Rate sheets don't tell the whole story.
In this episode, Alex Yarijanian breaks down the 8-indicator playbook he uses to evaluate any tele-behavioral health market before committing capital — and names the specific states he'd enter today and why.
Most operators default to the biggest states: California, Texas, Florida, New York. But population size alone is one of the weakest predictors of a winning market. The real levers live in parity law enforcement, workforce economics, MCO concentration, and infrastructure readiness.
WHAT YOU'LL LEARN
• Why the biggest states are rarely the best markets for tele-behavioral health
• The 8 indicators that separate win-win markets from cheap-rate mirages
• How to build a weighted scoring model before entering a new market
• What associate-level billing eligibility does to your workforce margins
• How MCO concentration affects contracting speed and rate-cut risk
• Which states Alex rates as best all-around, high-risk, and growth-stage bets
THE 8 MARKET INDICATORS
1. Medicaid market size: Total addressable population and realistic capture potential
2. Payment parity: State-level mental health parity laws and strength of enforcement
3. Cost of living index: The single best proxy for labor margin on clinical staff
4. Associate-level billing: Whether licensed associates can bill independently
5. HRSA HPSA demand mapping: Documented unmet need in mental health shortage areas
6. Broadband & 5G coverage: Infrastructure required for reliable telehealth delivery
7. MCO landscape: Plan count, behavioral carve-outs, any-willing-provider law exposure
8. Tax & corporate climate: State-level business environment and regulatory posture
MARKET ARCHETYPES
• Best all-around: Arizona, Nebraska, Delaware, Oregon
• Volume, thin margins: Arkansas, North Dakota
• High rate, high cost niche: Alaska
• Growth stage bets: New Mexico, Montana
4 ACTION STEPS
1. Build a scroll scoring model — layer all 8 indicators into a weighted scorecard
2. Validate demand on the ground — overlay HRSA HPSA maps + FCC broadband gap data
3. Check your plan mix — count Medicaid MCOs and behavioral carve-outs
4. Run a payroll stress test — model cost of living vs. your target clinician pay band
RESOURCES MENTIONED
• HRSA Mental Health HPSA maps: data.hrsa.gov
• FCC broadband coverage maps: broadbandmap.fcc.gov
• NCSL mental health parity law tracker
• Licensure compact maps: PSYPACT, ASWB Compact, Nurse Licensure Compact State Medicaid rate databases
