When our providers go above and beyond to ensure quality care for patients, they also often help pass along cost savings to our members and employer groups. Recently one provider at a local Louis & Clark medical equipment & supply store did just that.

Health New England had been working with a Be Healthy^TM member with a spinal cord injury who is paraplegic. Upon being discharged from his rehab facility, the member was given a prescription for a type of expensive catheter that is not normally ordered. MassHealth allows one catheter per day (or 30 per month) and the prescription was written for six per day (or 180 per month).

That’s when Wally at Footit at Louis & Clark stepped in. Recognizing that the member had no clinical documentation for the nurse practitioner who ordered this catheter type, Wally questioned the medical necessity behind the order. He made multiple attempts to try to contact the provider for a clinical note and eventually took it upon himself to research different types of cost effective catheters and found six different alternatives.

In the meantime, a request was made to the member’s PCP for a nurse to go into the home to observe and educate the member on use of the catheter. After learning that the nurse was not scheduled to enter the member’ home for a week after the request was made, Wally personally drove to the member’s home (with his permission) and dropped off the catheters and the end of the business day.

By helping the member bring his catheter order from 180 down to 30 per month, Wally helped ensure proper care, effective use and approximately $8,000 in cost savings.

Health New England thanks Wally and Louis & Clark for helping our member!