Recommendations for Implementing the Principles of Managed Competition in an Era of Delivery System and Market Consolidation.

Despite great promise, managed competition remains largely unrealized in the United States today. In this perspective, we explore managed competition and why it was considered promising. We identify barriers to its success, considering the role of consolidation in why the conditions for establishing managed competition were not more widely adopted. We offer potential paths forward for policymakers and purchasers that could create favorable market conditions, including market structures supporting managed competition, such as health insurance marketplace exchanges, which could enable integrated delivery systems to compete on value and thrive.