Summary
What do they do? RotaCare Bay Area, Inc. operates volunteer-supported clinics providing acute and chronic care. Northern Peninsula is in Daly City, not San Francisco; it lists prescriptions but no medication dispensing. Services and eligibility vary by clinic. More
Why this approach interests us
- Sustained blood-pressure treatment can prevent cardiovascular events when patients would otherwise lack effective care.
Our main reservations
- Local risk, achieved treatment differences, marginal costs and donor additionality are not measured. The longer health consequences may overstate benefit if prevented events instead occur later.
What do you get for your dollar?
The overall US estimate is $2.89 million. This conditional model counts an entire unrestricted gift while quantifying its blood-pressure-care share; other clinic benefits remain unquantified. It is not a demonstrated below-$100,000 opportunity. That is $339,551 per Bay QALY. Inspect all formulas, inputs and sources.
- bay estimate
- $3.40M / 10 QALYs — Central donor-cash estimate; $5.14M including gross associated resources.
- overall estimate
- $2.89M / 10 QALYs — All modeled US beneficiaries; includes Bay health, so the two are not additive.
- sf benefit
- Not established — Zero SF health credited pending residence evidence—not a claim that no SF residents receive care.
- evidence
- Trials inform treatment effect — No randomized RotaCare donation-to-health estimate.
1. What do they do?
RotaCare Bay Area, Inc. operates volunteer-supported clinics providing acute and chronic care. Northern Peninsula is in Daly City, not San Francisco; it lists prescriptions but no medication dispensing. Services and eligibility vary by clinic.
Make sustained care accessible
Assessment, prescribing, testing and follow-up may help uninsured people obtain effective blood-pressure treatment.
Improve outcomes beyond usual care
The model requires a sustained achieved blood-pressure difference—not merely screening, visits or referrals.
Scope of this review. We assign 40% of a hypothetical $100,000 unrestricted gift to five-year blood-pressure care offers. The remaining 60% supports the broader clinic portfolio and remains in the cost numerator, with health unquantified. This allocation is an analyst prior, not a reported budget. Operation Access surgery benefits are excluded to avoid duplicate credit.
2. Monitoring and information sharing
Blood-pressure treatment trials; Ettehad et al., 2016
Meta-analysis of randomized trials. A 10-mmHg systolic reduction was associated with a major cardiovascular-event risk ratio of .80.
Our assessment. Strong treatment anchor, not evidence that RotaCare achieves this incremental difference. Do not add separate mortality, stroke or heart-failure effects to the composite.
Increasing baseline cardiovascular-risk groups, 2014
Individual-participant trial meta-analysis. Higher-risk groups had larger absolute benefit from blood-pressure lowering.
Our assessment. Supports the importance of baseline risk; the local cohort risk remains unmeasured.
HOPE-3 intermediate-risk adults; separate 2024 coaching/practice-facilitation trial
Randomized trials. HOPE-3 found no overall benefit in its intermediate-risk cohort; coaching/facilitation did not outperform enhanced usual care in the separate trial.
Our assessment. Care contact is insufficient by itself. Benefit depends on sustained additional treatment and risk.
Oxford Vascular Study stroke survivors and controls
Longitudinal EQ-5D cohort. Persistent utility loss after stroke supports a finite morbidity pathway.
Our assessment. Observational survivor-state evidence informs scale, not the causal utility of every cardiovascular event or a saved lifetime.
RotaCare Bay Area clinics
Provider program reports and tax filing. Actual chronic-care delivery and organizational finances are documented.
Our assessment. No measured next-gift allocation, achieved BP contrast or SF-resident share. Filing evidence does not establish a marginal care offer.
3. Qualitative assessment
Sustained blood-pressure treatment can prevent cardiovascular events when patients would otherwise lack effective care.
Key reservations
- The central estimate and ordinary favorable scenario exceed $100,000 per 10 Bay QALYs.
- The advertised $200 cost-per-patient figure is not a complete five-year care cost.
- Clinical risk, treatment difference, funding additionality and Bay residence shares are analyst judgments. Shared and independent modeled harms use those same regional proportions; a separately SF-located harm would require its own allocation.
