The Behavioral Risk Economy · Per Million Lives

The Reactive Economy. The Behavioral Risk Accounting System.

An economic topology of what the current system extracts — beside the architecture of what it cannot yet see. Every figure sourced to federal administrative data or peer-reviewed research.

Working in Collaboration with Mayo Clinic · Patent Pending · USPTO Track One
Clinical Validation
Working in collaboration with Mayo Clinic
r = 0.68 (BDI-II) · 0.58 (SCL-90) · p < 0.01 · Archives of Psychology, 2018 · N = 292
Patent
Patent pending · USPTO Track One
USPTO Track One filed April 2026 · Original patent application filed April 22, 2008 · Published 2009
6 Federal Pathways
CMS CED · CPT · 1115 · HEDIS · Star Ratings · ACCESS
CMS CED · CPT 96127 / 96138 · Medicaid 1115 Waivers · NCQA HEDIS · CMS Star Ratings 2027 · CMS ACCESS Model
The Documented Cost · Per 1,000,000 Lives
$2.36B
documented behavioral cost — per million commercially insured lives, per year
$2,357
Per Person · Per Year
$196
Per Member · Per Month
93%
Unmeasured Today
Orientation

A flow architecture, not a forecast.

Every operator inside healthcare today is a node in this flow. What follows traces what the reactive economy already costs per million commercially insured lives — across six lanes and the substrate that now measures the 93% upstream. Every dollar anchored to federal administrative data or peer-reviewed research. No vendor surveys, no consulting estimates, no industry attestations.

01 · Documented Extraction

The Reactive Economy

A downstream collision architecture.

93%
Unmeasured · 930,000 Lives
Upstream of any clinical signal
7%
Reactive · ~70,000 Lives
Touch the system only after escalation
Six Extraction Lanes
01
The Unmeasured Majority
Workforce drag · presenteeism · premature mortality
$827M
02
The Reactive Screen
PCP incidentals · CPT 96127 · post-event triage
$4.5M
03
The Diagnosed Funnel
Therapy · Rx · psychiatry · clinical encounters
$128M
04
The Crisis Cohort
ED utilization · boarding · inpatient · SUD
$204M
05
The Comorbidity Multiplier
Silent surcharge across cardiac · surgical · oncology
$927M
06
The Downstream Tax
Productivity loss · workforce withdrawal · mortality
Source: BLS CPS · CDC NVSS
$266M
Total Documented Extraction · Per 1M Lives · Per Year
$2.36B
$2,357
Per Person · Per Year
02 · Measurement Architecture

The Accounting System.

An upstream coordinate system for the 93%.

100%
Continuously Measurable · 1,000,000 Lives
Stress Number™ coordinate · upstream of clinical signal
Architectural Model
Not Clinical Outcomes Claims
Proposed upstream telemetry architecture. Capability layer. No causal savings claim.
The Three Instruments
Coordinate
Stress Number™ — the position.
Standardized behavioral state coordinate, scored across Home · Work · Social. The canonical positional input.
The position
Economic Map
Pre-Diagnostic Index™ — the math.
Translation layer — coordinate to actuarial exposure. Peer-reviewed clinical validation (Williams 2018, N=292).
The math
Routing
Smart Referral Engine™ — the action.
Governed routing layer — measurement into auditable institutional action.
The action
The Predictive Intelligence Layer
Risk Stratification
Trajectory Modeling
Real-Time Signal
Member Context
Domain Sub-Scores
Population Aggregation
Early Intervention Pathways
Micro-Interventions
Care Navigation
Coaching & Support
Clinical Routing
Digital Therapeutics
Resource Linkage
The PDI Exposure · What The 93% Adds · Per Member
$515M
$515
Peer-Reviewed · Working in Collaboration with Mayo Clinic
See the Pre-Diagnostic Index™ →
Operator-Class Decomposition

The aggregate is vetted. The drill-down is directional.

The $2.36B above is anchored entirely in federal and peer-reviewed sources. The decomposition that follows allocates that aggregate across operator classes — by where the spend settles, not where it originates.

