extract: 2025-04-01-health-affairs-mtm-scaling-modeling

Pentagon-Agent: Epimetheus <968B2991-E2DF-4006-B962-F5B0A0CC8ACA>

inbox/queue/.extraction-debug/2025-04-01-health-affairs-mtm-scaling-modeling.json

@@ -0,0 +1,34 @@
+{
+  "rejected_claims": [
+    {
+      "filename": "medically-tailored-meals-show-null-glycemic-outcomes-in-controlled-trials-despite-strongest-observational-evidence.md",
+      "issues": [
+        "missing_attribution_extractor"
+      ]
+    },
+    {
+      "filename": "food-as-medicine-hospitalization-reduction-evidence-is-separate-from-glycemic-control-evidence-suggesting-different-mechanisms.md",
+      "issues": [
+        "missing_attribution_extractor"
+      ]
+    }
+  ],
+  "validation_stats": {
+    "total": 2,
+    "kept": 0,
+    "fixed": 4,
+    "rejected": 2,
+    "fixes_applied": [
+      "medically-tailored-meals-show-null-glycemic-outcomes-in-controlled-trials-despite-strongest-observational-evidence.md:set_created:2026-03-18",
+      "medically-tailored-meals-show-null-glycemic-outcomes-in-controlled-trials-despite-strongest-observational-evidence.md:stripped_wiki_link:SDOH-interventions-show-strong-ROI-but-adoption-stalls-becau",
+      "food-as-medicine-hospitalization-reduction-evidence-is-separate-from-glycemic-control-evidence-suggesting-different-mechanisms.md:set_created:2026-03-18",
+      "food-as-medicine-hospitalization-reduction-evidence-is-separate-from-glycemic-control-evidence-suggesting-different-mechanisms.md:stripped_wiki_link:medical-care-explains-only-10-20-percent-of-health-outcomes-"
+    ],
+    "rejections": [
+      "medically-tailored-meals-show-null-glycemic-outcomes-in-controlled-trials-despite-strongest-observational-evidence.md:missing_attribution_extractor",
+      "food-as-medicine-hospitalization-reduction-evidence-is-separate-from-glycemic-control-evidence-suggesting-different-mechanisms.md:missing_attribution_extractor"
+    ]
+  },
+  "model": "anthropic/claude-sonnet-4.5",
+  "date": "2026-03-18"
+}

inbox/queue/2025-04-01-health-affairs-mtm-scaling-modeling.md

@@ -7,9 +7,13 @@ date: 2025-04-01
 domain: health
 secondary_domains: []
 format: journal-article
-status: unprocessed
+status: null-result
 priority: medium
 tags: [medically-tailored-meals, mtm, health-economics, simulation, modeling, evidence-gaps, scaling, cost-effectiveness]
+processed_by: vida
+processed_date: 2026-03-18
+extraction_model: "anthropic/claude-sonnet-4.5"
+extraction_notes: "LLM returned 2 claims, 2 rejected by validator"
 ---
 
 ## Content
@@ -68,3 +72,14 @@ The simulation model projects cost savings; the perspective paper notes the evid
 PRIMARY CONNECTION: Food-as-medicine evidence claims — extends Session 1's produce prescription finding to MTMs
 WHY ARCHIVED: Documents the simulation-vs-RCT gap at the highest level of FIM intervention intensity; the Maryland MTM pilot null result is the key new finding
 EXTRACTION HINT: Focus on the Maryland MTM pilot null result (HbA1c -0.7% vs. -0.6%, not significant) — this is the strongest disconfirmation of the "better interventions fix the problem" hypothesis
+
+
+## Key Facts
+- Health Affairs published two simultaneous papers on MTM scaling in April 2025: a simulation model (hlthaff.2024.01307) and a perspective critique (hlthaff.2025.00161)
+- The simulation model projected MTMs would be cost-saving in nearly all US states
+- The perspective paper called for 'integrating real-world variations in MTM program design into future models, including dose, duration, and ancillary services'
+- Maryland MTM pilot (2024, JGIM): 74 adults, frozen meals + dietitian calls for 6 months, HbA1c change -0.7% treatment vs -0.6% control (not significant)
+- FAME-D trial ongoing: 200 adults, comparing MTMs to $40/month food subsidy
+- Australian MTM trial commenced Q1 2023, results anticipated March 2025
+- 16 states had active or pending Section 1115 waivers for FIM coverage at time of publication
+- Older MTM observational studies showed 49% reduction in hospital admissions