The Micro-Meso-Macro (3M) Impact Framework: Capturing Health System Value Across Interacting Levels
Author(s)
Sonja Haut, PhD1, Alvar Bucher, MA1, Ahmed Hesham Seddik, BSc, MSc2, Dennis Alexander Ostwald, PhD3, Mark Lightowler, PhD4, Rebecca Grün, PhD3, Malina Müller, BA, MA, PhD5.
1Novartis International AG, Basel, Switzerland, 2University Medical Center, Groningen, Netherlands, 3WifOR Institute, Darmstadt, Germany, 4Ernst & Young AG, Basel, Switzerland, 5Head of Health Economics, WifOR Institute, Darmstadt, Germany.
1Novartis International AG, Basel, Switzerland, 2University Medical Center, Groningen, Netherlands, 3WifOR Institute, Darmstadt, Germany, 4Ernst & Young AG, Basel, Switzerland, 5Head of Health Economics, WifOR Institute, Darmstadt, Germany.
OBJECTIVES: Health systems are under increasing strain due to aging populations, financial constraints, and a growing range of available treatments. Current approaches often assess value in an isolated manner, missing important interactions that shape real-world outcomes. Our proposed Micro-Meso-Macro (3M) Impact Framework aims at providing a clearer understanding of how decisions and dynamics at the individual (micro, e.g. patient or caregiver), institutional (meso, e.g. healthcare providers or health insurances), and societal (macro, e.g. societal norms or culture) levels interact and influence one another, potentially also identifying currently hidden potentials of new collaborations. By tracing the patient journey, the framework offers a system-wide lens to improve strategic decision-making and cost-effectiveness analysis with a broader, more connected perspective.
METHODS: We conducted a literature review of the patient journey, drawing on an interdisciplinary body of research, including behavioral science, health system research, studies on societal outcomes, and impact valuation. We explored patient behavior and decision-making across the care pathway, alongside the motivations of medical professionals and institutional actors from prevention to recovery. The traditional separation of micro, meso, and macro levels is reimagined as dynamic and non-linear, reflecting the interdependence between individuals, institutions, and society.
RESULTS: The 3M Framework enables a structured yet flexible analysis of health interventions. We will show an illustrative example by dynamically linking the micro (individual), meso (institutional), and macro (societal) levels along the extended patient journey, showing the framework helps uncover gaps, inefficiencies, and outlines opportunities for more aligned and optimized action.
CONCLUSIONS: The 3M impact framework can support more comprehensive evaluations by revealing opportunities for improved health outcomes and informing decisions that consider the system as a whole. It fosters collaboration, improves resource use, and helps patients achieve their treatment goals. Future research should apply the framework to real-world case studies to assess its value and adaptability.
METHODS: We conducted a literature review of the patient journey, drawing on an interdisciplinary body of research, including behavioral science, health system research, studies on societal outcomes, and impact valuation. We explored patient behavior and decision-making across the care pathway, alongside the motivations of medical professionals and institutional actors from prevention to recovery. The traditional separation of micro, meso, and macro levels is reimagined as dynamic and non-linear, reflecting the interdependence between individuals, institutions, and society.
RESULTS: The 3M Framework enables a structured yet flexible analysis of health interventions. We will show an illustrative example by dynamically linking the micro (individual), meso (institutional), and macro (societal) levels along the extended patient journey, showing the framework helps uncover gaps, inefficiencies, and outlines opportunities for more aligned and optimized action.
CONCLUSIONS: The 3M impact framework can support more comprehensive evaluations by revealing opportunities for improved health outcomes and informing decisions that consider the system as a whole. It fosters collaboration, improves resource use, and helps patients achieve their treatment goals. Future research should apply the framework to real-world case studies to assess its value and adaptability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD108
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas