{"model":{"schemaVersion":"1.0.0","modelId":"ymca-greater-sf-unrestricted-portfolio-proposal-v1","reviewDate":"2026-09-08","status":"Constructed conditional partial-health portfolio; independently reviewed; not measured expected value or verified marginal offer","organization":"YMCA of Greater San Francisco / Young Men’s Christian Association of San Francisco","budget":{"giftUsd":100000,"allocations":{"fitness":20000,"mental":25000,"family":20000,"dpp":5000,"youthEnrichment":15000,"aquatics":5000,"campCapitalOther":10000},"allSharedCostsIncludedOnce":true,"unquantifiedBudgetUsd":30000,"allocationBasis":"Judgment; historical broad categories inform service scope, NOT observed marginal weights"},"geography":{"meaning":"SFshare .65/.75/.4 is unverified residence allocation prior for each quantifiable component; remainder Marin/SanMateo/other Bay participants. BayincludesSF, samegift. No inference from location.","bayIncludesSf":true},"costPerspective":{"donor":"The entire $100,000 gift remains spent in every scenario. Offered-course allowances include noncompletion and allocated shared costs, but are judgments, not provider quotes.","resourceStress":"The additional $100,000 field is a hypothetical extra-resource stress, not measured net societal cost or a claim those resources arise in the no-additionality case. Null scenarios retain no positive ratio regardless of this unpriced assumption.","unpriced":"Public reimbursements, displaced payments, volunteer and participant time, travel and downstream resource savings are not reconciled. Do not label donor cash or the stress a comprehensive resource CEA."},"causalDefinitions":{"additionality":"Share of funded provision that changes access relative to no-gift public, private and household financing. Not course completion.","response":"Incremental response conditional on changed provision versus usual care, including noncompletion. No second adherence factor.","geographicPrior":"Assumes all quantified beneficiaries are Bay residents; SF fraction is unverified. Exclude or separately allocate any non-Bay benefit before claiming local health.","familyOverlap":"Remove family credit if short hardship-related health cannot be distinguished from mental-health therapy or partner-food benefits already credited. Shared people can have genuinely distinct health gains."},"duration":{"fitness":"16-week offered coached activity access, source QALY AUC months6–12 only, no later tail; transfer already incorporates response and weaker fidelity.","mental":"Bounded course over firstyear; integrated exposure.5/1/.1years by scenario includes response timing and decay, not lifetime remission.","family":"Short family hardship-support course; integrated health exposure.25/.5/.1year; not ongoing housing health.","dpp":"One-year course; three-year incident-risk contrast; prevented cases conservatively placed at endyear3, then utility relief in endyears3 through3+delay−1, discounted3%; delay2/5/1years. No lifelong diabetes avoidance."},"formula":{"offeredCourses":"allocation/courseCost; fractional offers are expectation accounting not purchasable fractions","fitness":"offers*additionality*.027*transfer","mentalFamily":"offers*additionality*incrementalResponse*netConditionalUtility*integratedYears","dpp":"offers*additionality*baseline3yearRisk*RRR*utilityLoss*sum(t=3..3+delayYears−1)(1.03)^(-t)","portfolio":"sum(componentBayQ); SF=grossBay*sfShare−donorSFharm; restBay=grossBay*(1−share)−donorRestharm; Bay=SF+restBay; ratio10*100K/Q onlyifQpositive"},"boundaries":["All local response, incidence, risk-reduction, utility, delay, cost and funding priors are judgments except external NERS .027 anchor.","Net conditional utility priors already include shared burdens; donor-specific harms outside funding. Core0notproofnoharm.","No DPP exercise benefit added again through fitness; distinguish overlapping health states, not all shared people.","Family credit limited short health-related hardship response, excludes separately counted therapy and food-bank outcomes.","Fitness