Musculoskeletal (MSK) conditions are a leading driver of health care costs. But the issues they represent go beyond financial expenses. Chronic pain is closely connected to mental health issues such as anxiety and depression, which can lead to absenteeism and decreased workforce productivity – and which, in turn, can compound health care costs.
According to Evernorth, the health services division of The Cigna Group, MSK conditions affect more than 1-in-2 adults and cost our health care system an estimated $420 billion annually — more than any other chronic condition.
People trying to manage painful MSK conditions often are on a fragmented and complicated journey, which may result in a variety of issues that profoundly impact cost:
- Receiving unnecessary, poorly timed, and costly advanced imaging including MRIs and CT scans
- Visiting lower-value sites of care or providers
- Lacking coordination across their care journey
- Overusing opioids and other controlled substances
- Undergoing avoidable and/or preventable MSK surgeries
Studies and data suggest that this ripple effect of inflated costs and ineffective treatments can lead to 25% to 40% waste in MSK care spend.
Preventing the ripple effect from MSK conditions
While treating acute injuries and providing long-term support during recovery are crucial when patients are navigating chronic pain, prevention is critical to addressing MSK issues before they become chronic – and costly.
People with these conditions should receive personalized and coordinated care; MSK conditions cannot be treated in isolation. When emotional pain accompanies physical pain, treatment complexity and costs increase.
“It is absolutely important to address issues as soon as possible and not let them become more severe,” said Dr. Douglas Nemecek, chief medical officer of Behavioral Health at Evernorth.
For employers looking to get ahead of the issue – a business necessity for many organizations – a passive approach to MSK conditions will not work. “Our predictive models can tell us who we should reach out to and engage with sooner, before problems get severe and become a crisis,” Dr. Nemecek said. “Using data and algorithms to identify people at risk and providing multiple opportunities to best engage them in a way that meets their personal needs and preferences will ultimately optimize their health outcomes from a clinical perspective.”
Condition-specific care
Cigna Pathwell Bone & Joint, a condition-specific care program, is our evidence-based, coordinated, and personalized approach to MSK care. Predictive models and data analytics allow for early identification and intervention. These models continually review member data to predict a likely health-related occurrence, such as surgery. Further, they can identify members at increased risk for knee, back, or hip surgeries as early as a year in advance, with 75% to 93% accuracy. Employees receive information, access, and guidance to personalized care at the right time – and often avoid surgery as a result.
Pathwell Bone & Joint creates an individualized care path grounded in evidence-based clinical care guidelines. Members can expect:
- A trusted care advocate who offers clinical guidance and works one-on-one with the patient to tailor a personalized care path and guide them through their wellness, treatment, and recovery journey.
- A guided digital experience that uses insights and evidence-based guidelines to create a unique experience for each member. The digital experience provides personalized activities, assessments, expert content, treatment guidance support, care navigation tools, and even email reminders to help members to stay engaged.
- Guidance to the right care at the right time for better outcomes. Earlier diagnosis means members can avoid unnecessary surgery and benefit from less invasive options, such as physical therapy. If surgery is necessary, they will have access to orthopedic surgeons and neurosurgeons who meet rigorous Cigna Healthcare criteria on quality, volume, outcomes, and affordability. The care program includes zero-cost or low-cost surgery, pre- and post-surgery support, and a travel benefit (for surgery with designated provider >60 miles from home. Amount varies based on factors such as treatment plan, location and duration of facility stay and are subject to program participation requirements).
“When each person gets connected to the right resources as early as possible, they can stay engaged in the right care,” Dr. Nemecek said. “That’s how we optimize health outcomes.”
Don’t let chronic pain impact the health of your business
With a challenge as complex as addressing the perfect storm of MSK conditions and mental health issues, your employees deserve a more predictive, connected, and customized health care experience that translates into positive outcomes and lower health care costs. Cigna Healthcare can be a consultative partner with you, leveraging our innovative benefit designs, best-in-class analytics, health engagement teams, and our dedication to treating each employee as a unique individual.
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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