Multi-Agent Reinforcement Learning in Value-Based Care
Keywords:
Agentic Artificial Intelligence, Multi-Agent Reinforcement Learning (MARL), Population Health Management, Risk- and Performance-Based Contracts, Healthcare Payment Redistribution, Actor–Network Healthcare Models, Complex Adaptive Healthcare Systems, Agent-Based Decision Support, Health Information Systems Innovation, Risk-Adjusted Outcome Optimization, Healthcare Econometrics, Decentralized Healthcare Governance, AI-Driven Policy Optimization, Strategic Interaction in Healthcare Ecosystems, Adaptive Multi-Agent Systems in Medicine.Abstract
Agentic artificial intelligence (AI) systems, including those realized through multi-agent reinforcement learning (MARL), are emerging in multiple domains, including information filtering, navigation, gaming, and robotics. These novel approaches may also be relevant to healthcare delivery and policy, as MARL is well suited to complex strategic problems that Richard Thaler characterized as “makeshift solutions to impossibly complex problems.” Population health management is such an arena, particularly in optimizing risk- and performance-based contracts, payment redistribution across agents and cadre types, and performance-related benchmarks for an actor-network consisting of several competing provider-organizations functioning in a shared ecosystem. Health information systems, including such agentic, MARL-based systems, could help realize “better, faster, cheaper, and ‘kinder’ healthcare” by improving risk-adjusted health and cost outcomes across multiple resident cohorts, thereby more effectively realizing the goals of modern econometrics in medicine and public health.
Current culture tends to represent healthcare decision-making as a Black Box or an informationally centralized “big brain” where supervision assures correctness and compliance with Thaler’s ideal of omniscience for coordinating activities. Yet actual healthcare organizations are not Black Boxes, much less a single Big Brain, corporate or otherwise. Decision makers are often overpromoted, misinformed, late in their decisions, veto the best ideas of the organization, or are unable to manage rich information effectively. Supporting such overloaded Decision Makers-MD, using training and expertise gained trying to wisely harvest large but incomplete information- is a hard problem. Because the decisions should be seen as Agents making active decisions, it is viewed in terms of Agent-based Systems, or the study of multi-oriented organizations as complex adaptive systems.
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