Trusted Health Ecosystems: Our project approach

Dr. Sebastian Schmidt-Kaehler
Dr. Inga Münch

The digital age is impacting our lives in ways we’ve never experienced before, and it’s doing so at an accelerating pace. This rapid change, coupled with the disruptive effects it brings, places considerable demands on society in terms of adaptability. Digital platforms are at the forefront of this change, as they supply the essential infrastructure and services driving this transformation.

Through their platforms, digital ecosystems have fundamentally altered entire sectors of the economy. They have changed how people interact and communicate with each other, how goods and services are marketed, and how educational and informational resources are accessed. Platforms are not only impacting the world of work, they have disrupted the media landscape and upended the power dynamics of the mobility industry. So why should healthcare be any different?

New power dynamics

Global tech companies are venturing into the healthcare sector, offering immense potential for a modern, patient-centered and continually evolving healthcare system. While network effects and economies of scale present impressive growth opportunities, they also pose risks to the principle of solidarity that finances our healthcare system. One thing is certain: Digital platforms will profoundly reshape the power dynamics within healthcare systems. It is our responsibility to harness and direct their innovative and guiding influence for the greater good (see video: Managing the risks of platform economy).

Platform strategies for national healthcare systems

The time has come for public and civil society actors to create their own platforms and take the lead in shaping the foundational digital infrastructure, defining value-based guidelines for the future of digital healthcare. National healthcare systems need to formulate their own platform strategies to carve out a position for themselves in the emerging healthcare market. With our “Trusted Health Ecosystems” project, we are paving the way forward to achieve this and developing a concrete vision of a future national healthcare platform. We thus aim to illustrate the potential benefits that can arise from collaborative efforts involving government, civil society and the private sector (see Conceptual considerations: an overview).

Promoting health literacy

The focus of our product concept is to provide patients personalized information and services. By doing this, we confront the enduring problem of health literacy, with more than half of the German population indicating significant struggles in accessing, understanding, appraising and applying health-related information (see Health literacy: challenges of the future). Without health literacy, patients find it difficult to make informed decisions about their health and actively participate in their treatment process. By consolidating and intelligently disseminating curated information, the platform could help streamline how information is handled and reshape the information landscape within the healthcare sector.


The Bertelsmann Stiftung cannot and will not implement and operate this platform itself, because merely providing a digital infrastructure would fall far short of the mark. To cultivate a digital ecosystem that benefits all participants, it requires more than a legal foundation; but also the insight and collective will of all relevant actors in the healthcare system. Therefore, as a foundation, we see our role to inspire those who can collaboratively bring this vision to fruition.

International context

Digital ecosystems have networked the world more tightly than ever before. While these platforms adapt to national circumstances, they often extend beyond borders. This presents challenges that can no longer be effectively tackled solely at the national level. International collaboration and coordination are thus imperative if we are to mitigate risks and seize the opportunities inherent in this transformation. We have therefore positioned our vision of a national healthcare platform within an international framework from the outset, engaging with international organizations in Europe and beyond. This applies in particular to the quality, safety and interoperability standards associated with such a platform (see InfoQ: Making quality visible).

Real-time project results

Since the advent of AI-powered language models, we have seen just how rapidly digital transformation is reshaping our lives. Given the exponential pace at which things are changing, we have we’ve chosen to release our project findings as they develop – in “real time” – rather than holding off until the project has concluded. This concept is a living document and as we move forward, this concept will undergo continual refinement through contributions and the addition of new sections, all aimed at further shaping the vision of the national healthcare platform.


Dr. Sebastian Schmidt-Kaehler serves as the co-director of the Healthcare Program at the Bertelsmann Stiftung. Before this, he held the position of managing partner at Patientenprojekte GmbH, a consultancy focused on organizational management with a specialization in patient communication. From 2011 to 2015, he assumed the role of national director at Germany’s Unabhängige Patientenberatung (UPD). He is also currently a member of the expert committee for the National Action Plan Health Literacy in Germany.

Dr. Inga Münch is a health researcher and co-lead of the “Trusted Health Ecosystems” project at the Bertelsmann Stiftung.  Most recently, she has been involved in various projects that merge patient-centered care with digital health solutions. Her PhD thesis centered around the concept of health-literate organizations. Through her work on a variety of scientific projects, Dr. Münch has conducted research in areas encompassing health education, patient-oriented care and health systems.

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    The transformative nature of digital ecosystems

    Dr. Matthias Naab
    Dr. Marcus Trapp

    Offering numerous benefits to everyone involved, the collaborative nature of digital ecosystems and platform economies has led to significant transformations in various domains of life. This overview highlights the appealing aspects of digital ecosystems and their platforms and explores ways to harness their innovative potential.


    Digital ecosystems ...

    ... are appealing

    Delivering real added value is the only way digital ecosystems can succeed in convincing independent participants to get involved. One major advantage of these ecosystems is the access they offer to a diverse community of participants, each contributing to the system either as suppliers or consumers, depending on their role. This diverse and geographically dispersed community can generate various additional advantages. To ensure widespread participation, digital ecosystems typically maintain an inclusive approach and strive to attract as many individuals, organizations, and companies as possible. As a result, access to their ecosystsems is rarely restricted (Choudary 2017).

