Turning policy into
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.
Our Approach
Technology-enabled consulting that does work.
First we learn, then we build
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.
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.
LastMile RCM is a product of The Health Co-Lab, LLC, a Service-Disabled Veteran-Owned Small Business.