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)
CLINICAL SCREENERS vs. POPULATION-SCALE BEHAVIORAL MEASUREMENT

Why single-test screening creates the sensitivity gap — and why measurement infrastructure closes it.

Most behavioral health tools diagnose conditions.
Stress Number™ measures the behavioral signal that precedes them.

BDI-II, PHQ-9, GAD-7, SCL-90 & Others Stress Number™
Clinical diagnostic screeners Population-scale behavioral measurement infrastructure
✓ Grounded in decades of clinical use ✓ Clinically validated in collaboration with Mayo Clinic (ROC AUC 0.88–0.92)
✗ Separate instruments required for stress, anxiety, and depression ✓ Unified behavioral signal measuring stress, anxiety, and depression in a single instrument
✗ May miss subclinical behavioral distress when using single-condition screeners ✓ Detected behavioral risk in individuals classified as "minimal" on BDI-II but clinically elevated on the SCL-90 Global Severity Index
✗ Do not measure stress as a standalone construct ✓ Measures stress directly across home, work, and social domains
✗ Do not quantify by life domain (home, work, social) ✓ Separately scores each domain — enables routing by item, domain, cutoff, and score
✗ Do not produce a unified longitudinal stress score ✓ 0–30 continuous score with validated clinical cutoff (≤23) for longitudinal tracking
✗ Built for clinical administration, not population-scale digital deployment ✓ Pre-diagnostic — designed for population-scale screening before crisis, before diagnosis
✗ Do not trigger automated referrals or structured routing ✓ Powers structured routing to care — measurement connected to action
✗ Snapshot screening — not designed for continuous measurement ✓ Continuous measurement — enables longitudinal population monitoring
✗ Do not sit upstream of AI — no structured behavioral input layer ✓ Provides the structured behavioral measurement layer AI systems require
Existing instruments diagnose individuals.
Stress Number™ measures populations — and activates care before diagnosis.
BDI-II (Beck Depression Inventory-II) is a registered trademark of Pearson Education, Inc. PHQ-9 (Patient Health Questionnaire-9) was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, and Kurt Kroenke, with an educational grant from Pfizer Inc. GAD-7 (Generalized Anxiety Disorder-7) was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. SCL-90 (Symptom Checklist-90) is a registered trademark of Pearson Education, Inc. Stress Number™ is a trademark of The Oxygen Plan Corporation. All other trademarks are the property of their respective owners. Reference to these instruments is for comparative and educational purposes only.
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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