LillyDirect vs. NovoCare vs. PfizerForAll: May the Best Ecosystem Win

The more you connect, the wider your economic playing field becomes.

Interdependence is no longer a choice. It’s a condition. 

Our only choice is whether markets are enabled to forge and compete based on positive interdependencies (‘market interoperability’), and rise together, or maintain unhealthy interdependences and fall together. To understand the direction and implications of the latter, look no further than the mutually-assured destruction in the decades-long discursive war between Big Pharma and Big PBM.

To understand the opportunities and potential of the former, look no further than a sweeping analysis of records from 2.5 million VA patients, which supports much of what scientists already suspected: GLP-1s might be able to help with more than 175 diseases.

The study, led by researchers at the (now gutted) Veterans Affairs found that using GLP-1s was associated with reduced risks for substance abuse, suicidal ideation, schizophrenia and other psychotic disorders. Risk reduction was also found for neurocognitive disorders like Alzheimer’s and dementia, along with infections, liver cancer, and even life-threatening clotting disorders, like blood clots in the lungs.

GLP-1s also reduced the risk of respiratory failure, sepsis, chronic obstructive pulmonary disease and pneumonia in the Nature Medicine study. 

“I think the elephant in the room here is that GLP-1s reduce the risk of obesity — and it’s possible that obesity is kind of the mother of all ills,” says Ziyad Al-Aly, who led the study and is director of the Clinical Epidemiology Center at VA St. Louis Health Care System. “Obesity impairs metabolic health and leads to chronic low grade inflammation, affecting multiple body systems and making the immune system less efficient.” (Related Blue Spoon thinking: What’s the Business Value of the VA to Eli Lilly?)

Another way to understand this is by thinking of ‘cardiometabolic health’ as an economic concept, like "cost" and "price" and GDP. GLP-1s have system-shaping potential, and ‘the production of cardiometabolic health’ can enable new policy and market relationships, the kind of mechanisms to mount a multi-sector effort at growth….value alignment across, above and throughout the business of healthcare, in which every business is a healthcare business, whether they like it or not. 

Demand — Not Supply — is Power

Markets aren’t about “efficiency” — they’re about power and control. And market innovation is the deliberate process of finding and positioning power, of inventing leverage in an organized and persistent way. The end state is/are a new economic system (“ecosystem”) that becomes a control point, a way to displace an embedded economic network.

LillyDirect is becoming a new, gravity-altering demand center within healthcare, which in turn is beginning to revolve around mass consumption of GLP-1s. Across a wide arc, ‘cardiometabolic health’ is becoming a klieg light for reframing the global landscape of healthcare.

Markets (and market makers) in the business of healthcare should accept that the primary mode of competition lies not in any one brand producing technology and technical inputs that are incrementally better than another equally-resourced brand’s technical inputs and technology, but in the unique integration schemes that widen the economic playing field for the most markets, at the same time. 

Which is why I think LillyDirect’s latest crab-like moves — expanding services to early diagnosis and access to Alzheimer’s disease care; Nourish to offer personalized nutrition support; metabolic care provider knownwell was integrated yesterday— is following the right model to ecosystem-centered market strategy:

When it comes to big market innovation, it's better to think in terms of gravitational pull, a new "universe" that rotates around the concepts of 'shared marketspace' and value alignment.

“Ecosystems" are economic systems with the power to reset how an entire market works; or they become a channel themselves, white space to enable new categories of products and services that are native to the new system. The process knowledge to construct and sustain industry ecosystems -- to intentionally design a system advantage -- is a new skill for brand, creative and technical management across business and government, worldwide.

Less ‘out there’ already than intentionally organized, they basically answer five questions: Where does growth come from? Where do markets come from? How do you understand them? How do you manage them? And then how do you sustain them?

LillyDirect is managing itself as a biological organism, living system, a coevolutionary fabric, a true diversity working as a single economic unit. The term of art here is 'progressive integration' ("value" is a flow, not an end state) that, once the basic architecture works itself out, will put it in a better position to set the conditions by which others have to play, much more so than NovoCare (narrowly positioned as a "pharmacy") and PfizerForAll, it's latest value-add (a new generative AI product, called Health Answers by Pfizer) safely sitting in the Land of the Standard Model: "It feels a little bit like typing queries into Google and getting answers from WebMD or another SEO-optimized health resource, without having to actually read (or skim) a whole article," says Mario Aguilar in his review for STAT.

LillyDirect is an "acorn molecule" in the emerging pharmaceutical-as-healthcare / healthcare-as-pharmaceuical market. It’s a dynamic mold that, like the invention of polymerase chain reaction (PCR) by Kary Mullis in 1985, has the ‘kinetic potential’ for printing stupendously large sets of opportunities for new markets and new products and new services and new technologies, which in turn, by their mutual interaction, are capable of self-generating vast ecosystems of complexity. 

LillyDirect produces, and is produced by, nothing other than itself. It is being organized and managed in such a way that its processes produce the very components necessary for the continuation of these processes. 

Writes Katalin Bártfai-Walcott founder and chief technology officer for Synovient:

“The fundamental shift isn’t from patients to platforms, but from siloed optimization to market interoperability, where the design challenge becomes how to orchestrate cross-sector value creation, not just care delivery. 

Ecosystems aren’t metaphors; they are architectures of control, with feedback loops, flywheels, and terms of engagement. They produce new power centers and force others to play by different rules. Until healthcare strategy internalizes that ecosystems require intent, orchestration, and enforceability, not just adjacency or messaging, it will keep mistaking complexity for innovation. 

The future isn’t about better serving the patient; it’s about structuring the system so value creation and human outcomes aren’t at odds.”

Framed through the lens of a modern strategy story, the plotline is simple: the more you connect, the wider your economic playing field becomes. 

Fortune favors the aggregators.

/ jgs

John G. Singer is Executive Director of Blue Spoon, the global leader in positioning strategy at a system level. Blue Spoon specializes in constructing new industry ecosystems.