Avalon Healthcare Solutions Launches
Medical Specialty Drug Real-Time Clinical Claim Editing
TAMPA, Fla. (October 28, 2019) – The first comprehensive Lab Benefit Manager (LBM), Avalon
Healthcare Solutions (Avalon), backed by Francisco Partners, Echo Health Ventures, and leading
BlueCross BlueShield plans launches new medical specialty drug benefit management software, which tackles the fastest growing component of healthcare costs and a leading concern for payers. The software at the heart of Avalon’s medical benefit management offerings has been applied to
outpatient laboratory services, saving health plans 8 to 12 percent of outpatient lab spend. Avalon
has now launched a second module to provide clinical claims editing for medical specialty
drugs. Avalon’s Medical Benefit Management Software (MBMS) can configure a health plan’s
policies and edits covering excessive units, vial optimization, off-label usage, and more. “Pharmacy costs represent approximately 20 percent of our healthcare spend. Specialty drugs are
projected to make up more than 50 percent of costs in 2019. Approximately half of the specialty
drug spend is processed under the medical benefit. Prior authorization is a valuable tool, but not
enough to manage the volume and utilization of medical specialty drugs effectively,” said Dr. Bill
Kerr, Chief Executive Officer at Avalon. “Avalon’s MBMS is cloud-based, connects to health
plans’ claim processing systems, provides real-time clinical editing and savings.” About Avalon Healthcare Solutions
Avalon is a healthcare information technology company focused on medical benefit management.
Avalon currently provides two modules: a comprehensive laboratory program to facilitate the
management of all outpatient laboratory services, across all providers, and a medical specialty
drug clinical claims editing module. Both drive considerable savings for health plans and
individuals by automating existing plan policy adherence. In addition, an independent Clinical
Advisory Board has developed a suite of evidence-based laboratory policies addressing all lab
testing categories. The majority of these policies impact high-volume, low-cost services, and are
administered through Avalon’s real-time Medical Benefit Management Software (MBMS). For
more information about Avalon, please visit www.avalonhcs.com.
Media Contact:
Barry S. Davis
Avalon Healthcare Solutions – Chief Growth Officer
813.751.3809
Barry.Davis@Avalonhcs.com