Two major nonprofit New York City hospital systems have reached agreement on a merger that The New York Times says could profoundly change how medical care is delivered in the city.

NYU Langone Medical Center and Continuum Health Partners announced on Wednesday a pact that would unite a highly specialized academic hospital with a network encompassing several community-oriented facilities.

Subject to final approval by both organizations’ boards and regulators, the merger would create one of New York’s largest health-care entities, with potentially significant competitive advantages in the lucrative Manhattan market, according to the Times.

Like similar consolidations around the country, the move is driven in large part by the new federal health-care law that demands more efficient, lower-cost hospital operations. Patient advocates fear the new system’s competitive strength could drive patient fees an insurance premiums up.