Turning policy into programscodereportsrules enginesapplicationsdataimprovementpractice
Whether it's a medical policy that needs to be translated into a ruleset for submitting claims, or a new federal policy your Medicaid office is trying to decipher and implement, we don't build PowerPoints, we build results.
We understand your business first, then we build what you need to succeed, whether that's a designed program, an application, a data layer, an evaluation, or just advisory services. First we learn, then we build you tools to run your business, non-profit, or government agency.
Rules, not AI
We don't use A.I. in our work, we use rules. We believe that turning policy into programs and operations is a function of correctly coded rule sets and procedures, and technology that relies on those rule sets to produce successful outcomes in a replicable and auditable manner.
Your data stays yours
We will never expose your data to artificial intelligence, and we do not integrate artificial intelligence into our products. We use AI to build, but we never put it between us and you.
Our Clients
Healthcare providers
We work with providers large and small, from nationwide networks to community health centers and community-based organizations. Anyone who provides health or wellness services and needs assistance with:
Business intelligence.We can work with your existing data to identify areas where you can improve both operations and financial sustainability.
Getting paid.We can improve your billing systems, or we can replace them with our own tool, LastMile RCM.
Serving clients.We can improve your case management or EMR system, or we can build you a custom one that sits on top of our claims tool.
Training.We can assist providers in improving things like clinical documentation or simple workflows that help alleviate the friction that drives so much negative impact across staff, clients, and patients.
Modernizing.Tell us where you need new technology development. We'll figure out if we can fix what you already have, help you switch to a different product, or build and integrate something new.
Healthcare payers
We work with managed care plans to identify and fix areas of friction, both internally and with their providers.
Prior authorization.We can assist in building tools that will streamline the prior authorization process, both for your providers and for your staff.
Claim submission.We built a claims submission technology layer that allows any provider to submit data in nearly any format and engage in a modern claiming process. We are a better office ally.
Program rollout.If you are adding a new benefit or making changes, we can assist with drafting provider manuals, identifying tools that will benefit your providers, and providing technical assistance to providers to ensure that benefit changes are not disruptive and outcomes stay the focus.
Analytics and management.We love working with large datasets to identify patterns in practice and help you optimize your networks and relationships with your providers.
Government agencies and academic institutions
As a service-disabled veteran-owned small business, we work with government agencies and universities across the country, including:
Medicaid agencies.We work directly with Medicaid agencies on policy development, managed care oversight, and analytics improvement.
Departments of Social Services.We can assist to improve case management systems operations, or work with you on developing sustainable solutions, like claiming, if you provide a service that Medicaid or Medicare pays for.
Managed care programs.We provide quality improvement oversight and External Quality Review Organization (EQRO) services over state managed care plans.
Departments of Correction.We provide utilization management services for individuals receiving care while in state custody, and we link jails and prisons to care coordination services both pre- and post-release.
Academic institutions.We have served as partners on federal research grants and in support of multi-year research and evaluation grants, both as subject matter experts and as grant managers for universities across the country.
Other services.We provide project management, analytics, technology development, and program evaluation services.
Case Studies
What turning policy into results has looked like for the people we work with.
Community Health Center: Enterprise Financial Modeling and Federal Policy Impact Analysis
Federally Qualified Health Center (eight clinical sites)
An eight-site Community Health Center serving a predominantly Medicaid and safety-net population needed to know which of its sites were financially sustainable, how much revenue federal Medicaid changes under H.R. 1 would put at risk, and whether its pharmacy program was leaving money on the table. Using five years of the health center's claims and financial data, The Health Co-Lab built an enterprise financial model that breaks performance down to the site, service line, and provider level, then layered on H.R. 1 revenue impact projections through FY 2030, a 340B pharmacy capture analysis, and a capital investment model for a potential facility expansion.
