Unlock Meaningful Savings Beyond Traditional Cost Containment

Helping Horizon Improve Affordability Through Smarter Lab Management

Trusted by 25+ Blue Cross Blue Shield plans nationwide

90M+ Members | 10–20% Outpatient Lab Savings | Proven BCBSA FEP Innovation Partner

As healthcare costs continue to rise, Horizon has an opportunity to improve affordability by managing laboratory utilization—not just unit costs. Avalon helps health plans reduce unnecessary routine testing through evidence-based lab guidance, intelligent automation, and a provider-centric approach, while providing a foundation for broader diagnostic management across routine and genetic testing.

Our premier solution, Routine Test Management (RTM), simplifies the determination of coverage criteria and reduces unnecessary utilization of high-volume, low-cost laboratory tests while preserving access to care.

Watch On Demand – Driving Lab Excellence for BCBS Plans: Proven Strategies for Cost Savings & Clinical Impact

Hear directly from Avalon and Blue Cross Blue Shield Association Federal Employee Program leaders discussing: FEP pilot outcomes, BCBS success stories, and proven lab management strategies.

Why Blue Plans Choose Avalon

Trusted by Blues plans across the country, Avalon combines laboratory science, policy enforcement automation, and proven outcomes to help health plans reduce waste, improve quality, and deliver measurable savings.

Trusted at National Scale

Supporting 25+ BCBS plans and 90M+ members, Avalon brings unmatched experience and a proven track record of helping Blues plans and many of the nation’s largest payers improve affordability across Commercial, Medicare, Medicaid, and FEP.

Deliver Savings Beyond Unit Costs

Managing unit costs alone doesn’t solve the lab spend problem. Avalon reduces unnecessary utilization through evidence-based laboratory guidance, delivering 10–20% savings in outpatient labs while preserving a positive member and provider experience.

Science-Driven Laboratory Management

130+ evidence-based laboratory policies, an independent Clinical Advisory Board, and patented policy enforcement automation to ensure appropriate lab testing—not simply payment and coding edits.

Minimize Provider Friction

Our approach emphasizes transparency, education, and clinical collaboration to help providers navigate testing requirements with minimal disruption while reducing unnecessary testing.

Flexible. Low-Lift Implementation.

Avalon’s solutions can be tailored to Horizon’s unique business objectives. Designed to complement existing network and payment integrity strategies with flexible implementation and minimal operational disruption.

How can Avalon transform your lab data into actionable insights?

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Proven Through BCBS Association FEP Innovation

Selected by the BCBS Association Federal Employee Program (FEP) to support innovation pilots focused on advancing laboratory management through technology-driven solutions.

FEP Innovation Highlights

BCBS Association-validated savings of $5.3M+ across participating Blue plans

Routine and Genetic Test Management pilots demonstrating measurable impact

Innovation supporting evidence-based laboratory stewardship and appropriate testing

Proven model for scalable laboratory management across Blue plans

Demonstrated Results and Lab Expertise You can Trust

20,000+ laboratory tests covered under rigorously researched policies

More than 10 years of validated outcomes

Ongoing clinical policy research and maintenance

Proven ability to reduce unnecessary routine testing while supporting quality care

Expanding Value Through Genetic Test Management

While routine laboratory testing remains a significant opportunity for cost optimization, Horizon may also benefit from enhanced oversight of rapidly growing genetic testing utilization.
Avalon’s Genetic Test Management solution complements Routine Test Management by helping ensure genetic testing is clinically appropriate, evidence-based, and aligned with established medical necessity criteria.
Together, these programs help health plans establish a comprehensive laboratory benefits strategy that improves affordability while supporting high-quality patient care.

Let’s Explore What’s Possible for Horizon

Avalon can help Horizon reduce unnecessary laboratory spending, improve transparency, support providers, and strengthen affordability initiatives through a flexible, evidence-based approach to laboratory management.

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