O2OS™

Population-Scale Behavioral Measurement & Routing Infrastructure
NSR-2026-001

Net Structural Exposure

Medical-Only Model
Per 1,000,000 Covered Lives
Actuarial Exposure This model quantifies the economic exposure created when behavioral risk goes unmeasured or misclassified at population scale.
System Infrastructure Standardized behavioral measurement infrastructure is required to close the detection, routing, and intervention gaps.
Operational Application Health systems, payers, and consulting firms can use this framework to model population-level behavioral risk and intervention impact.
DRIVERS OF STRUCTURAL EXPOSURE

Population-scale exposure emerges from three structural gaps in behavioral health infrastructure: penetration, sensitivity, and routing.

75%+ Penetration Gap

1,000,000 × 75% = 750,000 covered lives never reached by validated behavioral screening.

≈25% Sensitivity Loss

250,000 remaining × 25% = 62,500 misclassified by single-test screening. False negatives create invisible clinical and financial liability.

≈67% Routing Loss

187,500 correctly identified × ~67% = 125,000 never convert to care. Identification without connection does not translate into clinical intervention.

93% of Covered Lives Outside Structured Infrastructure
937,500 of 1,000,000 Covered Lives Outside Validated Screening, Measurement & Routing
WHAT EACH GAP MEANS
Penetration Gap Sensitivity Loss Routing Breakdown
The population never reached by validated behavioral screening. Unmeasured risk cannot be managed, priced, or routed. Single-test screening misclassifies ≈25% of measured individuals. False negatives create invisible clinical and financial liability. ≈67% of positive screens never convert to care. Identification without connection does not translate into clinical intervention.
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NET STRUCTURAL EXPOSURE
Medical-Only · Base Case
$593M
Per 1,000,000 Covered Lives
Sensitivity (λ): $494M–$692M
Assumptions (Midpoint Parameters): C=$6,200 | πp=17.5% | λ=30%
Full Methodology: NSR-2026-001 — Structural Exposure Model: Methodology, Parameters & Arithmetic
O2OS™ provides unified measurement and routing infrastructure to close all three gaps.
Download Exposure Model (PDF)
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THE OXYGEN PLAN CORPORATION

Behavioral Measurement: Before & After

O2OS™ converts behavioral health measurement from a labor event into a governed data infrastructure layer — eliminating manual workflow while enabling AI-ready measurement at population scale.

CURRENT STATE
Manual Clipboard Model
Per-visit, labor-dependent
O2OS™ INFRASTRUCTURE
Governed Signal Model
Pre-scored, digitally governed
1
Patient arrives at visit
Point of care only
1
Via patient portal
No visit dependency
DIGITAL
2
Clipboard PHQ-9 / GAD-7
Single-instrument
MANUAL
2
Stress Number™ tri-domain
Home, Work, Social
STANDARD
→
3
Staff administers
Clinical time consumed
LABOR
3
Pre-scored automatically
Zero staff time
AUTO
4
Manual scoring
Inconsistent thresholds
MANUAL
4
Governed routing
Thresholds trigger pathways
GOVERNED
5
Manual EHR entry
Redundant documentation
LABOR
5
EHR integration
Structured data, audit-ready
INTEGRATED
6
Provider reviews in visit
Visit time consumed
VISIT TIME
6
Governed signal upstream
Assessed before visit
UPSTREAM
7
Billing capture attempt
Missed CPT codes
LEAKAGE
7
CPT 96127/96138 mapped
Auto-captured reimbursement
CAPTURED
WHAT O2OS™ ELIMINATES
Staff Admin Time
Per-visit labor
Manual Scoring
Inconsistent
Data Entry
Double documentation
Visit Time
During appt
Billing Leakage
Missed CPT
ECONOMIC LEVER — PER 10,000 LIVES
$2–3
PEPM INFRASTRUCTURE
O2OS™ measurement layer
$7–15
PEPM LEAKAGE
Base case. Upper bound $46 in high-friction environments
13–20%
BREAK EVEN
Drops to 4.4–6.6% at upper bound
At 1M lives: $84M–$180M
base-case avoidable leakage annually
Upper bound: $552M at $46 PEPM | High-friction manual environments
Reflects environments with manual scoring, fragmented EHR workflows, and low CPT capture discipline.
Economics reflect measurement gap impact only.
The routing gap is a second, independent layer quantified separately.

"O2OS™ converts behavioral measurement from a labor event into a data infrastructure event — eliminating manual scoring workflow and enabling AI-ready behavioral state signals at population scale."

Patent Pending — Measurement → Routing → Reimbursement → Governance
theoxygenplan.com
The Oxygen Plan Corporation
Working in collaboration with Mayo Clinic
© 2026 The Oxygen Plan Corporation. All rights reserved. O2OS™ and Stress Number™ are trademarks of The Oxygen Plan Corporation. Governed by Get Lucas Inc.
The Oxygen Plan Corporation
Working in collaboration with Mayo Clinic
Exposure model derived from CMS utilization data, peer-reviewed sensitivity benchmarks, and published referral conversion studies.
This document has not undergone external academic peer review and is published for institutional discussion and methodological transparency.

Sources & Methodology

1. Greenberg PE, et al. The Economic Burden of Adults with Major Depressive Disorder in the United States (2019). Advances in Therapy. 2023;40:4599–4621. Incremental healthcare costs of MDD: $6,429 per adult (2019 USD).
2. Greenberg PE, et al. The Economic Burden of Adults with Major Depressive Disorder in the United States (2010 and 2018). PharmacoEconomics. 2021;39:653–665.
3. Happify Health. Healthcare Costs Are 149% Higher Among Individuals With Unrecognized Symptoms of Depression. National Health and Wellness Survey analysis. February 2022. Incremental cost for unrecognized depression: $6,269/year.
4. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
5. Spitzer RL, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.
6. SAMHSA. National Survey on Drug Use and Health (NSDUH), 2021–2023. Screening penetration and treatment gap estimates.
7. Cunningham PJ. Beyond Parity: Primary Care Physicians' Perspectives on Access to Mental Health Care. Health Affairs. 2009;28(3):w490–w501.
8. Melek SP, Norris DT, Paulus J. Economic Impact of Integrated Medical-Behavioral Healthcare. Milliman Research Report. 2014. Avoidable share (λ) range: 20–40%.
9. Williams DE, Lucas E, Haugen D, Creagan ET. Initial clinical validation of The Oxygen Plan Stress Number. Archives of Psychology. 2018;2(2). ROC AUC 0.88–0.92. Conducted in collaboration with Mayo Clinic.
10. O2OS™ foundational measurement architecture. Original priority date: 2008. International patent publication: October 2009 (US 2009/0265437 A1).
The structural exposure model presented above is derived from published, peer-reviewed, and government-source data. All parameters are explicit, substitutable, and reproducible. 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: NSR-2026-001 — Structural Exposure Model: Methodology, Parameters & Arithmetic.
For inquiries: info@theoxygenplan.com
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