The Norfolk, Virginia-based health care system that operates Pasquotank County’s hospital is seeking a merger with a Greensboro-based health care system.

Sentara Healthcare and and Cone Health have signed a letter of intent to combine organizations, both nonprofit health care systems said in a press release Wednesday.

Both systems said their intention in merging is to form “a unified, transformative and value-driven organization ... that will be a model for the rest of the nation’s healthcare systems.”

The trustee boards of both health care systems have approved the terms of the letter of intent, the press release states. The merger is still subject to state and federal regulatory review and closing conditions, but officials expect the merger to take effect in mid-2021. Officials believe it will take up to two years to fully combine and integrate the two health care systems.

Sentara Healthcare leases Sentara Albemarle Medical Center from Pasquotank County. SMAC spokeswoman Annya Soucy said the merger will have no immediate impact on local operations since a “definitive agreement” between the two health care systems won’t be in place until mid-2021.

“Eventually, the two systems hope their association will lead to better access to health insurance across North Carolina as Sentara and Cone combine their health plans,” Soucy said. “Both systems have a strong commitment to value-based care that increases access and affordability and both are committed to their not-for-profit missions and stable employment for their members of the team.”

Sentara Healthcare operates 12 hospitals in Virginia and northeastern North Carolina, including Sentara Albemarle, as well as hundreds of care sites. It employs more than 1,200 physicians and advanced practice clinicians and 30,000 staff members. Its Optima Health Plan and Virginia Premier Health Plan serve 858,000 members in Virginia, North Carolina and Ohio.

“This rapidly changing healthcare environment requires tremendous transformation and innovation to ensure the long-term success of each respective health system and, most importantly, the very best for those we are privileged to serve,” said Howard P. Kern, Sentara’s president and chief executive officer. “We can either react to change, or we can shape it. We are choosing to shape change and will lead this transformation of healthcare together.”

Cone Health operates five hospitals and more than 100 health care sites n North Carolina. It employs more than 13,000 people, including nearly 1,200 physicians and advanced practice providers. Its Medicare Advantage health plan, HealthTeam Advantage, serves 15,000 members. Its operations are in Guilford, Alamance, Rockingham, Forsyth, Caswell and Randolph counties.

“In Sentara Healthcare, we’ve found a like-minded organization who shares our commitment to transforming healthcare,” said Terry Akin, Cone’s chief executive officer. “The combined organization will build on our shared commitments and distinct expertise to promote better health outcomes and minimize healthcare costs for consumers. Our integration strengthens and accelerates our shared mission and strategy to transform healthcare in the communities we serve.”

Kern will oversee the combined health care system whose headquarters will remain in Norfolk. Greensboro, meanwhile, will serve as the regional headquarters for the Cone Health division. Akin will remain in Greensboro as president of that division.