auto-fix: strip 7 broken wiki links

Pipeline auto-fixer: removed [[ ]] brackets from links
that don't resolve to existing claims in the knowledge base.

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

@@ -61,22 +61,28 @@ The Trump Administration's Medicare GLP-1 deal establishes $245/month pricing (8
 
 
 ### Additional Evidence (challenge)
-*Source: [[2025-07-01-sarcopenia-glp1-muscle-loss-elderly-risk]] | Added: 2026-03-16*
+*Source: 2025-07-01-sarcopenia-glp1-muscle-loss-elderly-risk | Added: 2026-03-16*
 
 The sarcopenic obesity mechanism creates a pathway where GLP-1s may INCREASE healthcare costs in elderly populations: muscle loss during treatment + high discontinuation (64.8% at 1 year) + preferential fat regain = sarcopenic obesity → increased fall risk, fractures, disability, and long-term care needs. This directly challenges the Medicare cost-savings thesis by creating NEW healthcare costs (disability, falls, fractures) that may offset cardiovascular and metabolic savings.
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-12-01-who-glp1-global-guidelines-obesity]] | Added: 2026-03-16*
+*Source: 2025-12-01-who-glp1-global-guidelines-obesity | Added: 2026-03-16*
 
 WHO issued conditional recommendations (not full endorsements) for GLP-1s in obesity treatment, explicitly acknowledging 'limited long-term evidence.' The conditional framing signals institutional uncertainty about durability of outcomes and cost-effectiveness at population scale. WHO requires countries to 'consider local cost-effectiveness, budget impact, and ethical implications' before adoption, suggesting the chronic use economics remain unproven for resource-constrained health systems.
 
 
 ### Additional Evidence (challenge)
-*Source: [[2025-01-01-jmir-digital-engagement-glp1-weight-loss-outcomes]] | Added: 2026-03-16*
+*Source: 2025-01-01-jmir-digital-engagement-glp1-weight-loss-outcomes | Added: 2026-03-16*
 
 Danish cohort achieved same weight loss outcomes (16.7% at 64 weeks) using HALF the typical semaglutide dose when paired with digital behavioral support, matching clinical trial results at 50% drug cost. If this half-dose protocol proves generalizable, it could fundamentally alter the inflationary cost trajectory by reducing per-patient drug spending while maintaining efficacy.
 
+
+### Additional Evidence (extend)
+*Source: [[2026-02-01-cms-balance-model-details-rfa-design]] | Added: 2026-03-16*
+
+BALANCE Model's dual payment mechanism (capitation adjustment + reinsurance) plus manufacturer-funded lifestyle support represents the first major policy attempt to address the chronic-use cost structure. The Medicare GLP-1 Bridge (July 2026) provides immediate price relief while full model architecture is built, indicating urgency around cost containment.
+
 ---
 
 Relevant Notes:

domains/health/glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics.md

@@ -55,16 +55,22 @@ The $50/month out-of-pocket maximum for Medicare beneficiaries (starting April 2
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-07-01-sarcopenia-glp1-muscle-loss-elderly-risk]] | Added: 2026-03-16*
+*Source: 2025-07-01-sarcopenia-glp1-muscle-loss-elderly-risk | Added: 2026-03-16*
 
 The discontinuation problem is worse than just lost metabolic benefits - it creates a body composition trap. Patients who discontinue lose 15-40% of weight as lean mass during treatment, then regain weight preferentially as fat without muscle recovery. This means the most common outcome (discontinuation) leaves patients with WORSE body composition than baseline: same or higher fat, less muscle, higher disability risk. Weight cycling on GLP-1s is not neutral - it's actively harmful.
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-01-01-jmir-digital-engagement-glp1-weight-loss-outcomes]] | Added: 2026-03-16*
+*Source: 2025-01-01-jmir-digital-engagement-glp1-weight-loss-outcomes | Added: 2026-03-16*
 
 Digital behavioral support may partially solve the persistence problem: UK study showed 11.53% weight loss with engagement vs 8% without at 5 months, suggesting the adherence paradox has a behavioral solution component. However, high withdrawal rates in non-engaged groups suggest this requires active participation, not passive app access.
 
