Triple threat.

• Author: Martin, Edward
• Position: NC TREND: Triad Region

[ILLUSTRATION OMITTED]

Ten years ago, Robert Morrison, CEO of Randolph Hospital in Asheboro, was singing the praises of independence in a state dominated by giant health care systems ("Safety in numbers," March 2006). The rewards were great, he said, but "you work without a net financially." Now, after sealing a 10-year management agreement with Greensboro-based Cone Health, Randolph has a net of sorts, along with a loss of some independence.

While operating and joint-purchasing agreements among hospitals are sweeping North Carolina health care, Randolph's deal has a dose of the unusual. Only about 18 single-hospital systems remain in a state with more than 130 medical centers, says Julie Henry, vice president of communications at the N.C. Hospital Association. "You hear a lot about the little guys being gobbled up by the big guys, but it's about staying viable."

The twist in Randolph's case is that it will be managed for an undisclosed fee by Cone, a six-hospital system that in turn operates under a 2012 management agreement with Charlotte-based Carolinas Healthcare System. Randolph Hospital spokeswoman April Thornton says management teams from the two bigger systems planned to descend on the 145-bed hospital late last month.

Multiple layers of management advice are unusual. Cone and Randolph remain locally owned and governed, and Thornton and...