The Category, Applied

Payers.

Commercial · Medicaid · Medicare Advantage · Reinsurance · Stop-Loss · Private Equity

Twelve positions. One measurement standard.
12 institutional use cases mapped to O2OS™
— WHERE THE CATEGORY TOUCHES PAYERS —
Twelve institutional positions
Direct and adjacent positions across the payer ecosystem
— FROM POSITIONS TO MATH —

Every position above sits inside the same structural exposure. Below is that exposure, quantified — using two independent methods, published sources, editable inputs.

For payers, the question isn’t whether the risk exists — it’s how much of it is invisible.

↓
The Oxygen Plan Corporation
← Category
The Pre-Diagnostic Index™ (PDI) · v1.0 · April 2026

The Pre-Diagnostic Index™
The standardized exposure band.

The missing layer for behavioral health.
— ONE STANDARD · THREE LAYERS OF EVIDENCE —
Truth Net Structural Exposure Model · $593M
Proof Population Penetration · $553.8M
Proof Screening Gap · $515.3M
↓ THE PDI · $515M – $554M · Conservative convergence of two independent external models
The PDI is the conservative convergence of two independent external models. The Net Structural Exposure Model explains why that convergence must exist. Published sources only · Zero proprietary assumptions · Every input cited.
— THE GOVERNING ARCHITECTURE —

The Net Structural Exposure Model

Population-scale behavioral measurement and routing infrastructure. Three compounding gaps, one accumulating exposure.

NSR-2026-001 · Net Structural Exposure · Medical-Only Model · Per 1,000,000 Covered Lives
GAP 1
Penetration Gap · 75%+
750,000
1,000,000 × 75% = 750,000 covered lives
Never reached by validated behavioral screening. Unmeasured risk cannot be managed, priced, or routed.
GAP 2
Sensitivity Loss · ~25%
62,500
250,000 remaining × 25% = 62,500 misclassified
Single-test screening misclassifies approximately 25% of measured individuals. False negatives create invisible clinical and financial liability.
GAP 3
Routing Loss · ~67%
125,000
187,500 identified × ~67% = 125,000 never convert
70–80% of positive screens never convert to care. Identification without connection does not translate into clinical intervention.
93%
of Behavioral Health Risk Outside Structured Infrastructure
937,500 of 1,000,000 covered lives outside validated screening, measurement & routing
Net Structural Exposure · Base Case
$593M
Per 1,000,000 covered lives · Medical-only model
Sensitivity Range (λ)
$494M–$692M
Assumptions: C=$6,200 | πp=17.5% | λ=30%
Methodology: Exposure model derived from CMS utilization data, peer-reviewed sensitivity benchmarks, and published referral conversion studies. Published by The Oxygen Plan Corporation for institutional discussion and methodological transparency. Utility patent application pending.
— INDEPENDENT VALIDATION —

The Funnel explains why the exposure must exist. Below, two independent models derived from entirely different published source sets validate the math. Their convergence band is the PDI.

↓
Enter your Payer numbers ↓
Population Covered Lives Both models recalculate on population change
Penetration

Population Penetration Model

Prevalence × Productivity-Medical Cost
Interactive · Edit any input
Percent of population structurally affected default 8.5%
%
Affected lives 85,000
CDC NCHS Data Brief No. 444 (2022); corroborated by PMC7673056 and Gallup Workforce Wellbeing data (2022).
Published population prevalence of behavioral health conditions carrying direct healthcare cost exposure. Derivation uses conservative structural cost attribution — not severity-adjusted modeling.
View CDC source →
Annual cost per structurally affected life default $6,480
$
Subtotal $550,800,000
PubMed Central articles PMC7673056 and PMC5101346; American Academy of Family Physicians published productivity loss synthesis (2018).
Direct healthcare expenditure plus indirect productivity loss attributable to untreated or undiagnosed behavioral health conditions. Published per-person annualized figures from peer-reviewed sources.
View PMC7673056 →
Workflow friction overhead (per 1M lives) default $3M
$
Applied to pop. $3,000,000
AAFP (2018); Gallup Workforce Wellbeing data (2022).
Per-million workflow friction overhead attributable to non-standardized behavioral screening processes: re-work, duplicate assessments, care coordination overhead.
POPULATION PENETRATION MODEL · MODEL OUTPUT
Annual Structural Exposure
$553,800,000
Per life: $553.80
PEPM: $46.15
Gap