+
+### Additional Evidence (extend)
+*Source: [[2026-02-01-cms-balance-model-details-rfa-design]] | Added: 2026-03-16*
+
+BALANCE Model's manufacturer-funded lifestyle support requirement directly addresses the persistence problem by mandating evidence-based programs for GI side effects, nutrition, and physical activity—the factors most associated with discontinuation. This shifts the cost of adherence support from payers to manufacturers.
+
 ---
 
 Relevant Notes:

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

@@ -37,16 +37,22 @@ Medicare Advantage plans bearing full capitated risk increased GLP-1 prior autho
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-03-17-norc-pace-market-assessment-for-profit-expansion]] | Added: 2026-03-16*
+*Source: 2025-03-17-norc-pace-market-assessment-for-profit-expansion | Added: 2026-03-16*
 
 PACE represents the 100% risk endpoint—full capitation for all medical, social, and psychiatric needs, entirely replacing Medicare and Medicaid cards. Yet even at full risk with proven outcomes for the highest-cost patients, PACE serves only 0.13% of Medicare eligibles after 50 years. This suggests the stall point is not just at the payment boundary (partial vs full risk) but at the scaling boundary—capital, awareness, regulatory, and operational barriers prevent even successful full-risk models from achieving market penetration. The gap between 14% bearing full risk and PACE's 0.13% penetration indicates that moving from partial to full risk is necessary but insufficient for VBC transformation.
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-12-23-cms-balance-model-glp1-obesity-coverage]] | Added: 2026-03-16*
+*Source: 2025-12-23-cms-balance-model-glp1-obesity-coverage | Added: 2026-03-16*
 
 The BALANCE Model moves payment toward genuine risk by adjusting capitated rates for obesity and increasing government reinsurance for participating MA plans. This creates a direct financial incentive mechanism where plans profit from preventing obesity-related complications rather than just managing them. The model explicitly tests whether combining medication access with lifestyle supports under risk-bearing arrangements can shift the payment boundary.
 
+
+### Additional Evidence (extend)
+*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.
+
 ---
 
 Relevant Notes:

inbox/archive/.extraction-debug/2026-02-01-cms-balance-model-details-rfa-design.json

@@ -0,0 +1,32 @@
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inbox/archive/2026-02-01-cms-balance-model-details-rfa-design.md

@@ -7,9 +7,13 @@ date: 2026-01-08
 domain: health
 secondary_domains: [internet-finance]
 format: policy-document
-status: unprocessed
+status: enrichment
 priority: high
 tags: [balance-model, cms, glp-1, capitation, medicaid, medicare, value-based-care, lifestyle-support, manufacturer, adherence]
+processed_by: vida
+processed_date: 2026-03-16
+enrichments_applied: ["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", "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", "glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics.md"]
+extraction_model: "anthropic/claude-sonnet-4.5"
 ---
 
 ## Content
@@ -68,3 +72,13 @@ This is CMS explicitly designing around the misalignment I identified in March 1
 PRIMARY CONNECTION: [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]]
 WHY ARCHIVED: The BALANCE model's specific payment mechanism (capitation adjustment + reinsurance) is a direct policy response to the identified VBC misalignment — this design detail changes the analysis from "BALANCE is just drug coverage" to "BALANCE is structural incentive redesign"
 EXTRACTION HINT: Focus on the dual payment mechanism as the structural innovation, not the drug access expansion (which is the headline but not the analytically important insight)
+
+
+## Key Facts
+- BALANCE Model eligibility requires BMI thresholds per FDA labeling plus evidence of metabolic dysfunction (heart failure, uncontrolled hypertension, pre-diabetes)
+- Prior authorization requirements are negotiated with manufacturers, not blanket coverage
+- Manufacturers must reach 'Key Terms' agreement with CMS to become model participants
+- Medicare GLP-1 Bridge launches July 2026, earlier than full BALANCE rollout
+- Bridge provides access to manufacturer-negotiated prices before full model launches
+- State and plan participation is voluntary, creating potential adverse selection risk
+- 9.5% average body weight reduction is the manufacturer eligibility threshold