HOLDING THEM ACCOUNTABLE: A PENDING PARTNERSHIP OF TWO BIG HEALTH CARE BUSINESSES OFFERS A CHANCE TO PROVE THAT MERGERS CAN HAVE A PUBLIC PAYOFF.

• Author: Mildenberg, David
• Position: UPFRONT

Combining the largest hospital systems in the Triangle and Charlotte--and two of the best, based on our annual ranking (Page 52)--makes sense. That's a hard sentence to write given my general aversion to corporate consolidation. But the patchwork system that has made U.S. health care overly complex and expensive needs a shake-up to produce efficiencies and clarity. "Absolute opaqueness" is the way David King, chief executive officer of Burlington-based LabCorp, described the current pricing model at a Raleigh conference in February. While health care mergers typically haven't cut costs, soaring spending and an aging population are forcing a reckoning by business and political leaders.

Consider N.C. State Treasurer Dale Folwell's clever idea of asking leaders of UNC Health Care and Atrium Health (formerly Carolinas HealthCare System) to post a $ 1 billion bond to back up their nebulous pledge that a merger would lead to better care delivered more efficiently. If the hospital execs really believe that, they have a rare opportunity to put their money where their mouth is.

Of course, Folwell says, the hospital systems laughed at his request, noting such an agreement was unworkable. Such is the power of the two systems, with leadership that has shown limited interest in informing people outside of their boardrooms. That's not just the media's perspective: UNC System board members, N.C. Attorney General Josh Stein and Patrick Conway, president of Blue Cross and Blue Shield of North Carolina, have criticized the lack of transaction details put forth.

Staying under wraps is an art form at Atrium, which holds quarterly board meetings at 7 a.m. and publishes scant financial data despite its $9 billion in revenue, quasi-public structure and huge economic impact. System publicists say the meeting times are set to enable attendance by early rising hospital physicians.

Another explanation is that the duo who took a...