Perspectives

Reviving Managed Competition

Alan Enthoven’s Vision and the Emergence of Episode-Based Plans at Oxbridge Health

When Alan Enthoven introduced the theory of managed competition in the 1970s and 1980s, his vision was simple but radical: create a competitive marketplace where health plans would vie for consumer trust not by denying care, but by delivering value—high-quality outcomes at the lowest possible cost.

In Enthoven’s ideal world, consumers would choose from a menu of plans, each offering a different balance of access, quality, and price—with transparent trade-offs and aligned incentives.

Decades later, that vision remains more aspiration than reality. Legacy insurers and large provider networks have largely sidestepped competition through consolidation, opaque pricing, and rigid networks. Enthoven’s concept of consumer sovereignty through transparency has been diluted into actuarial games and narrow networks.

But a new model is emerging that revives Enthoven’s ideals using modern tools: Oxbridge Health’s Episode Benefit Plans, powered by Episode Advantage™.

What Is Managed Competition?

At its core, Enthoven’s model called for:

• Structured choice: A curated set of health plans for individuals to choose from.
• Price and performance transparency: True comparability before care.
• Aligned incentives: Plans that manage cost and quality effectively win enrollment.
• Standardized benefits: Simpler decisions for consumers.

The employer—especially self-funded ones—was envisioned as a rational purchaser, demanding value on behalf of workers.

Episode Advantage: Enthoven, Updated

Oxbridge’s Episode Advantage program reframes the unit of healthcare competition—from a plan to a care episode.

• Structured Choice: Members don’t navigate opaque networks—they shop from guaranteed, pre-priced care bundles for common procedures like joint replacements, maternity, or cardiac care.
• Transparent Tradeoffs: Members know what they’re buying, who is providing it, and how much it will cost—up front.
• Incentives That Work: Providers are paid for outcomes, not volume. Consumers share in the savings.
• Standardization & Personalization: Tools like TIGERS (rules-based episode definitions) and Quilt (personalized outreach) drive clarity and engagement.

The Realization of a Dormant Vision

Managed competition never scaled because insurers lacked both the motive and the mechanics to compete on value. Oxbridge sidesteps them entirely. It makes care episodes the unit of competition, providing a plug-and-play model for employers and a guided shopping experience for consumers.

It’s the kind of market-based structure Enthoven imagined—but one that’s technologically feasible and administratively elegant in 2025.

Conclusion: A New Health Economy

Managed competition was never about choosing a health plan. It was about aligning every actor—consumer, provider, employer—around value. Oxbridge Health brings that alignment to life through:

• Predictable pricing
• Episode-based cost control
• Engaged, informed consumers

Alan Enthoven may have been ahead of his time. But maybe, just maybe, that time has arrived.