generic EQ5D includes mental health. Central and stress allocations assume distinct fitness versus therapy health increments: separate cohorts, or remove therapy-related distress improvement already captured by fitness for the same person and period. Do not add full generic utilities for overlapping care; this cohort separation is a judgment, not verified local linkage.","30K youth/aquatics/campcapital cost remains while health unquantified; these streams have welfare and possible harm, not assumed valueless.","No current marginal weight, clinic-course quote, capacity or live donoroffer verified.","Donor prices are full-course resource allowances, not just copays. Publicfunding replacement is modeled viaadditionality. Grosscashspend not netsocietalresources.","Do not add allBaytoSF or use DPPalone as wholeorganization estimate."],"scenarios":[{"id":"central","sfShare":0.65,"fitness":{"cost":600,"additionality":0.4,"trialQaly":0.027,"transfer":0.2},"mental":{"cost":1500,"additionality":0.4,"response":0.2,"utility":0.1,"effectiveYears":0.5},"family":{"cost":500,"additionality":0.4,"response":0.2,"utility":0.02,"effectiveYears":0.25},"dpp":{"cost":600,"additionality":0.4,"baselineThreeYearRisk":0.08,"relativeReduction":0.3,"diabetesDelayYears":2,"utilityLossPerYear":0.05},"donorHarm":{"sf":0,"restBay":0},"outputs":{"fitnessQaly":0.07200000000000001,"mentalQaly":0.0666666666666667,"familyQaly":0.016,"dppQaly":0.007214514829075395,"grossBayQaly":0.16188118149574213,"sfNetQaly":0.10522276797223239,"restBayNetQaly":0.05665841352350974,"bayIncludingSfNetQaly":0.16188118149574213,"donorCost":100000,"sfUsdPer10Qaly":9503646.58971805,"bayUsdPer10Qaly":6177370.283316733,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":19007293.1794361,"bayStressUsdPer10Qaly":12354740.566633467}},{"id":"favorable","sfShare":0.75,"fitness":{"cost":300,"additionality":0.8,"trialQaly":0.027,"transfer":0.75},"mental":{"cost":1000,"additionality":0.75,"response":0.4,"utility":0.15,"effectiveYears":1},"family":{"cost":250,"additionality":0.75,"response":0.4,"utility":0.04,"effectiveYears":0.5},"dpp":{"cost":350,"additionality":0.8,"baselineThreeYearRisk":0.15,"relativeReduction":0.5,"diabetesDelayYears":5,"utilityLossPerYear":0.08},"donorHarm":{"sf":0,"restBay":0},"outputs":{"fitnessQaly":1.08,"mentalQaly":1.125,"familyQaly":0.48,"dppQaly":0.2960100520923443,"grossBayQaly":2.981010052092344,"sfNetQaly":2.235757539069258,"restBayNetQaly":0.745252513023086,"bayIncludingSfNetQaly":2.981010052092344,"donorCost":100000,"sfUsdPer10Qaly":447275.6918070366,"bayUsdPer10Qaly":335456.76885527745,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":894551.3836140732,"bayStressUsdPer10Qaly":670913.5377105549}},{"id":"pessimisticPositive","sfShare":0.4,"fitness":{"cost":1000,"additionality":0.1,"trialQaly":0.027,"transfer":0.02},"mental":{"cost":2500,"additionality":0.1,"response":0.05,"utility":0.03,"effectiveYears":0.1},"family":{"cost":1000,"additionality":0.1,"response":0.05,"utility":0.005,"effectiveYears":0.1},"dpp":{"cost":1000,"additionality":0.1,"baselineThreeYearRisk":0.03,"relativeReduction":0.1,"diabetesDelayYears":1,"utilityLossPerYear":0.02},"donorHarm":{"sf":0,"restBay":0},"outputs":{"fitnessQaly":0.00108,"mentalQaly":0.00015000000000000001,"familyQaly":0.00005,"dppQaly":0.00002745424978059479,"grossBayQaly":0.0013074542497805946,"sfNetQaly":0.0005229816999122379,"restBayNetQaly":0.0007844725498683567,"bayIncludingSfNetQaly":0.0013074542497805946,"donorCost":100000,"sfUsdPer10Qaly":1912112795.0897918,"bayUsdPer10Qaly":764845118.0359168,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":3824225590.1795835,"bayStressUsdPer10Qaly":1529690236.0718336}},{"id":"nullAdditionality","sfShare":0.65,"fitness":{"cost":600,"additionality":0,"trialQaly":0.027,"transfer":0.2},"mental":{"cost":1500,"additionality":0,"response":0.2,"utility":0.1,"effectiveYears":0.5},"family":{"cost":500,"additionality":0,"response":0.2,"utility":0.02,"effectiveYears":0.25},"dpp":{"cost":600,"additionality":0,"baselineThreeYearRisk":0.08,"relativeReduction":0.3,"diabetesDelayYears":2,"utilityLossPerYear":0.05},"donorHarm":{"sf":0,"restBay":0},"outputs":{"fitnessQaly":0,"mentalQaly":0,"familyQaly":0,"dppQaly":0,"grossBayQaly":0,"sfNetQaly":0,"restBayNetQaly":0,"bayIncludingSfNetQaly":0,"donorCost":100000,"sfUsdPer10Qaly":null,"bayUsdPer10Qaly":null,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":null,"bayStressUsdPer10Qaly":null}},{"id":"nullClinicalEffect","sfShare":0.65,"fitness":{"cost":600,"additionality":0.4,"trialQaly":0.027,"transfer":0},"mental":{"cost":1500,"additionality":0.4,"response":0,"utility":0.1,"effectiveYears":0.5},"family":{"cost":500,"additionality":0.4,"response":0,"utility":0.02,"effectiveYears":0.25},"dpp":{"cost":600,"additionality":0.4,"baselineThreeYearRisk":0.08,"relativeReduction":0,"diabetesDelayYears":2,"utilityLossPerYear":0.05},"donorHarm":{"sf":0,"restBay":0},"outputs":{"fitnessQaly":0,"mentalQaly":0,"familyQaly":0,"dppQaly":0,"grossBayQaly":0,"sfNetQaly":0,"restBayNetQaly":0,"bayIncludingSfNetQaly":0,"donorCost":100000,"sfUsdPer10Qaly":null,"bayUsdPer10Qaly":null,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":null,"bayStressUsdPer10Qaly":null}},{"id":"centralDonorHarm","sfShare":0.65,"fitness":{"cost":600,"additionality":0.4,"trialQaly":0.027,"transfer":0.2},"mental":{"cost":1500,"additionality":0.4,"response":0.2,"utility":0.1,"effectiveYears":0.5},"family":{"cost":500,"additionality":0.4,"response":0.2,"utility":0.02,"effectiveYears":0.25},"dpp":{"cost":600,"additionality":0.4,"baselineThreeYearRisk":0.08,"relativeReduction":0.3,"diabetesDelayYears":2,"utilityLossPerYear":0.05},"donorHarm":{"sf":0.1,"restBay":0.1},"outputs":{"fitnessQaly":0.07200000000000001,"mentalQaly":0.0666666666666667,"familyQaly":0.016,"dppQaly":0.007214514829075395,"grossBayQaly":0.16188118149574213,"sfNetQaly":0.005222767972232381,"restBayNetQaly":-0.043341586476490265,"bayIncludingSfNetQaly":-0.038118818504257884,"donorCost":100000,"sfUsdPer10Qaly":191469352.136003,"bayUsdPer10Qaly":null,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":382938704.272006,"bayStressUsdPer10Qaly":null}},{"id":"nullAdditionalityDonorHarm","sfShare":0.65,"fitness":{"cost":600,"additionality":0,"trialQaly":0.027,"transfer":0.2},"mental":{"cost":1500,"additionality":0,"response":0.2,"utility":0.1,"effectiveYears":0.5},"family":{"cost":500,"additionality":0,"response":0.2,"utility":0.02,"effectiveYears":0.25},"dpp":{"cost":600,"additionality":0,"baselineThreeYearRisk":0.08,"relativeReduction":0.3,"diabetesDelayYears":2,"utilityLossPerYear":0.05},"donorHarm":{"sf":0.1,"restBay":0.1},"outputs":{"fitnessQaly":0,"mentalQaly":0,"familyQaly":0,"dppQaly":0,"grossBayQaly":0,"sfNetQaly":-0.1,"restBayNetQaly":-0.1,"bayIncludingSfNetQaly":-0.2,"donorCost":100000,"sfUsdPer10Qaly":null,"bayUsdPer10Qaly":null,"inducedResourceStressUsd":100000,"sfStressUsdPer10Qaly":null,"bayStressUsdPer10Qaly":null}}],"sources":[{"title":"YMCA financial audit","url":"https://media.ymcasf.org/wp-content/uploads/2025/11/12144641/Young-Mens-Christian-Association-of-San-Francisco-2025-Audit-FS-Final.pdf","date":"Year ended June30,2025; October24,2025","meaning":"Functional allocations and existing public/fee financing, not marginal costs","retrieved":"September8,2026"},{"title":"YMCA annual report","url":"https://media.ymcasf.org/wp-content/uploads/2025/12/24152248/Annual-Report-YMCA-of-Greater-San-Francisco-2024-2025.pdf","date":"December2025, FY2024–25","meaning":"Reach, service breadth and funded projects; not causal health","retrieved":"September8,2026"},{"title":"YMCA DPP","url":"https://www.ymcasf.org/program/diabetes-prevention/","date":"Undated; accessed September8,2026","meaning":"Actual prevention eligibility and insurance alternatives; no measured local QALYs","retrieved":"September8,2026"},{"title":"YMCA mental health","url":"https://www.ymcasf.org/location/mental-health-services-ymca/","date":"Undated; accessed September8,2026","meaning":"Actual therapy and substantial DPH/school/Medi-Cal