As Greensboro providers face reductions in patient volume and financial woes amid the COVID-19 pandemic, significant health system consolidation looms on the horizon. Wake Forest Baptist Health, Novant Health, and Cone Health, are pursuing merger partners outside of the market. Randolph Health, one of the market’s last independent hospitals, also has found a buyer across state lines. The trend of regional consolidation is expected to give health systems more bargaining power over insurers in Greensboro. As the state shifts to a managed Medicaid model that integrates physical health, behavioral health, and pharmacy services, look for the adoption of alternative payment models, including risk-based contracts. With more than 270,000 local Medicaid beneficiaries, the transition also presents a major opportunity for the five managed care organizations chosen to serve this population.