Methodology Disclosure
The figures above are anchored to federal administrative data and peer-reviewed research only. The decomposition below applies independent nonprofit research (KFF, Commonwealth Fund, RAND, NASEM, NIMH) and standards-body data (NCQA HEDIS, NQF, Joint Commission) to allocate the federally-vetted aggregate across operator classes. The aggregate is auditable. The per-sector allocation is directional and reconciles to the federal total. We do not use proprietary research from competitive industry sources — no consulting firms, no vendor analytics, no industry association estimates.
Federal Aggregate
$2.36B
Per 1M Lives · Vetted Above
Decomposition Total
$2.36B
Allocated Below · Reconciled
Variance
±0%
Tie-Out · Forced to Federal
Maintenance Layer
Touchpoints in daily life — before any clinical signal. EHR · EAP · digital apps. The signal exists here; capture is structurally trivial.
Crash Layer
Touchpoints after the diagnosis or the event — therapy, Rx, ED, inpatient, disability, mortality, reinsurance. The signal arrives too late.
Hospital Systems
37.2%
$877M
Inpatient psychiatric · ED utilization · boarding · medical/surgical comorbidity surcharge. Largest single capture class.
● Crash
Comorbid Medical/Surgical
19.7%
$465M
Silent surcharge across cardiac, surgical, and oncology populations. Behavioral status drives 30-60% medical cost multiplier.
● Crash
Ambulatory Providers
16.1%
$380M
Therapy, psychiatry, office-based behavioral encounters. 41.5% of direct adult MH spend in MEPS data.
Source: AHRQ MEPS
● Crash
Pharma + PBMs
10.2%
$240M
Antidepressants, anxiolytics, antipsychotics. 26.2% of MEPS adult MH spend. PBM rebate retention captures additional margin.
Source: AHRQ MEPS
● Crash
Disability + Workforce Loss
7.7%
$182M
Absenteeism, presenteeism, LTD/STD claims. Bleeds without ever clearing an HR audit trail.
Source: Greenberg 2023 · KFF
● Crash
Premature Mortality
3.6%
$84M
Suicide, overdose, behavioral-related early mortality. Lifetime earnings loss applied at federal discount rate.
Source: CDC NVSS
● Crash
Payer Care Management
3.2%
$76M
Utilization management, prior authorization, behavioral case management. Embedded in MLR administrative load.
Source: CMS MLR · NCQA HEDIS
● Crash
Reinsurance Cession
1.7%
$39M
Treaty cession on high-cost behavioral claims. Lossy without a behavioral coordinate to price against.
● Crash
Crisis Authorities · 988
0.3%
$7M
988 line operators, mobile crisis response, county behavioral authorities. Last-resort capture, public-sector funded.
Source: SAMHSA 988
● Crash
EHR Platforms
0.2%
$4M
Behavioral health modules across major EHR vendors. 0.4% of total EHR spend per ONC adoption data.
Source: ONC HealthIT
◐ Maintenance
EAP Vendors
0.1%
$2.5M
Employee Assistance Programs. Low single-digit utilization rates per commercial member.
Source: RAND Health
◐ Maintenance
Digital MH Apps
0.1%
$2.5M
Calm, Headspace, Talkspace, BetterHelp, Lyra, Spring Health, et al. Per-commercial-member capture at long tail of the topology.
Source: Commonwealth Fund · MEPS-derived
◐ Maintenance
Maintenance vs. Crash · Per 1,000,000 Lives
The system spends $9M maintaining the people closest to a behavioral signal.
It spends $2.35B absorbing the people who crash.
Nobody wants people to crash. The capture map is the inverse of the prevention map.
The Frame

Federal datasets already document the downstream cost.
The substrate now measures what they cannot yet see.

93%
Unmeasured Today
$2,357
Reactive · Per Person
$515
PDI · Per Person
2008
Prior Art
Source Evidence Hierarchy

Every figure linked. Federal or peer-reviewed origin.

The same evidentiary standard the Pre-Diagnostic Index™ holds. No vendor research. No consulting estimates. No industry attestations. If a source cannot be linked to a federal administrative dataset or a peer-reviewed journal, it does not appear above.

