economic-brain-bhi/docs/target_questions.md

BHI Layer — Target Opportunity Questions

These are the questions the BHI layer must answer. They double as acceptance criteria: the layer ships when every question can be answered with a SQL query or a short Python notebook against brain with BHI tables populated.

Scope assumptions: all 50 states, facility-level where available, tagged adolescent (13-17) and young adult (18-25).

1. Supply / capacity

1. Which US counties have the highest HPSA mental health scores AND the lowest bed density (top 50)?
2. Which counties have ZERO licensed adolescent inpatient psychiatric beds within 60 miles?
3. Which counties have ZERO licensed young-adult residential treatment beds within 60 miles?
4. How many IPFs have closed vs opened in the last 24 months, by state?
5. Which IPFs have the worst HBIPS restraint+seclusion rates and are therefore vulnerability candidates for competitive entry or acquisition?
6. Which nursing homes are disproportionately housing under-65 residents with SMI (SNF-IMD dynamic) and are candidates for conversion/specialty buildout?
7. Where are the biggest drops in psych bed count over the last 5 years (via POS termination data)?
8. Which states have the lowest ratio of PRTF beds per 10k adolescents?

2. Demand

9. Which counties have the highest 13-17 suicide rate and fastest-growing trend (CDC WONDER)?
10. Which counties have the highest 18-25 overdose death rate trend?
11. Which states have the highest YRBSS "considered suicide" % and highest unmet-treatment need on NSCH, simultaneously?
12. How does adolescent ED visit rate for self-harm compare across states (cross-joining HCUP when available)?
13. Which school districts have the highest IDEA Part B Emotional Disturbance child count per 1,000 students?
14. Which states are seeing the largest YoY increase in 988 + crisis line volume per capita?

3. Workforce

15. Which MSAs have the highest YoY wage growth for psychiatrists (SOC 29-1223) — indicates a shortage?
16. Which MSAs have psychiatrist employment per 100k in the bottom quartile AND mental health HPSA coverage in the worst quartile?
17. Where are LCSW/LMHC wages spiking (21-1014, 21-1018) while employment is flat?

4. Financial / opportunity

18. What is the median psych Medicare margin (revenue - cost) per discharge, by state, from MCR data?
19. Which for-profit IPF chains are expanding fastest (opened_date + chain_id from nursing home join)?
20. Which counties have the biggest gap between HPSA score and SAM.gov / state contract dollars flowing in (underinvested vs need)?
21. What are the median acquisition multiples for BH facilities in each state? (Requires later enrichment.)

5. Adolescent transport / crisis (specific focus)

22. Which counties dispatch the most EMS runs coded "behavioral/psych" per 10k adolescents (NEMSIS, when access granted)?
23. Where do adolescent psychiatric holds most frequently result in out-of-county or out-of-state transport (indicates no local capacity)?
24. Which states have the longest average ED boarding time for adolescents awaiting inpatient psych admission (via AHRQ + state HAI reports)?
25. Which states have dedicated secure transport statute/reimbursement (bhi_policy_events filter on "secure transport") — these are bluefields for BH transport vendors?
26. Which counties combine: high adolescent suicide rate + no in-county adolescent psych beds + high ED boarding = highest-need adolescent transport markets?
27. Which chains/operators already provide adolescent secure transport and where are their service gaps (via scraping state BHO contract registries)?

6. Regulatory / tailwind

28. Which states passed Medicaid rate increases for BH residential in the last 24 months?
29. Which states expanded the definition of "mobile crisis response" to include adolescents in the last 24 months?
30. Where are IMD exclusion waivers (Section 1115 SMI/SED waivers) active or pending?

7. Composite / prioritization

31. Top 10 states ranked by composite_score for "adolescent inpatient psychiatric"?
32. Top 50 counties ranked by composite_score for "young adult residential SUD"?
33. Top 20 MSAs ranked by composite_score for "outpatient adolescent therapy (IOP/PHP)"?
34. For each of the top 10 composite-score opportunities, list: (a) top 3 operators already there, (b) workforce wage growth, (c) most recent policy event, (d) closest open SAM.gov opportunity.

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Acceptance criteria: When the BHI layer is live and all Phase A sources are ingested, a user should be able to run SQL or ask the Brain's natural-language interface these 34 questions and get a grounded answer with citations to the underlying bhi_* tables.