4.7.1.1. Building block: Value Proposition of the service
A business model based thinking offers ideas around enhanced value propositions for the customers or service beneficiaries. Currently, customers (or users) of telehealthcare services are predominantly older people with frailty and/or disability. Telehealthcare services designed to address special care needs such as young people with learning disabilities (Miles and Doughty, 2011; Wilkie, 2010) and people with dementia (McCabe and Innes, 2013; Cahill et al., 2007) could provide tailored offerings targeted to specific customer segments. Designing GPS–based location tracking services for people with dementia can be an example of such a new service (Robinson et al., 2009). The literature on telehealthcare services suggests that telecare service providers need to broaden the scope of services to address holistic needs of vulnerable people (Miles and Doughty, 2011), for example, ‘smart home’ solutions to meet social interaction needs of service users (Demiris and Hensel, 2008). Ethical issues play a vital role in the adoption of telehealthcare services (Eccles, 2015; Perry et al., 2009) and accordingly, any value proposition for telehealthcare services need to include ethical aspects, such as trust (Bhattacharya et al., 2017; Lie et al., 2006).
A business model perspective also highlights the importance of marketing elements in the value proposition of service. Likewise, insights from service research emphasises on social and relational marketing aspects in healthcare technology adoption and service value co-creation (Giuseppe and Geisler, 2009; McGuire, 2012; Wright and Taylor, 2005). Organisational marketing initiatives
largely ignore the older consumer and concentrate on younger targets (Szmigin and Carrigan, 2001), and service marketing literature provides some useful insights into older consumers in the UK (Ahmad, 2002) and practical strategies to engage this segment of consumers (Nielson and Curry, 1997; Melkas, 2008). To summarise, the value proposition element of a telehealthcare service business model needs to address the following key issues:
Addressing differentiated needs for service users and potential customers Embedding ethical aspects, such as trust in the service design
Relational and social marketing around the service
4.7.1.2. Building block: Value Network connecting actors across Service Ecosystem
A value network for a telehealthcare service comprises the actors at the micro and meso level of the service ecosystem (see Chapter 2 for an illustration of a telehealthcare service ecosystem). One of the key objectives of the value network is to co-create value with the customers (or service users). Co-designing with elderly users for aesthetics and usability aspects of telecare equipment (such as alarm pendants and wearables) can potentially address the challenges associated with stigma, cognitive, and functional aspects associated with ageing (Wherton et al., 2015; Proctor et al., 2014). In a nutshell, value network element of a telehealthcare service business model needs to consider the following key aspects:
Opportunities for co-designing technology solutions with service users (and their families)
Collaborations and partnerships with other economic and social actors across the service ecosystem
4.7.1.3. Building block: Value Architecture of the provider
One of the crucial elements that define the value architecture of a telehealthcare business model is its information infrastructure (Collinge and Liu, 2009). As Lennon et al. (2017) noted, technology interoperability across health and care sectors remains a big challenge. A robust information infrastructure, backed up by effective information governance to support interoperability, data sharing and integration of information systems are critical to driving collaboration across health and social care organisations (Waring and Wainwright, 2015). In its current form, telecare in England is mostly restricted to PSTN based (fixed telephone line) systems. An upgrade to digital technology will enable opportunities for more ‘value-added’ service designs – allowing integrations with other ‘smart home’ digital services built around home security, home communication, entertainment, and home care (TSA, 2017a).
In addition to infrastructure, digital skills, and competence of the service provider organisation are vital elements in the value architecture. Lack of knowledge and skills concerning digital health technologies (Lennon et al., 2017) and technical competence in operating equipment (Sander et al., 2012) have been cited as one of the critical barriers in large scale deployment of telehealthcare implementations. An open organisational culture that encourages risk-taking and innovations (Bock et al., 2012) could facilitate the development of such skills. A service logic-based perspective underscores the role of interactional ‘operant’ resources – technology, knowledge, and institutions in forming value architecture. Institutions concern the organisational policies, business processes and practices, and the relationships with other stakeholders. A detailed discussion of these resources is made later in this chapter (see section 4.6.2), in connection with the value co -creation in a telehealthcare service ecosystem. To summarise the key points, the value
architecture element of a telehealthcare service business model needs to focus on the following key areas:
Digital technology skills for the staff involved in provisioning and delivery of service
An information infrastructure that allows inflow of information within as well as across organisational boundaries
Business processes and practices
Organisational culture that promotes openness and innovation
4.7.1.4. Building block: Value Capture from the service
Business model-driven thinking emphasises both the creation and capture of value. A value-driven dialogue helps the provider organisation to achieve the efficiency through gains in productivity and cost reduction, without compromising the effectiveness or quality of the service. This is important for the scalability and sustainability of the service. As the literature on healthcare services suggest, the value created by a service should not be measured purely in tangible and traditional economic currencies, rather in the form of long-term benefits that can be measured using intangible social currencies, such as citizens’ well-being, support to independent living and better quality life (Schwamm, 2014; Lluch, 2011; Goodwin, 2010). It can be argued that while value capture through monetisation is critical for service providers to keep their business running and become sustainable, capturing the value in other currencies is no less important for the provider to attract public or philanthropic funding and make visible organisation’s contribution towards social responsibility.
Introduction of personal budgets and direct payments for social care (Glasby 2007; Carr, 2009) has brought opportunities for service providers to offer customers with more choice-driven, personalised services. For such consumer-led
yet public-funded telehealthcare procurement options, service providers need to perform an intermediary role through information sharing and advocacy (Barrett et al., 2015). To summarise, the value capture element of a telehealthcare service business model needs to put attention on the following issues:
Opportunities for additional revenue channels Cost efficiency
Value assessment mechanisms and tools