Despite the economic blow caused by the COVID-19 pandemic, health systems in Charlotte continue to grow across market lines through mergers and acquisitions, reshaping North Carolina’s provider landscape. Market leader Atrium Health and Wake Forest Baptist Health—including the Wake Forest School of Medicine—have combined, giving Atrium Health a foothold in Greensboro. Meanwhile, Novant Health has acquired New Hanover Regional Medical Center, which has a lock on patient volume in Wilmington. Consolidation could give health systems more bargaining power over insurers in Charlotte, where hospitals already hold considerable influence. To gain more control over the delivery of care, the market’s largest payers are designing new value-based care models that pay providers for meeting quality and cost standards. Blue Cross and Blue Shield of North Carolina is leading the charge, launching models that target specialty care. Payers are also expected to gain greater influence over the delivery of healthcare services with the state’s transition to managed Medicaid. The new program, which goes into effect July 1, 2021, integrates physical health, behavioral health, and pharmacy services.