Reinforcement focuses on objectives from entities in the ecosystem . These entities are similar or different in scale and for purposes of value, measurement and influence draws from the relevant portions of the ecosystem. Designing scenarios provides pathways for tracking moments and their changing context.

This simple graphic shows how the entire ecosystem collapses into “the environment ” which provides feedback framed as pathways to the provider, “you and me”. Counterfactual principles and counterfactual possibilities blend with standard transactional information to give a range of feedback to the agent of transformation, the provider. This range is realistic for the provider and the patient, “you and me”, the actions dynamically drive the pathway of value. The environment provides the scenario, and the details of the desired transformation. 

As is clear in many contexts, the moment of the provider or agent’s actions are not isolated actions. Functioning in the ecosystem, many entities influence the behavior in the moment. Arranging these entities hierarchically centered on a single agent of the moment, shows linkages stratified by the local topology of the ecosystem. For example, providers have groups, are members of networks, communicate with plans, and respond to quality metrics promulgated from the population level. Engagement means linking providers to other agents in the network or ecosystem. Applying a metric from a population to a provider, can create the objective of engagement from incentives designed at the population level avoiding the unintended consequence of estrangement. The cycle of engagement graph (shown in the Scenario tab’s Transformation tab) shows the double edge sword that is a hazard of metrics that do not account for individual variation, which is always a feature of the organic, holistic moment. The point here is that using a hierarchical framework of the local ecosystem lends status and attention to the complexity of the moment. This will tip the scales from estrangement to engagement, particularly when the hierarchy transcends transactional information alone.

Concisely, reinforcement frames the moment as a destination for a pathway to Value . The sources of the pathway originate in Scenarios built to connect moments of patient care to value through network. The power of reinforcement with a counterfactual context comes from the broader range of possibilities for choices and actions in the organic moments.