Screening Gap Model

(1 − screening rate) × MDD × Incremental Cost
Interactive · Edit any input
Documented depression screening rate (primary care) default 4.2%
%
Unmeasured 95.8%
U.S. Preventive Services Task Force Evidence Synthesis 223 (drawn from National Ambulatory Medical Care Survey / NAMCS medical record data).
Depression screening occurred in only 4.2% of primary care visits among adults without a known diagnosis. Nationally representative medical record data — not self-report.
View USPSTF →
MDD prevalence (adult population) default 8.4%
%
Exposed lives 80,472
National Institute of Mental Health, National Survey on Drug Use and Health (2023).
Published national MDD prevalence rate for adults. Used here as the floor population prevalence applied across unmeasured primary care visits.
View NIMH →
Direct incremental annual healthcare cost default $6,404
$
Cost basis 38.1% of $16,854
Greenberg PE et al., Advances in Therapy, 2023. PubMed Central: PMC10499687.
$6,404 = 38.1% of the $16,854 total annual incremental per-person burden of MDD — isolating the direct healthcare cost component. Conservative, payer-defensible modeling.
View Greenberg 2023 →
SCREENING GAP MODEL · MODEL OUTPUT
Annual Structural Exposure
$515,342,000
Per life: $515.34
PEPM: $42.95
— THE STANDARD —

The Pre-Diagnostic Index™ · Standardized Exposure Band

The PDI is the conservative convergence of two independent external models. The Net Structural Exposure Model explains why that convergence must exist.

Two independent external models converge between $515M – $554M per 1M covered lives. This conservative convergence defines The Pre-Diagnostic Index™ — the standardized exposure benchmark for behavioral health systems. The patent-derived Net Structural Exposure Model arrives at $593M, reinforcing the same underlying condition through a causal architecture rather than a benchmark calculation.

The Pre-Diagnostic Index™
$515M – $554M
standardized exposure band · per 1M covered lives
Model Spread
7.3%
narrow — two independent paths
Proprietary Assumptions
0
every input cited
— THREE PATHS · ONE REALITY —
Population Penetration Model
$553.8M
CDC / PMC / AAFP
Screening Gap Model
$515.3M
NAMCS / NIMH / Greenberg 2023
Net Structural Exposure Model
$593M
Patent-derived · Causal architecture
The convergence is the standard. The Net Structural Exposure Model explains why the convergence must exist.
Why the convergence holds

Any single derivation can be challenged on assumption choice. Three independent derivations — two from external data sets, one from the patent-derived causal model — converging within a narrow band is a different category of evidence. The Net Structural Exposure Model explains why the exposure must exist. The two external models, drawn from entirely different sources, prove it exists. The Pre-Diagnostic Index™ is where all three converge. Change any input. Stress-test any assumption. The band moves — but the three methodologies remain within a narrow spread because they are observing the same underlying structural condition: the absence of a pre-diagnostic measurement standard.

How to Cite
The Oxygen Plan Corporation. (2026). The Pre-Diagnostic Index™ (PDI), v1.0. Retrieved from theoxygenplan.com
Inline reference: "Per the Pre-Diagnostic Index™ (The Oxygen Plan Corporation, v1.0, April 2026) — the standardized exposure band defined by the independent convergence of two external models and explained by the patent-derived Net Structural Exposure Model — structural behavioral exposure is $515M–$554M per one million covered lives."
Scope Disclosure

The Pre-Diagnostic Index™ (PDI) is for illustrative purposes only, derived exclusively from published, peer-reviewed, and government data sources. It represents structural exposure — the cost of operating behavioral health without a pre-diagnostic measurement standard — not a projection of what any single intervention, product, or infrastructure deployment will produce. No outcome is guaranteed. No causation is claimed. Sector-specific exposure analysis, including dependency assessment and architectural alignment, is available through Institutional Access at theoxygenplan.com. O2OS™, Stress Number™, and The Pre-Diagnostic Index™ are trademarks of The Oxygen Plan Corporation. Utility patent application pending.