{"edition":"los-angeles","organization":"Bienestar Human Services","organizationId":"org:bienestar-human-services","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"la-bienestar-clinical-component-v1","costScope":"Full recipient cost; only an explicitly limited clinical component is priced.","geographicAttribution":"g=.95 is a resident-share judgment for LA/Orange, not an observed geographic split.","formula":"ND=B*e/u; NA=M*h*a/ua; NP=M*h*(1-a)/up; A(T)=sum(y=1..T)(1.03^-y). QD=ND*q*t*b/1.03; QA=NA*ea*ta*b*.02*qe/1.03; QP=NP*ep*b*i*.86*v*A(T)/1.03. QLA=(QD+QA+QP)*g; Price10=10*C/QLA. Portfolio Q=QLA+Qother-H; Qother unknown.","counterfactual":"Existing public contracts, pharmacy coverage, ordinary wellness support and alternative care remain. Depression uses a usual-care treatment contrast; ART credit only concerns interruption-sensitive strategy equivalents; PrEP credit only concerns otherwise uncovered risk. Funding responsiveness is additional to clinical compatibility, not a second completion adjustment.","attribution":"Behavioral and medication budgets are disjoint. No HIV-testing count, PrEP enrollment count, therapy-session count or all-client count becomes an outcome. ART and PrEP pools are mutually exclusive; depression/HIV quality areas may still overlap, so totals require validation.","uncertainty":"Subjective conditional best estimate, not empirically calibrated delivery rates or a complete portfolio estimate. Joint stress scenarios are not probability bounds. Zero, adverse effects and omitted health gains remain possible.","nativeOutcomes":"Central budget equivalents: 152.537 depression offers, 129.8348 ART strategy-year resource equivalents, 86.55653333333333 PrEP coverage-year equivalents before eligibility and funding. All-population QALYs: depression 1.055170995145631, ART 0.03939162621359223, PrEP 0.13440032498305424. These are modeled expectations, not observed patients.","inputs":[{"name":"C","value":11511459,"unit":"USD full annual recipient expense","basis":"observed","rationale":"Audit and Part IX agree.","sourceIds":["audit25","99025"]},{"name":"B","value":1525370,"unit":"USD behavioral service expense","basis":"observed","rationale":"Audit functional allocation.","sourceIds":["audit25"]},{"name":"M","value":2596696,"unit":"USD primary-care medicine expense","basis":"observed","rationale":"Audit medicine column; not all primary-care cost.","sourceIds":["audit25"]},{"name":"e","value":0.3,"unit":"compatible depression budget fraction","basis":"judgment","rationale":"No observed diagnosis/course mix; test .1–.6.","sourceIds":["mental"]},{"name":"u","value":3000,"unit":"USD behavioral resources per compatible offer","basis":"judgment","rationale":"Planning assumption, not a measured unit cost; test 1500–6000.","sourceIds":["mental","audit25"]},{"name":"q","value":0.057,"unit":"QALY per randomized depression offer over 12 months","basis":"observed","rationale":"CoBalT effect, not local effectiveness.","sourceIds":["cobalt"]},{"name":"t","value":0.5,"unit":"depression effect transfer","basis":"judgment","rationale":"Different service and population; test .1–1.","sourceIds":["mental","cobalt"]},{"name":"b","value":0.25,"unit":"proportional funding responsiveness","basis":"judgment","rationale":"After public payer, reserve and donor replacement; test .05–.75.","sourceIds":["audit25","award"]},{"name":"g","value":0.95,"unit":"LA/Orange resident share","basis":"judgment","rationale":"LA sites support concentration, not an exact share; test .8–1.","sourceIds":["mental","harm"]},{"name":"h","value":0.8,"unit":"HIV-related share of medicine budget","basis":"judgment","rationale":"Actual drug mix unobserved.","sourceIds":["hiv","prep","audit25"]},{"name":"a","value":0.75,"unit":"ART share of HIV medicine budget","basis":"judgment","rationale":"Complement .25 goes to PrEP; actual mix unobserved.","sourceIds":["hiv","prep"]},{"name":"ua","value":12000,"unit":"medicine USD per ART strategy-year resource equivalent","basis":"judgment","rationale":"Not full treatment cost; all staffing remains in C; test 6000–12000.","sourceIds":["audit25"]},{"name":"up","value":6000,"unit":"medicine USD per PrEP coverage-year equivalent","basis":"judgment","rationale":"Not observed 340B acquisition cost; test 3000–6000.","sourceIds":["audit25"]},{"name":"ea","value":0.25,"unit":"ART equivalents exposed to relevant interruption