Discounts Don’t Equal Savings

Our solutions provide real value and deliver proven savings of 10–20% on outpatient lab spend to over 30 health plans serving more than 44 million members.

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Fee schedule discounts are insufficient to manage lab spend and combat lab practices such as volume-shifting, cost-masking, and generic code utilization, which obscure test intent and complexity, weaken claim defense. As an independent laboratory benefit management partner, we assist health plans and lab partners in delivering appropriate testing, strong clinical justification, and evidence-based utilization, which reduce waste, enhance claim defensibility, and ensure testing aligns seamlessly with payer policies.

Connect with us to learn how we’re transforming lab management to better serve health plans, providers, and members alike.

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Partner With Trusted Lab Stewards

Avalon stewards care by elevating quality, transparency, and independence while removing waste and delivering demonstrated savings.

Enforcement Based on Science

Medical necessity is essential to laboratory stewardship programs and compliance with the OIG mandate. Our programs enhance compliance efforts by ensuring appropriate test ordering for medical necessity, improving quality, and reducing cost. 

Preventative Care Integration

Avalon policies follow evidence-based practices and national guidelines, such as OIG, Choosing Wisely, and ASCP guidelines, ensuring that wellness testing is clinically appropriate.

Fully Transparent

Avalon policies are reviewed by our independent Clinical Advisory Board. Avalon’s health plan clients have full control over the adoption and adaptation of policies, including variances.

Provider-Friendly Tools

Avalon supports ordering providers via education, policy visibility, and defensible, evidence-based edits. Denials are justified and based on the health plans’ adopted policies. Reconsideration/appeal rates for Avalon programs are low <.01%.

Myths vs Facts

Myth: LBMs are not driving provider behavior change

Fact: Avalon supports ordering providers via education, policy visibility, and defensible, evidence-based edits. Ordering providers and patients are not impacted and reconsideration/appeal rates for Avalon programs are very low (<.01%.). Proven savings demonstrate behavior change impact- ~7.6% averted costs on average POS 81 with savings 10-20% for outpatient lab spend.

Fact: Avalon’s science-based policies, developed with lab expertise and an independent Clinical Advisory Board, cover over 20,000 lab tests. Our health plan clients retain full control over the adoption and adaptation of policies, including variances.

Fact: Avalon’s science-based policies, developed with lab expertise and an independent Clinical Advisory Board, cover over 20,000 lab tests. Our health plan clients retain full control over the adoption and adaptation of policies, including variances.

Fact: Avalon’s science-based policies, developed with lab expertise and an independent Clinical Advisory Board, cover over 20,000 lab tests. Our health plan clients retain full control over the adoption and adaptation of policies, including variances.

Fact: Avalon’s science-based policies, developed with lab expertise and an independent Clinical Advisory Board, cover over 20,000 lab tests. Our health plan clients retain full control over the adoption and adaptation of policies, including variances.

Fact: Avalon’s science-based policies, developed with lab expertise and an independent Clinical Advisory Board, cover over 20,000 lab tests. Our health plan clients retain full control over the adoption and adaptation of policies, including variances.

Strategic and Effective LBM partners

Avalon transforms lab management into measurable, value-based care using a scalable, science-driven frameworks that unlock the full value of diagnostic intelligence. Unlike other “lab stewardship” programs, our solutions provide tools and critical insights to take back control from lab-owned management programs.

Evidence-Based Science that Delivers Results

  • 20,000+ lab tests covered under rigorously researched policies
  • Ongoing in-house clinical policy research to ensure medical relevance and integrity
  • Over 10 years of validated outcomes

Lab Expertise You Can Trust

  • Dedicated MDs and PhDs with lab-specific expertise
  • Independent Clinical Advisory Board with 140+ years of combined experience
  • Science- and data-driven policy decisions

Technology That Drives Affordability

  • Patented, cloud-based SaaS platform managing 18M+ claims monthly
  • Dynamic management of 1M+ edits/client
  • Seamless integration for high-impact, low-disruption results
  • Dynamic, scalable, and secure – designed to grow with your needs

Resources, Education & Insights