Fresno Community Health Improvement Partnership (FCHIP): Centralized Billing Operations for a Community Care Hub
Community-based Hub and Master Services Organization
FCHIP operates as a Hub for a network of Coordinating Care Agencies delivering Community Health Worker and Community Supports to Medi-Cal members across the Central Valley. The Health Co-Lab has partnered with FCHIP to expand its capabilities through the implementation of technology that lets the Hub bill on behalf of every partner in its network.
County Department of Social Services: First-Ever CalSAWS Integration for Medicaid Claiming
County government (California)
A California county Department of Social Services wanted to become an Enhanced Care Management provider under CalAIM, but its systems were built for benefit administration, not medical billing. Its case data lived in CalSAWS, the statewide eligibility system used by every California county, which has no capacity to produce a compliant claim.
New Jersey Medicaid: External Quality Review Organization (EQRO) Services
State Medicaid agency
The Health Co-Lab is part of the team delivering External Quality Review Organization services to New Jersey's Division of Medical Assistance and Health Services under a four-year engagement that began in fall 2025. Working alongside a national quality review partner, The Health Co-Lab provides subject matter expertise and analytical support for quality studies spanning the full Medicaid enterprise, including NJ FamilyCare, Managed Long Term Services and Supports (MLTSS), and Fully Integrated Dual Eligible Special Needs Plans (FIDE SNP). Study topics are set by the State based on federal, state, and waiver program requirements, and each study produces evidence the State uses to oversee and improve its managed care plans.
Tracy Community Connections Center: From No Billing Capability to a Custom Transitional Rent Platform
Community-based organization serving people experiencing homelessness
Tracy Community Connections Center (TCCC) helps individuals experiencing homelessness in California's Central Valley with daily living support and finding interim and permanent housing. CalAIM opened the door to Medi-Cal reimbursement for that work, but TCCC's legacy case management system could not support the documentation or billing that Enhanced Care Management and Community Supports require.
Nationwide Behavioral Health Provider Network: End-to-End Revenue Cycle Assessment
National behavioral health provider network, 1,500+ providers, 115 payer contracts
A nationwide behavioral health provider network with over 1,500 providers and 115 payer contracts was losing revenue and creating friction for patients and clinicians, and did not know where in the revenue cycle the problems were coming from. The Health Co-Lab conducted a systematic review from front-end eligibility verification through claims adjudication and accounts receivable recovery, examining both operations and the configuration of the network's platform stack.
CalHHS and California Department of Social Services: H.R. 1 Work Requirements Technology
State health and human services agencies
Through the generous support of various philanthropies, The Health Co-Lab has developed, on behalf of CalHHS and the California Department of Social Services, the tool that supports California's seven-county pilot for implementing the work and community engagement requirements created by H.R. 1. The pilot is one of the first state efforts in the country to address the new requirements across both Medi-Cal and CalFresh in a single coordinated approach.
Peer Professionals of California: Reentry Peer Support Model and CalAIM Provider Enablement
Peer Professionals of California (PPofCA) supports people returning to the community from incarceration. The Health Co-Lab partnered with PPofCA to design its reentry peer support service model and establish the organization as a contracted CalAIM provider. We defined a service portfolio spanning Justice-Involved Enhanced Care Management, the Housing Trio of Community Supports, Community Health Worker services, peer support, sobering centers, recuperative care, and day habilitation, and led managed care plan contracting strategy and applications across Kaiser (ILS), Molina, Community Health Group/Health Net, and Blue Shield Promise.
LastMile RCM
Simplifying the billing experience for payers, providers, and everyone else.
LastMile RCM is our claims and revenue cycle platform. It connects the case management and EMR systems providers already use to the health plans that pay them, and it runs on the same rules-first approach as the rest of our work, so policy becomes an auditable claim rather than a guess.
It is in production today as the central billing operation for a community care hub in California's Central Valley, as the claiming engine for a peer-led reentry organization, and as the first system to take data out of a county-run CalSAWS eligibility system and produce a claim a Medi-Cal managed care plan can pay.