counterfactual","basis":"judgment","rationale":"Most medication spending does not imply an otherwise interrupted patient; test .05–.5.","sourceIds":["smart","hiv"]},{"name":"ta","value":0.5,"unit":"ART strategy effect transfer","basis":"judgment","rationale":"2006 interruption trial differs from modern care gaps.","sourceIds":["smart"]},{"name":"deltaA","value":0.02,"unit":"composite opportunistic-disease-or-death events per strategy follow-up year","basis":"observed","rationale":"SMART 3.3 versus 1.3 per 100; not a mortality rate or per additional ART year.","sourceIds":["smart"]},{"name":"qe","value":0.5,"unit":"QALY per composite event prevented","basis":"judgment","rationale":"Finite one-year area, no lifetime extrapolation; event mix unobserved.","sourceIds":["smart"]},{"name":"ep","value":0.5,"unit":"PrEP equivalents otherwise uncovered","basis":"judgment","rationale":"Prior care substitution distinct from funding response; test .1–.8.","sourceIds":["siempre","prep"]},{"name":"i","value":0.01,"unit":"annual HIV incidence without PrEP in modeled risk group","basis":"judgment","rationale":"Not Bienestar observed incidence; below PROUD high-risk population; test .002–.03.","sourceIds":["proud"]},{"name":"rP","value":0.86,"unit":"relative HIV reduction","basis":"observed","rationale":"PROUD offer-based effect; no extra completion multiplier.","sourceIds":["proud"]},{"name":"v","value":0.1,"unit":"survival-adjusted utility difference per year after infection prevented","basis":"judgment","rationale":"Finite health-area assumption includes survival differences; no separate life-years added; test .03–.15.","sourceIds":[]},{"name":"T","value":20,"unit":"years of post-infection health area","basis":"judgment","rationale":"No value after year 20; low scenario 10.","sourceIds":[]},{"name":"d","value":0.03,"unit":"annual discount rate","basis":"judgment","rationale":"One-year delivery delay plus explicit HIV trajectory discount.","sourceIds":[]},{"name":"Qother","value":null,"unit":"non-overlapping additional LA QALYs","basis":"unknown","rationale":"Harm reduction, housing, education and other pathways unpriced.","sourceIds":["harm","about"]}],"scenarios":[{"id":"central","label":"Conditional clinical component","costUSD":11511459,"allPopulationQalys":1.2289629463422775,"editionQalys":1.1675147990251635,"assumptions":"{\"e\":0.3,\"u\":3000,\"q\":0.057,\"t\":0.5,\"b\":0.25,\"g\":0.95,\"h\":0.8,\"a\":0.75,\"ua\":12000,\"up\":6000,\"ea\":0.25,\"ta\":0.5,\"qe\":0.5,\"ep\":0.5,\"i\":0.01,\"v\":0.1,\"T\":20} C=11511459; B=1525370; M=2596696; deltaA=.02; rP=.86; d=.03. Joint judgment scenario, not a portfolio bound."},{"id":"low","label":"Weak delivery and transfer","costUSD":11511459,"allPopulationQalys":0.008795082965859052,"editionQalys":0.007036066372687242,"assumptions":"{\"e\":0.1,\"u\":6000,\"q\":0.057,\"t\":0.1,\"b\":0.05,\"g\":0.8,\"h\":0.8,\"a\":0.75,\"ua\":12000,\"up\":6000,\"ea\":0.05,\"ta\":0.5,\"qe\":0.5,\"ep\":0.1,\"i\":0.002,\"v\":0.03,\"T\":10} C=11511459; B=1525370; M=2596696; deltaA=.02; rP=.86; d=.03. Joint judgment scenario, not a portfolio bound."},{"id":"high","label":"Favorable delivery and transfer","costUSD":11511459,"allPopulationQalys":31.602897437326195,"editionQalys":31.602897437326195,"assumptions":"{\"e\":0.6,\"u\":1500,\"q\":0.057,\"t\":1,\"b\":0.75,\"g\":1,\"h\":0.8,\"a\":0.75,\"ua\":6000,\"up\":3000,\"ea\":0.5,\"ta\":0.5,\"qe\":0.5,\"ep\":0.8,\"i\":0.03,\"v\":0.15,\"T\":20} C=11511459; B=1525370; M=2596696; deltaA=.02; rP=.86; d=.03. Joint judgment scenario, not a portfolio bound."},{"id":"zero","label":"Complete substitution or no clinical effect","costUSD":11511459,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0."},{"id":"adverse","label":"Illustrative net harm","costUSD":11511459,"allPopulationQalys":-1,"editionQalys":-1,"assumptions":"One LA QALY lost is a stress test, not observed harm."},{"id":"portfolio-unknown","label":"Whole-portfolio return unestimated","costUSD":11511459,"allPopulationQalys":null,"editionQalys":null,"assumptions":"Omitted pathways and overlap remain unresolved."