It Takes a Village: An Ecosystem Perspective on Caring for Patients with High Need

Abstract

Providing high-value care for patients with high need requires effective organization of collaboration and integration across care sectors. To better organize care, recent work suggests a need to move away from individual organizations that deliver parts of care to encompass care as being delivered by an entire ecosystem including all actors involved in care delivery. However, empirical evidence of processes through which value is created within ecosystems and the governance mechanisms that support value creation is limited. In a qualitative study of eight primary care practices in the United States, we explore with which actors primary care practices interact to deliver high-value care for patients with high need. And, which governing mechanisms help primary care practices interact with actors in the service ecosystem to deliver high-value care for these patient. In adopting a service ecosystem perspective, we categorize the broad group of actors with whom primary care practices interact. We discover that governance mechanisms are more intentional and formalized between actors between which professional understanding is more closely aligned and task interdependence is higher, while more governance voids existed between actors from more divergent sectors such as primary care practices and community resource providers. Key words: Ecosystems, governance voids, governance mechanisms, high cost high need patients