Routine Test Management
How Avalon enforces evidence-based policies to reduce overuse, eliminate waste, and maintain provider alignment in routine testing.
Avalon’s Approach
Avalon turns adopted evidence-based lab policies into automated rules that enforce appropriate routine test utilization in real time.
- Applies claims-level logic to ensure tests align with coverage policies
- Automates post-service review to reduce inappropriate utilization
- Leverages evidence-based guidelines to minimize waste while preserving provider and member access
- Delivers scalable oversight through Avalon’s Diagnostics Insights Platform, ensuring consistency across millions of claims
This approach streamlines oversight, prevents waste, and supports effective, compliant test management.
Proven Impact
In one year, a high-volume regional health plan ensured 1.5M patients received the right test, improving health outcomes. The program also generated $112 million in cost savings by better managing lab services and aligning with the plan’s medical policies. Avalon’s platform identified these in real time, reducing inappropriate tests and improving provider documentation without additional admin burden.
Key Capabilities Used
- Routine Test Management Program
- Diagnostic Insights Platform
- Real-Time Claims Enforcement
Impact
- 10–20% reduction in outpatient lab spend
- $1–3 PMPM savings
- Increased policy adherence with minimal provider abrasion