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Healthcare has a vibrant ecosystem of digital healthcare platform start-ups offering many innovations. However, these start-ups often struggle to scale and ensure a consistent adoption of their services by healthcare providers and patients. Scaling involves increasing the capacity and reach of platforms to handle larger user bases while maintaining performance quality and efficiency. Digital platforms are expected to scale and capture value through network effects. While digital healthcare platform start-ups successfully practice collaborative innovation to cocreate value, they often fail to build transactional relationships with their collaborators, preventing them from capturing value. This unresolved tension impedes platform scaling. Our study addresses the tension and poses the question of how digital healthcare platform start-ups can capture value from collaborative innovation. To explore this, we conducted a multiple-case study of 24 digital healthcare platform start-ups in Italy and Lithuania. We integrate open innovation and an industrial platforms framework to explain the transition from collaborative innovation and value co-creation to establishing transactional relationships with collaborators, thereby capturing financial and social value.