    The appeal of digital platforms for providing and consuming ecosystem services lies in their high-level harmonization, user-friendly interfaces, and excellent user experiences. These factors enable efficient access to a wide range of ecosystem participants. Initiators and operators of digital platforms invest significant time and resources to achieve this harmonization, encompassing various aspects such as business models, technical standards (e.g., standardized access via APIs), and legal frameworks (e.g., standardized contractual relationships), particularly for commercial ecosystems. This harmonization is reflected in functions like payments, search capabilities, and data transformations. Not-for-profit ecosystems follow a similar approach, although their goals are not profit-oriented. Users often don’t realize the effort invested in creating seamless processes due to the smooth and enjoyable experiences provided. However, it is important to recognize that the simplicity and elegance of a digital ecosystem’s services do not imply a lack of complexity in its design.

    Digital ecosystems offer bundled online services, eliminating the need for users to extensively research individual service providers. The added value lies in the integration of the digital platform and the active participation of the community members, which results in a combined power that enhances the services provided. To attract users, a digital ecosystem must ensure seamless interaction between its platform and community.

    ... are scalable

    Digital ecosystems present operators with significant opportunities to develop innovative business models. By becoming a central point of contact for a large number of participants, organizations can strategically reposition themselves in the market or sector and expand their influence. The scalability and high growth potential of digital ecosystems are facilitated by their ability to provide services in a purely digital form.  As the ecosystem attracts more participants, network effects come into play, generating increased business activity within the ecosystem. This growth opens up avenues for further expansion of the platform and services, enhancing the overall attractiveness of the ecosystem as a whole.

    ... are disruptive

    A digital ecosystem doesn’t exist in isolation or simply emerge out of nowhere. Instead, it is intricately woven into a landscape that involves multiple stakeholders and their interconnected relationships. We refer to an established network of partners and value chains in an industry as a domain ecosystem.  Today, we witness the constant emergence of new digital ecosystems, each catering to specific needs and offering unique services. When these ecosystems thrive, they disrupt existing business relationships within their respective domains. The introduction of a new digital ecosystem and the involvement of its participants bring about changes in the dynamics and positions of various stakeholders within the domain ecosystem (Trapp 2020).

    Multiple digital ecosystems can coexist within the same domain ecosystem, and they can either compete or complement each other. It is also possible for an actor to participate in multiple digital ecosystems simultaneously, assuming different roles in each. In the mobility industry, for instance, there are various digital ecosystems such as Uber and Lyft that offer services in the realm of personal transportation. Flixbus, as a digital ecosystem, has transformed and harmonized the market for long-distance bus travel. Additionally, there are numerous other digital ecosystems focused on mobility services, including those involved in capturing and providing telematic data from vehicles manufactured by different companies.

    ... are only lucrative n the long term

    Creating a digital ecosystem is a complex and time-consuming process that requires more than just developing a software system. It involves a holistic and well-coordinated design approach to continually attract and engage participants.

    This process typically unfolds over several years and starts with gradual growth, which gains momentum as network effects come into play. Looking at successful digital ecosystems like Amazon and Airbnb, we can see that it takes around ten to fifteen years for them to reach a substantial size and become self-sustaining operations. During the building phase, significant investments are made to fuel growth, and it’s only in the later stages that the ecosystem becomes self-sustaining. Therefore, building a successful digital ecosystem requires long-term commitment and a willingness to invest resources. In other words, digital ecosystems cannot be expected to generate a positive return on investment within a short period, like 18 months.

    ... are diverse

    While the provision of ecosystem services is a fundamental principle shared by all digital ecosystems, it doesn’t mean they are all the same. In fact, they can vary significantly in terms of the providers and consumers involved and the assets they focus on, ranging from accommodations to vehicle data or even initiating contacts. Digital ecosystems can adopt various business models, whether they are nonprofit or profit-oriented. They can facilitate business-to-business matchmaking (B2B), serve as intermediaries between private individuals (C2C), or operate with a combination of different relationship types. Government agencies can also play a role in these ecosystems

    The design possibilities for digital ecosystems are nearly limitless, as long as they remain attractive to participants and secure sufficient funding to navigate the startup and growth phases. This is why there is still ample space for the emergence of new digital ecosystems.

    ... are powerful

    Despite all the potential benefits, digital ecosystems can also entail risks, depending on how you look at them. These risks primarily stem from the self-reinforcing network effects that occur when digital ecosystems achieve success and attract a growing number of participants. On the one hand, this can lead to a concentration of power in the hands of the ecosystem operator. On the other hand, it often results in a limited number of successful competing ecosystems, typically only one to three direct competitors. Consequently, profits become centralized within the ecosystem service provider, potentially creating a situation where local providers become highly dependent on the ecosystem.


    Choudary S (2017). Die Plattform-Revolution im E-Commerce: Von Airbnb, Uber, PayPal und Co. lernen: Wie neue Plattform-Geschäftsmodelle die Wirtschaft verändern.

    Trapp M (2020). Digitale Ökosysteme und Plattformökonomie: Was ist das und was sind die Chancen?


    Dr. Matthias Naab and Dr. Marcus Trapp

    Dr. Matthias Naab and Dr. Marcus Trapp, co-founders of Full Flamingo, an eco-tech startup, aim to leverage the platform economy to maximize sustainability impact.  Before 2022, they held senior executive positions at Fraunhofer IESE, where they played a pivotal role in developing and overseeing the field of “Digital Ecosystems and the Platform Economy.”

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