- Durable health consequences may be overstated if events are postponed rather than permanently avoided.
- Actual Bay operations do not establish SF-resident health; no positive SF ratio is reported.
Benefits not included in our estimate
- Unquantified acute, diabetes, asthma, diagnostic and other clinic benefits.
- Operation Access partner surgery outcomes already represented elsewhere.
- Additional cardiovascular events or separate all-cause mortality credit beyond the first-event model.
- Unverified SF-resident benefits, healthcare savings and monetary opportunity-cost effects.
4. What do you get for your dollar?
A $100,000 gift yields an estimated 0.295 Bay QALYs.
The central model reserves $1,750 for each five-year offered care pathway, including unsuccessful participation, medicines, tests, coordination and allocated overhead. It funds 22.857 offers. Future cash is reserved at the gift date; no reserve interest or inflation is modeled.
A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.
How we calculate the estimate
Central Bay model: 22.857 offers × .50 funding additionality × (.0313168 Q before shared harm − .001 Q shared harm) × .85 Bay share
.294506 Bay QALYs; $100,000 × 10 / .294506 = $3,395,514
Model inputs and assumptions
- Gift allocated to blood-pressure care
- 40% (range: Fixed across these scenarios). All gift cash is counted once. Other clinic health is unquantified, not known to be zero. Judgment.
- Complete five-year cash cost
- $1,750 per offer (range: $1,000–$3,500). Central annual budget: $60 medicines, $60 tests and $230 delivery/coordination/overhead. These are constructed budgets, not quotes. Judgment.
- Additional unpaid resources
- $450 per offer-year (range: $300–$650). Donated clinical labor, facilities and other inputs outside cash; no duplicate medication or lab charge. Gross spending envelope, not net societal cost. Judgment.
- Usual-care five-year first-event risk
- 10% (range: 3–25%). No-new-gift cardiovascular risk; not a measured RotaCare cohort or universally untreated population. Judgment.
- Sustained systolic difference
- 10 mmHg (range: 3–20 mmHg; separate 30-mmHg stress). Average difference versus accessible care already incorporates receipt and persistence. No second adherence multiplier. Judgment.
- Major cardiovascular-event risk ratio
- .80 per 10 mmHg (range: Fixed source anchor). Ettehad et al. randomized-trial meta-analysis. Exponentiation and transfer to local five-year risk are modeling assumptions. Trial synthesis; transferred.
- Funding additionality
- 50% (range: 0–80%). Activity beyond existing grants, reserves, other donations and public care; distinct from clinical alternatives already embedded in the achieved BP difference. Judgment.
- Event-specific health consequences
- Finite 2–20-year central tails (range: Separate five-calendar-year clipping). First events changed during five years of care are partitioned into fatal event, nonfatal stroke, MI and heart failure. Utility, survival and 3% discount are explicit assumptions; later event catch-up is not directly modeled. Judgment.
- Bay residence allocation
- 85% (range: 70–95%). Monterey and Santa Cruz are outside the nine-county Bay Area. These are residence priors, not clinic-count ratios; SF share is unverified. Judgment.
How much could the estimate change?
- central: $3,395,514 per 10 Bay QALYs. 0.29451 Bay QALYs from the same gift; $5,141,778 with gross associated resources. SF residence share is not established.
- favorable: $122,413 per 10 Bay QALYs. 8.1691 Bay QALYs from the same gift; $195,861 with gross associated resources. SF residence share is not established.
- pessimistic: $1,011,991,705 per 10 Bay QALYs. 0.00098815 Bay QALYs from the same gift; $1,387,874,338 with gross associated resources. SF residence share is not established.
- no funding: No positive-health ratio per 10 Bay QALYs. 0.0000 Bay QALYs from the same gift; No positive-health ratio with gross associated resources. SF residence share is not established.
- no clinical difference: No positive-health ratio per 10 Bay QALYs. 0.0000 Bay QALYs from the same gift; No positive-health ratio with gross associated resources. SF residence share is not established.
