Reinforcement learning (RL) in healthcare has had mixed results, with reward sparsity, unreliable off-policy evaluation, and deployment-simulation gap as recurring failure modes. We argue that chronic disease management is structurally a more tractable RL setting than the acute-care problems the field has primarily studied, but only if the problem is formalized to exploit chronic care's properties. We propose such a formalization. The agent's objective is to compress time-to-control (TTC) under a tiered reward calibrated to the CMS ACCESS Model. Two quantities from our companion preference-learning paper [Singh et al. 2026] enter as load-bearing structural elements: the execution intensity \epsilon bounds action availability under a constrained Markov Decision Process, and the clinician capability \kappa weights offline-data transitions during RL training. Together they couple preference learning and RL into a two-loop architecture. We present simulation results on synthetic state machines for hypertension and type 2 diabetes. Capability-weighted offline RL outperforms uniform-weighted offline RL and the behavior policy by 15 percentage points on T2D TTC; the uniform-weighted formulation (the standard in existing healthcare RL) underperforms even the heterogeneous behavior policy. \Epsilon-aware policies generalize across deployment regimes while \epsilon-naive policies do not.
@article{arxiv.2605.09818,
title = {Learning to Compress Time-to-Control: A Reinforcement Learning Framework for Chronic Disease Management},
author = {Prabhjot Singh and Abhishek Gupta and Chris Betz and Abe Flansburg and Brett Ives and Sudeep Lama and Jung Hoon Son},
journal= {arXiv preprint arXiv:2605.09818},
year = {2026}
}