}],"sensitivity":["Central price 98597970.7461669; low 16360645835.697964; favorable 3642532.7844793783 USD per 10 LA QALYs.","Depression contributes about 86% of central clinical QALYs; its compatibility and course cost dominate.","Setting ART and PrEP benefits to zero leaves the depression component; setting depression transfer to zero removes most of the estimated benefit.","Doubling funding responsiveness halves the positive component price; budget unit costs, diagnosis mix and untreated incidence are priorities for data collection.","Finite health trajectories avoid repeated lifetime credit; additional public or participant costs would worsen a social-cost price."],"missingInputs":["Unique eligible depression offers and actual resource cost.","Medicine mix, acquisition costs, coverage duration and true alternative coverage.","LA/Orange residence and health outcomes.","Marginal unrestricted funding bottleneck and current contract renewal.","Non-overlapping health effects of harm reduction, MOUD, housing, education and community support."]},"sources":[{"id":"audit25","title":"FY2025 audited statements, audit dated February 9, 2026; functional table visually verified","url":"https://projects.propublica.org/nonprofits/display_audit/2025-06-GSAFAC-0000403756","publisher":"Bienestar / Federal Audit Clearinghouse","published":null,"retrieved":"2026-09-14"},{"id":"99025","title":"FY2025 original Form 990; submission date","url":"https://projects.propublica.org/nonprofits/full_text/202610929349301506/IRS990","publisher":"Bienestar / IRS","published":"2026-04-02","retrieved":"2026-09-14"},{"id":"99024","title":"FY2024 original Form 990; submission date","url":"https://projects.propublica.org/nonprofits/full_text/202500639349301955/IRS990","publisher":"Bienestar / IRS","published":"2025-03-04","retrieved":"2026-09-14"},{"id":"99023","title":"FY2023 original Form 990; submission date","url":"https://projects.propublica.org/nonprofits/full_text/202400169349302190/IRS990","publisher":"Bienestar / IRS","published":"2024-01-12","retrieved":"2026-09-14"},{"id":"about","title":"Recipient scope and historical timeline","url":"https://www.bienestar.org/about-us/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"mental","title":"Current bilingual mental-health treatment and locations","url":"https://www.bienestar.org/wellness/mental-health/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"hiv","title":"Current HIV clinical care","url":"https://www.bienestar.org/clinica-bienestar/hiv-health/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"prep","title":"Current PrEP prescriptions and access support","url":"https://www.bienestar.org/clinica-bienestar/prep-services/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"harm","title":"Current syringe services, naloxone and mobile geography","url":"https://www.bienestar.org/community/harm-reduction/","publisher":"Bienestar","published":null,"retrieved":"2026-09-14"},{"id":"siempre","title":"Siempre Seguiré randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/41085861/","publisher":"Siempre Seguiré investigators / AIDS and Behavior","published":null,"retrieved":"2026-09-14"},{"id":"siempre-full","title":"Original full-text trial, costs and counterevidence","url":"https://www.ebi.ac.uk/europepmc/webservices/rest/PMC12614472/fullTextXML","publisher":"Trial investigators / Europe PMC","published":null,"retrieved":"2026-09-14"},{"id":"adherence","title":"Pilot randomized stigma and ART-adherence trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8084890/","publisher":"Trial investigators","published":null,"retrieved":"2026-09-14"},{"id":"artas","title":"ARTAS case-management randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/15750396/","publisher":"Gardner and colleagues / AIDS","published":"2005-03-04","retrieved":"2026-09-14"},{"id":"award","title":"Bienestar Por Vida current CDC award and June 2026 supplement","url":"https://taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=NU62PS924729&arg_ProgOfficeCode=143","publisher":"US HHS","published":null,"retrieved":"2026-09-14"},{"id":"cobalt","title":"CoBalT randomized clinical and economic evaluation","url":"https://pubmed.ncbi.nlm.nih.gov/24824481/","publisher":"Wiles and colleagues / NIHR","published":null,"retrieved":"2026-09-14"},{"id":"smart","title":"SMART randomized continuous versus interrupted ART strategies","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa062360","publisher":"SMART Study Group / NEJM","published":null,"retrieved":"2026-09-14"},{"id":"proud","title":"PROUD daily PrEP randomized trial","url":"https://pubmed.ncbi.nlm.nih.gov/26364263/","publisher":"McCormack and colleagues / Lancet","published":null,"retrieved":"2026-09-14"}]}