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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.<\/jats:p>","DOI":"10.1177\/10775587261471943","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:51:23Z","timestamp":1790592683000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Recommendations for Implementing the Principles of Managed Competition in an Era of Delivery System and Market Consolidation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3374-1177","authenticated-orcid":false,"given":"Sara J.","family":"Singer","sequence":"first","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain C.","family":"Enthoven","sequence":"additional","affiliation":[{"name":"Stanford University, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"An act providing access to affordable quality accountable health care. 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