Tier 1
Federal Administrative Data — direct observation
AHRQ HCUP
Healthcare Cost and Utilization Project — Nationwide Emergency Department Sample, National Inpatient Sample. Direct observation of behavioral health utilization, costs, boarding. hcup-us.ahrq.gov
SAMHSA NSDUH
National Survey on Drug Use and Health — annual nationally representative prevalence, treatment access, treatment gap measurement. samhsa.gov/data
CMS NHE
National Health Expenditure Accounts · IPF PPS · Physician Fee Schedule · CPT 96127 reimbursement. cms.gov
CDC NCHS
National Ambulatory Medical Care Survey · National Hospital Care Survey · National Vital Statistics System. Outpatient encounter rates, mortality. cdc.gov/nchs
BLS CPS
Current Population Survey · Employee Benefits Survey · workforce participation by behavioral status. bls.gov/cps
HRSA
Workforce data on mental health professional shortage areas, behavioral provider distribution. data.hrsa.gov
Tier 2
Independent Nonprofit Research — policy-grade analysis
KFF
Kaiser Family Foundation — independent nonprofit health policy research. State Health Facts, mental health coverage analyses, parity tracking. kff.org/mental-health
Commonwealth Fund
Commonwealth Fund — health policy foundation, peer-reviewed Health Affairs research on behavioral health infrastructure. commonwealthfund.org
RAND Health
RAND Corporation Health — nonprofit federally-contracted research on behavioral health workforce, utilization, parity. rand.org/health
NASEM
National Academies of Sciences, Engineering, and Medicine — congressionally-chartered health research, NIH-aligned. nationalacademies.org
NIH NIMH
National Institute of Mental Health — federal prevalence and treatment statistics, official mental health research authority. nimh.nih.gov/statistics
Tier 3
Peer-Reviewed Research — statistical derivation
Greenberg 2021
"The Economic Burden of Adults with Major Depressive Disorder in the United States (2010 and 2018)." Pharmacoeconomics 39, 653–665. doi: 10.1007/s40273-021-01019-4
Greenberg 2023
"The Economic Burden of Adults with Major Depressive Disorder in the United States (2019)." Advances in Therapy 40, 4460–4479. PMC10499687
Williams 2018
Working in Collaboration with Mayo Clinic — clinical validation of Pre-Diagnostic Index™ instrument (N=292). Archives of Psychology. Correlations: r=0.68 BDI-II, r=0.58 SCL-90 (p<0.01).
JAMA Network
Behavioral comorbidity cost multipliers across cardiac, surgical, oncology populations — peer-reviewed cohort studies. jamanetwork.com
Health Affairs
Health Affairs Journal — peer-reviewed health policy research on US mental health spending decomposition. healthaffairs.org
Tier 4
Standards & Regulatory — infrastructure rails
NCQA HEDIS
Healthcare Effectiveness Data and Information Set — behavioral health measure specifications. ncqa.org/hedis
NQF
National Quality Forum — multi-stakeholder consensus body for healthcare quality measures, including behavioral health. qualityforum.org
Joint Commission
The Joint Commission — independent nonprofit healthcare accreditation, behavioral health standards. jointcommission.org
ONC CMS-0057-F
Interoperability and Prior Authorization Final Rule. federalregister.gov
CPT 96127 / 96138
AMA Current Procedural Terminology codes for brief behavioral health screening and assessment — reimbursement pathway under Medicare and commercial coverage.
Methodology Disclosure
The $2.36B federal aggregate is anchored entirely in Tier 1 (federal administrative) and Tier 3 (peer-reviewed) sources. The operator-class decomposition applies Tier 2 (independent nonprofit) and Tier 4 (standards-body) research to allocate that vetted aggregate across capture classes. The aggregate is auditable. The per-sector allocation is directional and reconciles to the federal total within ±0% by design — figures are forced to tie out. The PDI Exposure figure of $515 per member is derived from peer-reviewed prevalence multiplied by the per-member behavioral exposure component from Greenberg 2023. The right-side architecture is an architectural model — not a clinical outcomes claim. No projected savings, reduction percentage, or attributed outcome is asserted. No proprietary research from competitive industry sources is used at any tier.
How to Cite

Cite the topology. Consistently.

A published reference format for the Behavioral Risk Economy decomposition — for use in clinical, regulatory, actuarial, and contractual contexts.

Formal Citation
The Oxygen Plan Corporation. (2026). The Behavioral Risk Economy: A Federally-Sourced Decomposition (O2OS-BRE-2026). Working in Collaboration with Mayo Clinic. Retrieved from theoxygenplan.com
Inline Reference
"Per the Behavioral Risk Economy decomposition (The Oxygen Plan Corporation, O2OS-BRE-2026) — anchored to federal administrative and peer-reviewed sources — documented behavioral cost is $2,357 per commercially insured life per year, of which the system spends $9M maintaining and $2.35B absorbing per million lives. The capture map is the inverse of the prevention map."
Methodology Note
Federal aggregate ($2.36B / 1M lives) anchored to AHRQ HCUP · AHRQ MEPS · CMS NHE · SAMHSA NSDUH · CDC NCHS · BLS · Greenberg 2021/2023 · JAMA Network. Operator-class decomposition allocated via independent nonprofit (KFF · Commonwealth Fund · RAND · NASEM · NIMH) and standards-body (NCQA HEDIS · NQF · Joint Commission) research, reconciled to the federal total. Architectural model — not a clinical outcomes claim. No proprietary industry sources used.
Citation ID
O2OS-BRE-2026
The Oxygen Plan Corporation
Working in Collaboration with Mayo Clinic
The Behavioral Risk Economy · O2OS-BRE-2026 · 2026 · 2008 Prior Art
Intelligence Needs Oxygen™