Hospitals and physician practices that form care-coordinating networks called "Accountable Care Organizations (ACOs)," under provisions of the new health-care law could reap cost-savings and other benefits. However, experts at Johns Hopkins and the University of Pennsylvania warn that such networks could potentially be designed to exclude minorities and widen disparities in health care.

In a commentary appearing in the April 27 issue of the Journal of the American Medical Association, a Johns Hopkins physician says that as a result of new provisions in the Patient Protection and Affordable Care Act, wealthy hospitals and practices may "cherry-pick" similar, wealthy institutions and groups to form ACOs, and avoid poor and minority-heavy patient populations treated elsewhere in order to lower costs and raise quality of care.

ACOs are designed to encourage patients to seek care within their own network, further accentuating the disparities between networks.

In practical terms, writes Craig Pollack, M.D., M.H.S., assistant professor of medicine at Johns Hopkins, hospitals and physician practices that treat a disproportionate share of minorities may be unable to join ACOs and fall further behind in the cost and quality of care benefits likely to occur in such networks.

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