From ec7cd15e3092cc3650c618a6dc58a87fc7b4f766 Mon Sep 17 00:00:00 2001 From: Teleo Agents Date: Wed, 18 Mar 2026 17:54:38 +0000 Subject: [PATCH] auto-fix: strip 6 broken wiki links Pipeline auto-fixer: removed [[ ]] brackets from links that don't resolve to existing claims in the knowledge base. --- ...del makes the net cost impact inflationary through 2035.md | 2 +- ...ue-across-kidney-cardiovascular-and-metabolic-endpoints.md | 2 +- ...lays-dialysis-creating-largest-per-patient-cost-savings.md | 2 +- ...te more treatable conditions faster than prices decline.md | 2 +- ... touch value metrics but only 14 percent bear full risk.md | 4 ++-- 5 files changed, 6 insertions(+), 6 deletions(-) diff --git a/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md b/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md index 1c64d27c5..6f907bdeb 100644 --- a/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md +++ b/domains/health/GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md @@ -85,7 +85,7 @@ BALANCE Model's dual payment mechanism (capitation adjustment + reinsurance) plu ### Additional Evidence (challenge) -*Source: [[2025-12-01-who-glp1-guidelines-behavioral-therapy-combination]] | Added: 2026-03-18* +*Source: 2025-12-01-who-glp1-guidelines-behavioral-therapy-combination | Added: 2026-03-18* WHO's conditional recommendation structure and behavioral therapy requirement suggest the 'chronic use model' framing may be incomplete. The guideline establishes medication-plus-behavioral-therapy as the standard, not medication alone, which may have different economics than the pure pharmaceutical model. WHO also announced it will develop 'an evidence-based prioritization framework to identify which adults with obesity should be prioritized for GLP-1 treatment'—implying targeted use rather than universal chronic treatment. diff --git a/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md b/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md index 110c50624..834d07e7a 100644 --- a/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md +++ b/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md @@ -50,7 +50,7 @@ FLOW trial demonstrated 29% reduction in cardiovascular death (HR 0.71, 95% CI 0 ### Additional Evidence (extend) -*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* +*Source: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd | Added: 2026-03-16* Quantified lifetime savings per subject: $14,431 from avoided T2D, $2,074 from avoided CKD, $1,512 from avoided CV events. Diabetes prevention is the dominant economic driver, not cardiovascular protection, suggesting targeting should prioritize metabolic risk over CV risk. diff --git a/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md b/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md index d50745e9a..1423c77ce 100644 --- a/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md +++ b/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md @@ -36,7 +36,7 @@ FLOW trial (N=3,533, median 3.4 years follow-up) showed 24% reduction in major k ### Additional Evidence (confirm) -*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* +*Source: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd | Added: 2026-03-16* SELECT trial economic model shows $2,074 per-subject lifetime savings from avoided CKD, supporting the claim that kidney protection generates substantial cost savings. However, diabetes prevention ($14,431) generates even larger savings. diff --git a/domains/health/the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline.md b/domains/health/the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline.md index 80f2ca42d..b81f6261d 100644 --- a/domains/health/the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline.md +++ b/domains/health/the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline.md @@ -33,7 +33,7 @@ The composition of spending shifts dramatically: less on chronic disease managem ### Additional Evidence (extend) -*Source: [[2026-02-23-cbo-medicare-trust-fund-2040-insolvency]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5* +*Source: 2026-02-23-cbo-medicare-trust-fund-2040-insolvency | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5* (extend) The Medicare trust fund fiscal pressure adds a constraint layer to the cost curve dynamics. While new capabilities create upward cost pressure through expanded treatment populations, the trust fund exhaustion timeline (now 2040, accelerated from 2055 by tax policy changes) creates a hard fiscal boundary. The convergence of demographic pressure (working-age to 65+ ratio declining to 2.2:1 by 2055), MA overpayments ($1.2T/decade), and reduced tax revenues means automatic 8-10% benefit cuts starting 2040 unless structural reforms occur. This fiscal ceiling will force coverage and payment decisions in the 2030s independent of technology trajectories, potentially constraining the cost curve expansion that new capabilities would otherwise enable. diff --git a/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md b/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md index 8f0f871a1..d1bb6e12a 100644 --- a/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md +++ b/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md @@ -49,13 +49,13 @@ The BALANCE Model moves payment toward genuine risk by adjusting capitated rates ### Additional Evidence (extend) -*Source: [[2026-02-01-cms-balance-model-details-rfa-design]] | Added: 2026-03-16* +*Source: 2026-02-01-cms-balance-model-details-rfa-design | Added: 2026-03-16* CMS BALANCE Model demonstrates policy recognition of the VBC misalignment by implementing capitation adjustment (paying plans MORE for obesity coverage) plus reinsurance (removing tail risk) rather than expecting prevention incentives to emerge from capitation alone. This is explicit structural redesign around the identified barriers. ### Additional Evidence (extend) -*Source: [[2025-01-01-nashp-chw-state-policies-2024-2025]] | Added: 2026-03-18* +*Source: 2025-01-01-nashp-chw-state-policies-2024-2025 | Added: 2026-03-18* CHW reimbursement infrastructure demonstrates the same payment boundary stall in the SDOH domain: 20 states with approved SPAs after 17 years, with billing code uptake remaining slow even where reimbursement is technically available. The bottleneck is not policy approval but operational infrastructure — CBOs cannot contract with healthcare entities, transportation costs are not covered, and 'community care hubs' are emerging as coordination infrastructure. This parallels VBC's 60% touch / 14% risk gap: technical capability exists but the operational infrastructure to execute at scale does not.