- no clinical gain with treatment harm: No positive-health ratio per 10 Bay QALYs. -0.0097143 Bay QALYs from the same gift; No positive-health ratio with gross associated resources. SF residence share is not established.
- independent donor harm: No positive-health ratio per 10 Bay QALYs. -0.085000 Bay QALYs from the same gift; No positive-health ratio with gross associated resources. SF residence share is not established.
- severe untreated stress: $90,307 per 10 Bay QALYs. 11.073 Bay QALYs from the same gift; $144,491 with gross associated resources. SF residence share is not established.
- central calendar5 only: $15,920,973 per 10 Bay QALYs. 0.062810 Bay QALYs from the same gift; $24,108,902 with gross associated resources. SF residence share is not established.
- severe untreated stress calendar5 only: $491,691 per 10 Bay QALYs. 2.0338 Bay QALYs from the same gift; $786,706 with gross associated resources. SF residence share is not established.
Uncertainty. These are analyst scenarios, not confidence intervals. First-event differences are scheduled over five years and discounted; mutually exclusive event consequences then receive finite survival/utility flows. Fatal events are not counted again as nonfatal injuries. The core assumes durable consequences of changed events; competing mortality alone does not resolve later cardiovascular catch-up. Clipping all flows at calendar year 5 is an explicit sensitivity, not an additional treatment duration.
5. Funding and previous grants
Verify the complete care budget and sustained treatment difference beyond accessible alternatives. Actual Bay operations do not establish an SF-resident benefit share.
The annual report’s $200 cost-per-patient figure is not a reconciled complete-cost price. FY2024–25 filing expenses of $1,413,811 divided by 1,582 reported unique patients are about $894—a scope cross-check, not a BP-course estimate. The model’s favorable $200 annual budget is a separate optimistic judgment. The report describes a CPA review, not an audit. Existing funds and donated resources remain baseline; full five-year staffing and follow-up capacity are not established. Gross associated resources are not net new societal costs when a gift replaces existing funding.
This review does not establish a verified marginal funding offer or a complete history of grants.
We have not verified a suitable donation route for this reviewed activity. Confirm the legal recipient and intended allocation before donating.
6. Sources
- Northern Peninsula clinic. RotaCare Bay Area. Primary clinic description. Published: Current page; retrieved: September 8, 2026.
- San Rafael Transitional Care Clinic. RotaCare Bay Area. Primary clinic description. Published: Current page; retrieved: September 8, 2026.
- 2024–2025 Annual Report. RotaCare Bay Area. Primary organizational report. Published: July 2024–June 2025; retrieved: September 8, 2026.
- FY2024–25 Form 990. RotaCare Bay Area. Provider-posted tax filing; not an audit. Published: Prepared January 16, 2026; retrieved: September 8, 2026.
- Blood pressure lowering for prevention of cardiovascular disease and death. Ettehad et al., Lancet. Primary randomized-trial meta-analysis. Published: 2016; retrieved: September 8, 2026.
- Blood pressure-lowering treatment based on cardiovascular risk. Blood Pressure Lowering Treatment Trialists’ Collaboration / Oxford. Author-institution primary abstract. Published: 2014; retrieved: September 8, 2026.
- Quality of life after TIA and stroke: Oxford Vascular Study. Luengo-Fernandez et al., Neurology. Primary longitudinal utility study. Published: 2013; retrieved: September 8, 2026.
- Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. HOPE-3 investigators, NEJM. Randomized trial. Published: 2016; retrieved: September 8, 2026.
- Practice Facilitation and Peer Coaching for Uncontrolled Hypertension Among Black Individuals. JAMA Internal Medicine. Cluster randomized trial. Published: 2024; retrieved: September 8, 2026.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $1,346,813. Organization size is separate from the modeled cost-effectiveness of a donation.
Rotacare Bay Area Inc
Form 990/990-EZ reported whole-entity expenses; includes program, administration and fundraising costs, but excludes any costs netted against revenue.
Original returns checked for legal identity, full-year period and total expenses. Latest three linked original returns.