baseline","retrieved":"September8,2026"},{"title":"YMCA family resource centers","url":"https://www.ymcasf.org/program/family-resource-centers/","date":"Undated; accessed September8,2026","meaning":"Actual family service route, not incremental response","retrieved":"September8,2026"},{"title":"YMCA financial assistance","url":"https://www.ymcasf.org/membership/membership-benefits/financial-assistance/","date":"Undated; accessed September8,2026","meaning":"Income-verified assistance, not extra activity","retrieved":"September8,2026"},{"title":"YMCA annual campaign","url":"https://www.ymcasf.org/donate/annual-campaign/","date":"Undated; accessed September8,2026","meaning":"General access fundraising, not priced offer","retrieved":"September8,2026"},{"title":"Edwards et al., NERS economic RCT","url":"https://eprints.gla.ac.uk/89420/1/89420.pdf","date":"BMC Public Health2013,13:1021","meaning":"798 economic participants (55% trial),.027QALY AUC6–12months; no baseline EQ5D; selection/transfer uncertainty","retrieved":"September8,2026"},{"title":"RAPID YMCA trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC4605179/","date":"2015","meaning":"509 randomized low-income adults with elevated glucose; actual community adaptation, not localYMCAQALY. Indexed primary abstract only; directPMCchallenge.","retrieved":"September8,2026"},{"title":"DPP ten-year economic evaluation","url":"https://diabetesjournals.org/care/article/35/4/723/38335/The-10-Year-Cost-Effectiveness-of-Lifestyle","date":"April2012","meaning":"Longer intensive trial program not assigned numerically toYMCA; methodological context only","retrieved":"September8,2026"},{"title":"SF Rec/Park Bayview Safety Swim","url":"https://sfrecpark.org/1613/Bayview-Safety-Swim-Splash","date":"Undated; priorSeptember8,2026read","meaning":"Joint free program, no local drowning effect estimated","retrieved":"September8,2026"}]},"evaluated":[{"id":"central","fitnessQaly":0.07200000000000001,"mentalQaly":0.0666666666666667,"familyQaly":0.016,"dppQaly":0.007214514829075394,"grossBayQaly":0.16188118149574213,"sfNetQaly":0.10522276797223239,"restBayNetQaly":0.05665841352350974,"bayIncludingSfNetQaly":0.16188118149574213,"donorCost":100000,"sfUsdPer10Qaly":9503646.58971805,"bayUsdPer10Qaly":6177370.283316733},{"id":"favorable","fitnessQaly":1.08,"mentalQaly":1.125,"familyQaly":0.48,"dppQaly":0.2960100520923443,"grossBayQaly":2.981010052092344,"sfNetQaly":2.235757539069258,"restBayNetQaly":0.745252513023086,"bayIncludingSfNetQaly":2.981010052092344,"donorCost":100000,"sfUsdPer10Qaly":447275.6918070366,"bayUsdPer10Qaly":335456.76885527745},{"id":"pessimisticPositive","fitnessQaly":0.00108,"mentalQaly":0.00015000000000000001,"familyQaly":0.00005,"dppQaly":0.000027454249780594786,"grossBayQaly":0.0013074542497805946,"sfNetQaly":0.0005229816999122379,"restBayNetQaly":0.0007844725498683567,"bayIncludingSfNetQaly":0.0013074542497805946,"donorCost":100000,"sfUsdPer10Qaly":1912112795.0897918,"bayUsdPer10Qaly":764845118.0359168},{"id":"nullAdditionality","fitnessQaly":0,"mentalQaly":0,"familyQaly":0,"dppQaly":0,"grossBayQaly":0,"sfNetQaly":0,"restBayNetQaly":0,"bayIncludingSfNetQaly":0,"donorCost":100000,"sfUsdPer10Qaly":null,"bayUsdPer10Qaly":null},{"id":"nullClinicalEffect","fitnessQaly":0,"mentalQaly":0,"familyQaly":0,"dppQaly":0,"grossBayQaly":0,"sfNetQaly":0,"restBayNetQaly":0,"bayIncludingSfNetQaly":0,"donorCost":100000,"sfUsdPer10Qaly":null,"bayUsdPer10Qaly":null},{"id":"centralDonorHarm","fitnessQaly":0.07200000000000001,"mentalQaly":0.0666666666666667,"familyQaly":0.016,"dppQaly":0.007214514829075394,"grossBayQaly":0.16188118149574213,"sfNetQaly":0.005222767972232381,"restBayNetQaly":-0.043341586476490265,"bayIncludingSfNetQaly":-0.038118818504257884,"donorCost":100000,"sfUsdPer10Qaly":191469352.136003,"bayUsdPer10Qaly":null},{"id":"nullAdditionalityDonorHarm","fitnessQaly":0,"mentalQaly":0,"familyQaly":0,"dppQaly":0,"grossBayQaly":0,"sfNetQaly":-0.1,"restBayNetQaly":-0.1,"bayIncludingSfNetQaly":-0.2,"donorCost":100000,"sfUsdPer10Qaly":null,"bayUsdPer10Qaly":null}]}