Accenture developed a cloud-based platform for Avalon Healthcare Solutions to optimize lab management and reduce unnecessary lab expenditures for health payers. The solution, a Claims Editor as a Service (CEaaS) hosted on AWS, processes up to 150,000 claims per hour with high accuracy and quick response times. This system facilitates real-time claim processing, supports scalability, and provides analytics for minimizing redundant lab tests.

1. Avalon: Providing
cloud-based lab reviews
at lightning speed

2. Overview

3. Accenture built a first-of-its-kind
platform on the public cloud for
Avalon Healthcare Solutions,
helping payers reduce
unnecessary lab spend
while maintaining
quality care.
Copyright © 2016 Accenture All rights reserved.

4. Client profile

5. Copyright © 2016 Accenture All rights reserved.
Avalon Healthcare
Solutions
• Laboratory benefit management
Company founded in 2013
• Headquartered in Tampa, Florida
• Helps health payers manage the
cost and effective use of diagnostic
lab tests
• Assesses lab charges within end-to-
end claims review process

6. 6
Project
objectives

7. Avalon sought to accelerate service
delivery using a cloud solution
Chose Accenture for:
Copyright © 2016 Accenture All rights reserved.
Deep knowledge of
the healthcare
industry
Technology skills Cloud-based
solutions
Partnership with
Amazon Web
Services (AWS)
through Accenture
AWS Business
Group (AABG)

8. Copyright © 2016 Accenture All rights reserved. 1. The Health Insurance Portability and Accountability Act (HIPAA) took effect in 2003.
AWS cloud has history of
secure operations, essential for
complying with health privacy
guidelines.1

9. 9
Opportunity

10. Copyright © 2016 Accenture All rights reserved. 2. G2 Intelligence 2010; Francisco Partners analysis.
In the U.S.,
8+ billion lab tests
performed annually
30+ percent
overused or unnecessary2
Initially, Accenture helped Avalon
weigh go-to-market options
Avalon chose cloud-based platform vs. high cost
of building infrastructure in-house

11. Solution

12. Copyright © 2016 Accenture All rights reserved.
AABG supported in
the architecture and
build of a 100-
percent cloud-based
Claims Editor as a
Service (CEaaS)
Accenture clinicians
assisted in the
development of 130+
laboratory policies
Business rules/
algorithms were
developed for
real-time claim
processing
New portals were
built for Avalon’s
customers to access
data, claims and
prior authorization

13. Copyright © 2016 Accenture All rights reserved. 2. G2 Intelligence 2010; Francisco Partners analysis.
AWS’s elasticity
supports rapid
onboarding of health
plans and claims
volume

14. Results

15. Copyright © 2016 Accenture All rights reserved.
Claims Editor as a Service (CEaaS)
cloud-based solution hosted on AWS
Edits up to 150,000
claims per hour
99 percent uptime and 99.5
percent accuracy
Response time per claim
averages less than a
second: 856 milliseconds

16. Copyright © 2016 Accenture All rights reserved.
Flexible: scales as demand
grows for Avalon’s services
Future proof: Easy to update
based on changing insurer
policies, research findings,
regulations

17. Analytics
capabilities

18. Copyright © 2016 Accenture All rights reserved.
Claims Editor as a
Service (CEaaS)
has built-in advanced
analytics
Avalon can mine
data for statistical
analysis based on
findings from clinical
research
Important as new lab
tests and treatments
emerge
Analytic Insights help
Avalon’s customers
save by minimizing
unnecessary lab
tests

19. Copyright © 2016 Accenture All rights reserved.
Thank you!
Related content:
Accenture AWS Business Group
Accenture Healthcare
Accenture Operations