65 lines
4.6 KiB
Markdown
65 lines
4.6 KiB
Markdown
# 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.
|
|
|
|
---
|
|
|
|
**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.
|