Avalon Healthcare Solutions
Software & Data
Overall Rank: 316
Category: Software & Data
Category Rank: 60
- Top HealthTech Company of 2022
Avalon Healthcare Solutions, the world’s first and only Lab Insights company, is pioneering a new era of value-driven healthcare by unlocking the potential of lab values to proactively drive appropriate care and enhance clinical outcomes. Avalon is transforming the way care is delivered and reducing unnecessary lab costs by bringing together proven lab benefit management solutions, lab science expertise, digitized lab values, and proprietary analytics.
Avalon generates actional lab-driven insights in real-time at scale, helping healthcare plans (commercial, Medicaid, Medicare, and Federal) accelerate results and unleash new opportunities to achieve the Triple Aim of improving the care experience, improving the health of populations, and reducing per capita healthcare costs. Avalon also helps physicians and other providers obtain the lab tests, data, and intelligence they need to care for their patients while reducing the amount that patients and their health plans pay for unnecessary tests.
Avalon, headquartered in Tampa, FL, was co-founded in 2013 by CEO Bill Kerr, MD, and Adam Boehler. With a focus on equity and diversity, Avalon has more than 175 professionals on its team and is recognized for its workplace leadership each year through honors such as the 2022 Top Healthcare Workplace National Industry Award.
As a rapidly growing company, Avalon works with healthcare payers across the US to cover 33 million lives and deliver 7-12% outpatient lab benefit savings. In 2021, Avalon helped payers achieve $39 million in annual member out-of-pocket savings.
Avalon continues to innovate and is collaborating with Optum on a new lab benefit management solution to reduce unnecessary testing and ensure patients receive the screenings that truly inform the right care through timely diagnosis. The tool helps align lab tests with clinical guidance and automates large parts of lab benefit administration.
Avalon helps payers, providers, and patients identify the right lab test, data, and intelligence to inform the right care.
Lab Insights Platform
Avalon delivers impactful lab benefit management solutions that remove waste and abuse from lab testing, help navigate the increasing complexities of genetic testing, and assist health plans in reducing their independent network unit cost. Avalon’s independent Clinical Advisory Board creates policies defining when lab testing is clinically useful, and payers use those policies to manage testing authorization and reimbursement.
- Does apply fixed criteria and ensures consistent application of the health plan’s scientific lab policies across its member population.
- Does identify when a claim includes unnecessary tests that are not supported by science.
- Does inform patients, physicians, lab providers, and health plans as to which lab tests are within the scope of the health plan’s scientific lab policies.
- Does NOT adjudicate claims or make coverage decisions.
- Does NOT alter the physician/patient relationship or substitute a physician’s judgment.
- Does NOT mandate the use of a particular physician, lab provider, or test.
- Does NOT penalize a physician when a lab panel includes unnecessary tests.
Lab Insights Solutions
Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings. Avalon’s proprietary Lab Insights System captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down costs. The Lab Insights System, which includes Routine Test Management, Lab Values Management, and Genetic Test Management, uses proprietary analytics and evidence-based science. Avalon’s Lab Insights solutions unlock the power of lab data to provide a whole patient view of healthcare.
Specialty Pharmacy Solution
Avalon has adapted its proven automated policy enforcement lab claims editing system to apply a health plan’s medical specialty pharmacy clinical and administrative policies in real-time. The solution helps identify the pharmacy benefit claims appropriate for payment consistent with policies while preventing payment for unnecessary or wasteful drug administration.
“…our relationship [with Avalon] has resulted in significant savings for our health plan and our customers. We could not be more pleased with the results provided with the implementation of the program.” — Martha Owens Perry, Vice President – Health Care Service (Retired), BlueCross BlueShield South Carolina
“Our collaboration with Avalon has given us more insight into improving the quality and reducing the cost of lab services for our members.” – Roberta Capp, MD, chief medical officer at Blue Cross NC.