article is portion of a business betwixt The Charlotte Ledger and North Carolina Health News to nutrient original wellness attraction reporting. You tin support this effort pinch a tax-deductible donation.

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