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May 14, 2024
Getting the right care at the right time helps to avoid costly surgeries

More than half of adults in the United States have a musculoskeletal (MSK) condition of the spine, shoulder, hip, or knee. Many also have behavioral health or other chronic conditions, which are often interconnected with MSK conditions. Finding and getting the right treatment can be complex, which means that MSK conditions can spiral, causing poor health outcomes and increased costs for employers.

Cigna Healthcare is shaping a new standard of care for MSK conditions by guiding customers to the right care at the right time across their MSK journey. Cigna Pathwell Bone & Joint, which is fully integrated with Cigna Healthcare Solutions, brings together state-of-the art predictive models, personalized guidance, expansive networks, customized support, clinical expertise, and a guided digital experience to empower members to take charge of their health – which reduces unnecessary surgeries and other procedures.

Cigna Healthcare’s research shows that MSK patients with integrated medical, pharmacy, and behavioral benefits experience:

  • 133% lower rate of surgeries in an inpatient setting
  • 16% of non-surgical procedures, such as injections and biopsies, avoided because they were unnecessary

Connecting the dots and leading the way

Cigna Pathwell Bone & Joint’s condition-specific care program reaches out to and engages with patients in a number of ways.

Identify: Advanced predictive analytics identify customers at risk for spine, knee, hip, or shoulder surgery up to a year in advance. We proactively reach out to encourage enrollment in the Pathwell Bone & Joint program, which enables us to help arrange proper support before the pain can lead to more severe consequences.

Engage: We help customers take greater control of their MSK pain with our guided digital experience. Powered by an intelligence engine that uses insights and evidence-based guidelines, the digital experience provides personalized activities, assessments, expert content, treatment guidance support, care navigation tools, and more, all customized for each member.

Personalize:  A dedicated clinical care advocate works one-on-one with each customer via digital messaging or by phone. The advocates customize the program based on insights, assessment responses, and the customer’s unique needs, while guiding, motivating, and encouraging success.

Guide: When additional care is needed, we connect customers with the right type of provider, with in-person and virtual options, and help to optimize available benefits.

*Cost Share can be as low as $0/100% to the customer, program participation requirements must be met, deductible then cost share applies for HSA plans. Applies when using Pathwell Bone & Joint designated surgeons. Other high-performing in-network provider options available with standard in-network benefit coverage. High-performing providers are providers and facilities that meet our quality and cost efficiency standards.

Guiding to the right path

When surgery is the optimal treatment, customers are guided to a designated board- and fellowship-certified surgeon who meets our care and quality standards, including: 

  • Has received advanced training in specific bone and joint conditions
  • Performs a specified number of surgeries or more per year, ensuring their skills are up to date
  • Has above-average surgery results with fewer complications, compared to national standards
  • Is part of our $0 surgery benefit

When our evidence-based care guidelines indicate that the optimal treatment path should be more conservative than surgery, customers are guided to the resources that will help them most, such as physical therapy, pain management, or lifestyle support. Providers who support these treatments are available in person and virtually.

To learn how you can improve employee health and lower costs through health coverage backed by Cigna Healthcare’s suite of preventive, holistic solutions, visit cigna.com/better or contact your broker or representative today.

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