O2OS™
Population-Scale Behavioral Measurement & Routing Infrastructure
Net Structural Exposure
$468M – $564M
Per 1,000,000 Covered Lives
Exposure currently invisible to the organizations bearing the cost.1,2,3
The Hidden Denominator Problem
$500M – $1.1B
Estimated Unmeasured Exposure1,2,3
Per 1,000,000 Covered Lives
Drivers of Structural Exposure
75%+
Penetration Gap1
75% of covered lives are never reached by validated behavioral screening.
250,000 Covered Lives
Exposure Impact
Up to $600M
(Gross)
O2OS™ enables population-scale screening via unified stress/anxiety/depression
measure.4a,4b
~25%
Sensitivity Loss2
Single-test screening misclassifies ~25% of measured individuals.
187,500 Under-identified
Exposure Impact
$100M–$200M
Structural Leakage
(nested within penetration)
(nested within penetration)
↓
Net Structural Exposure
$468M – $564M
Per 1,000,000 Covered Lives
Exposure translates into measurable PEPM, workflow waste, and downstream claims
volatility.6
O2OS™ provides unified measurement, routing, and governance infrastructure to close all three gaps.
The Oxygen Plan Corporation
Working in collaboration with Mayo Clinic
Sources & Methodology
1.
Screening penetration estimates derived from CMS behavioral health screening utilization data and the Substance
Abuse and Mental Health Services Administration (SAMHSA),
National Survey on Drug Use and Health (NSDUH), 2021–2023. Approximately 70–80% of commercially insured
adults do not receive validated behavioral health screening in a given year.
See also: Mojtabai, R., et al., "Unmet Need for Mental Health Care in the United States," Psychiatric
Services, 2011.
2.
Sensitivity limitations of single-administration screening instruments. The PHQ-9 demonstrates sensitivity of
0.80 and specificity of 0.92 for major depression at the ≥10 cutoff (Kroenke, K., Spitzer, R.L., & Williams,
J.B., "The PHQ-9: validity of a brief depression severity measure," Journal of General Internal
Medicine, 2001).
The GAD-7 demonstrates sensitivity of 0.89 and specificity of 0.82 for generalized anxiety (Spitzer, R.L., et
al., "A brief measure for assessing generalized anxiety disorder," Archives of Internal Medicine,
2006).
Single-test sensitivity limitations result in approximately 20–25% false-negative rates across standard
instruments.
3.
Referral-to-care conversion failure rates. SAMHSA, National Survey on Drug Use and Health, reports that
approximately 57% of adults with mental illness received no treatment in the prior year (2022).
Among those screened positive in primary care, referral completion rates range from 20–30% (Cunningham, P.J.,
"Beyond Parity: Primary Care Physicians' Perspectives on Access to Mental Health Care," Health Affairs,
2009).
See also: Kramer, T.L. & Garralda, M.E., "Psychiatric disorders in adolescents in primary care," British
Journal of Psychiatry, 1998.
4a.
Stress Number™ tri-domain (home, work, social) behavioral state assessment methodology validated and published
in Archives of Psychology, Vol. 2, No. 7, 2018. Study conducted in collaboration with Mayo Clinic.
4b.
Clinical cutoff (≤23) and Receiver Operating Characteristic (ROC) Area Under the Curve (AUC) performance
(0.88–0.92) derived from IRB-approved clinical research conducted in collaboration with Mayo Clinic. Data on
file, The Oxygen Plan Corporation.
5.
EHR integration and clinical workflow architecture. O2OS™ is designed to map to existing electronic health
record infrastructure and reimbursement pathways including CPT 96127 (Brief emotional/behavioral assessment;
American Medical Association, Current Procedural Terminology) and CPT 96138 (Psychological testing
evaluation services; AMA CPT).
Coverage with Evidence Development (CED) pathway as defined by the Centers for Medicare & Medicaid Services
(CMS), Medicare Evidence Development & Coverage Advisory Committee.
6.
Behavioral health cost burden and downstream economic impact. Melek, S.P., Norris, D.T., & Paulus, J.,
"Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry," Milliman
Research Report, 2014.
Estimated $200B+ in annual U.S. behavioral health spend operating without a unified measurement standard.
Per-employee-per-month (PEPM) exposure, workflow waste, and claims volatility estimates derived from employer
behavioral health cost analyses published by the Integrated Benefits Institute and the National Business Group
on Health.
7.
O2OS™ patent estate. Original priority date: 2008. PCT patent application published October 2009 (US
2009/0265437 A1). Comprehensive patent estate filed 2026, spanning measurement, routing, governance, and
reimbursement infrastructure families. Patent pending.
The structural exposure model presented above is derived from published, peer-reviewed, and government-source
data.
Individual exposure estimates are modeled per 1,000,000 commercially insured covered lives and are not adjusted
for specific payer, employer, or regional variation.
Net structural exposure represents the estimated economic value of behavioral health risk currently outside
validated measurement, clinical routing, and governance infrastructure.
This model is intended for institutional planning and strategic analysis purposes.
Full methodology available in O2OS™ Exposure Model Documentation.
For inquiries:
[email protected]