Avalon Healthcare Solutions Launches Medical Specialty Drug Real-Time Clinical Claim Editing

Oct 28, 2019 at 09:29 am by pj

TAMPA, Fla., -- 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 Benefits Management services 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 represents 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 benefits 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.