The need to advance value in health and care presents numerous challenges for companies, providers, payers and policymakers.

Now more than ever, complex, fast-evolving markets and systems demand advanced capabilities for sensing value-based innovation, growth and transformation opportunities, for designing adaptive organisations, strategy and value propositions, and for sustaining value-creation through continuous learning and renewal.

To realise higher value, companies and organisations can no longer rely on limited disease-based reductionist thinking, on narrow outcome-over-cost measures of value, on technology-driven innovation, on piecemeal ideas-first methods or on serendipitous, safe-to-fail experimentation. 

In short, a new, more expansive ecosystem perspective of value is needed – one that achieves higher forms of systemic value on a more sustained, viable and adaptive basis. 

What is ecosystem value?

But what is ecosystem value? How does it differ from established perspectives on value in health, and what are they? How do existing beliefs influence how health value is created and evaluated by various stakeholders? How can we better understand and overcome current assumptions to discover alternative, more transformative and longer-term paths for ecosystem value-creation? 

This paper addresses these questions. In it, I define four varieties of value in health and care. I describe their defining elements and mechanisms and, using an example from industry, I outline a roadmap for co-creating health ecosystem value

Read on to discover a new perspective for advancing value in health and care, for an exploration of novel value-creation possibilities, and to gain new insight in how to realise and continuously nurture value contextually, sustainably … and ECOsystemically.

Introduction

Many of the greatest social, economic and political thinkers have explored the rather vague and subjective concept of value. Aristotle in 5 BC, Adam Smith, Ricardo and Marx in the 18th and 19th centuries, and many more since, all sought to define value, identify its different forms, describe its elements and extract the various implications of different conceptions on pricing, markets, labour, production, consumer relationships and many other areas. Whilst fiercely debated, two primary conceptions of value became most widely understood and most pervasive in political, and especially economic and business thinking. First described by Aristotle, these became known as value-in-exchange and value-in-use.

In the last decade or so, a third form of value has emerged from the marketing field. In response to new awareness and understanding of the increasing role of customers in the value-creation process, this extended, more dynamic form of value incorporates and adds to the exchange and use conceptions. Called value-in-context, it acknowledges and seeks to better explain the complex, multiple determinants of value-creation involving many actors co-creating knowledge, products, services and experiences in more unique and diverse ways, and in context to their particular circumstances. 

Much more recently, emerging from value-in-context, a fourth form of value is being advanced too. Though not yet really given a separate identity, I call this form of value, value-in-ecosystem.

In this paper, I explore the four different forms of value – exchange, use, context and ecosystem. I examine the assumptions that define each, their content or elements, the roles of producers and consumers (and others) in their practices of creation, their limitations and consequences, and their main differences. I illustrate each with examples from health and care. Also, I describe a path of value evolution through the four forms using a single case-study. This is of a wound care company seeking to transform its value profile and perspective to realise the highest form of value – ecosystem value. I explain how it can do so sustainably, systemically and with positive impact for itself, patients, health professionals and other important stakeholders.   

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