Blue Cross NC, Avalon Healthcare Solutions Collaboration Yields $112 Million in Cost Savings, Quality Improvements for Lab Services

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has found success in delivering cost savings in another area of health care – laboratory services. The company, working with Avalon Healthcare Solutions, a leading lab benefits manager, generated $112 million in cost savings and quality improvements for Blue Cross NC members in 2020 by better managing lab services.

The cost savings go together with improved health outcomes through the reduction of inappropriate lab testing and better adherence to clinical guidelines.

Blue Cross NC’s agreement with Avalon, in place since 2017, has led to improvements in lab services in three areas

• Network: The use of labs within the Blue Cross NC provider network now stands at 99% of all lab services, up from 86% before the company’s agreement with Avalon.
• Medical policy: Avalon’s program provides greater clarity and automation for providers to follow clinically accepted, peer-reviewed guidelines for lab services.
• Utilization management: Providers use the Avalon pre-service approval system – designed for provider ease of use – to help ensure lab services are appropriate and covered.

For further details, read the press release.