Rapid urbanization in the Huaihe River Basin has reshaped land use and intensified the tension between ecological protection and food security. A key gap is that most basin-scale ecosystem service value (ESV) assessments describe changes in land-cover composition but do not identify how landscape configuration–ESV associations vary across space. Using land use remote sensing images from 2000 to 2020, we quantitatively characterized the spatiotemporal evolution of land use via transfer matrices and landscape pattern indices. By integrating the equivalent value factor method, contribution analysis, spatial correlation analysis, and the geographically weighted regression (GWR) model, we examined the spatiotemporal dynamics and driving mechanisms of ecosystem service value (ESV). Key findings are as follows: (1) From 2000 to 2020, cropland area steadily decreased, while construction and forest land expanded markedly, with a synthetic land-use dynamic degree reaching 9.66%. (2) ESV first rose then fell, showing an overall decline. Forest land (18.882 billion CNY) and water areas (20.331 billion CNY) were the primary contributors. The ESV response to land use change manifested as a trade-off between short-term gains and long-term degradation. (3) Landscape patterns exhibited significant spatial heterogeneity, and ESV correlated strongly with patch number (NP) and landscape shape index (LSI). Class area (CA) emerged as the dominant factor, with CA of forest land, cropland, and water areas exerting the most pronounced effects. Based on the differential driving effects of landscape patterns and identified land use change hotspots, we propose enhancing ecosystem service values and mitigating conflicts between ecological conservation and food security through differentiated ecological engineering and ecological compensation strategies.