Article
Digital Innovation and Patient Engagement: Strategic Drivers of Health System Performance in Value-Based Healthcare
Background: Value-based healthcare rewards the outcomes a system achieves for each unit of cost rather than the volume of care it delivers. Digital innovation and patient engagement are often proposed as the main routes to that goal. However, little is known about how the two operate together inside provider organizations, or which internal capabilities decide whether they pay off, particularly in emerging health systems such as India’s.
Methods: We conducted a cross-sectional survey of 385 healthcare managers, hospital administrators, digital health officers, and senior clinicians drawn from 42 healthcare organizations in urban and semi-urban India. Organizations were selected through stratified sampling by ownership type, bed size, and region. A 47-item questionnaire using five-point Likert scales measured Digital Innovation, Patient Engagement, Organizational Integration, Strategic Management Orientation, and Health System Performance. The hypotheses were tested with partial least squares structural equation modeling (PLS-SEM) in SmartPLS 4.0, and SPSS 27 was used for descriptive and reliability analyses.
Results: The measurement model showed satisfactory reliability and convergent and discriminant validity. Digital innovation (β = 0.412) and patient engagement (β = 0.387) each had a significant positive effect on health system performance (both p < .001), and the model explained 61.4% of its variance. Organizational integration partially mediated the digital innovation–performance relationship (indirect effect = 0.178) and fully mediated the patient engagement–performance relationship (indirect effect = 0.201). Strategic management orientation positively moderated the effect of digital innovation on performance (β = 0.193, p < .01), such that a given level of digital capability yielded larger performance gains in more strategically strong organizations.
Conclusion: Digital innovation and patient engagement improve health system performance primarily when organizations embed them into clinical and operational processes and, for digital innovation, when strategic management capability is strong. Technology purchases and engagement programs pursued in isolation are therefore unlikely to deliver proportionate value. Managers and policymakers in India and comparable settings should treat organizational integration and strategic management orientation as prerequisites of value-based healthcare improvement rather than as by-products of it.