Organizations: University of Notre Dame · Emory University
Abstract
Healthcare automation is shaped by local procedures and organizational constraints, so agent capabilities rarely transfer unchanged across settings. Agent skills, self-contained directories that package reusable procedures for AI agents, are emerging as a procedural layer for adapting healthcare agents across diverse healthcare settings. We present the first empirical analysis of healthcare agent skills, drawing on 557 healthcare-related skills filtered from 58,159 public skills on ClawHub and annotated along ten dimensions covering function, deployment context, autonomy, and safety. We find that public healthcare skills emphasize patient-facing workflow automation and monitoring rather than the diagnostic and treatment-oriented tasks foregrounded in healthcare-agent research; coverage of the healthcare lifecycle and specialized clinical inputs remains uneven; and general technical risk does not reliably capture clinical risk. These findings position healthcare skills as a procedural layer not yet addressed by current benchmarks and risk frameworks.
End-to-end automation of realistic healthcare operations stresses three capabilities underrepresented in current benchmarks: policy density, decisions must be grounded in a large library of medical, insurance, and operational rules; Multi-role composition: a single task requires the agent to play multiple roles with handoffs; and multilateral interaction: intermediate workflow steps are multi-turn dialogs, such as peer-to-peer review and patient outreach. We introduce χ-Bench, a benchmark of long-horizon healthcare workflows across three domains: provider prior authorization, payer utilization management, and care management. Each task hands the agent a clinical case in a high-fidelity simulator of 20 healthcare apps exposed via 87 MCP tools, which it must drive to a terminal status through tool calls and writing the role's artifacts, guided by a 1,290+ document managed-care operations handbook skill. Across 30 agent harness/models configurations, the best agent resolves only 28.0% of tasks, no agent clears 20% on strict pass^3, and executing all tasks in a single session slumps the performance to 3.8%. These results raise the hypothesis that similar gaps are likely to surface in other policy-dense, role-composed, irreversible enterprise domains.
Agent skills have become a practical way to extend large language model agents, but the growing skill ecosystem still lacks a reliable way to judge whether a skill is worth deploying. Existing evaluation methods remain largely anchored to fixed task suites, assessing skills through performance on predefined tasks and environments. As skill marketplaces expand, this paradigm becomes inadequate: fixed suites can conflate a skill's marginal contribution with backbone strength and miss its value when tasks fall outside the skill's intended scope. We introduce SkillAudit, an end-to-end framework for skill-centered assessment that takes an arbitrary agent skill as input and automatically generates a comprehensive, multi-dimensional evaluation report spanning utility, efficiency/cost, and safety. SkillAudit focuses on the skill artifact itself and constructs capability-aligned evaluation tasks directly from the skill package. The generated tasks are conducted in isolated sandbox environments to collect execution evidence, followed by automated checks with LLM-based judging to produce auditable results. To dissect the agent skills, we propose the baseline comparison principle to measure utility and efficiency/cost, and introduce a two-stage detection paradigm combining static semantic analysis with dynamic runtime verification to assess safety risks. After scanning top-ranked real-world skill packages spanning 23 occupational categories, we found that over 7% of skills are at risky status.
Agent skills encode reusable procedural knowledge for large language model (LLM) agents, and existing benchmarks show that such skills can improve task-level performance. However, a task outcome does not reveal which parts of a reusable skill were exercised, nor whether the agent followed the relevant skill instructions when those parts were exercised. This gap makes it unclear whether a skill has been adequately tested, or whether observed task failures provide actionable evidence for improving agent skill effectiveness. To fill this gap, we introduce skill coverage, a trajectory-based test-adequacy metric for reusable agent skills. Our framework extracts skill behavior constraints from each skill, translating natural-language skill instructions into semi-structured constraints that specify the expected agent behavior under particular conditions. It then determines whether each constraint is covered by an agent trajectory and, for covered constraints, assigns a Pass or Fail verdict according to the agent behavior. We apply this framework to SkillsBench. The results show that agent trajectories on the benchmark leaderboard cover only 38.66 to 45.51% of the extracted skill behavior constraints on average. We then use Fail verdicts to strengthen the corresponding skill content only by emphasizing the original instructions that the agent failed to follow, and run the same tasks with the strengthened skills. This emphasis yields an average 16.0% recovery rate of the failed tasks across the five agent-model rows. These results show that skill coverage is both a test-adequacy metric and a fine-grained signal for observing skill-use behavior. In failed tasks, failed constraint labels provide actionable evidence for improving agent skill effectiveness. A project website accompanies the paper.