Avalon Health Management

Avalon Healthcare Solutions, founded in 2013 and headquartered in Tampa, Florida, operates as a healthcare information technology and medical benefits management company. The company was co-founded by Bill Kerr, who currently serves as CEO, alongside Adam Boehler and Ezra Perlman of Francisco Partners. Kerr's background includes an MD and an MBA, with a strategic interest in leveraging lab data to influence health plan operations, while Boehler had experience in companies managing lab billing. Their collaboration was financed by Francisco Partners, a private equity firm, after securing Blue Cross Blue Shield of South Carolina as their first client.

The firm's business is centered on laboratory benefits management (LBM), providing a platform for health insurance plans, physicians, and patients. It targets the outpatient laboratory services market, aiming to manage testing utilization and control costs for its health plan clients. Revenue is generated by offering services that automate the enforcement of health plan policies for lab testing, which the company states saves clients 7 to 12 percent on outpatient lab expenditures. Its client base consists of healthcare payers, with whom it partners to manage lab services for over 39 million members.

Avalon's core product is a comprehensive program for managing outpatient laboratory services, including routine and genetic testing. The platform uses a suite of science-based laboratory policies, developed and reviewed by an independent Clinical Advisory Board, to guide testing decisions. Key features include technology-driven clinical claim editing and utilization management to reduce inappropriate testing and ensure adherence to evidence-based medical science. This process involves digitizing lab results to provide real-time, actionable insights that help health plans manage costs and improve clinical outcomes by ensuring the right tests are performed at the appropriate times.

Keywords: laboratory benefits management, LBM, health information technology, medical benefits management, diagnostic testing management, health plan solutions, outpatient lab services, genetic testing management, clinical claim editing, value-driven care