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Jul 7, 2023
A guided approach to musculoskeletal condition care improves health outcomes and lowers costs

Quick Take

  • MSK conditions are the top driver of chronic condition health care spend for U.S. employers.
  • MSK care is typically uncoordinated and confusing, leading to wasted spending.
  • A more guided approach to care can have a significant impact on outcomes and costs.

More than half of American adults suffer from musculoskeletal (MSK) issues, and more than 1 in 5 miss work due to these conditions. They are the leading cause of chronic pain and of disability and greatly impact quality of life and work performance. As such, musculoskeletal conditions are the No. 1 driver of chronic condition health care spend for American employers.

“Musculoskeletal conditions are a major health issue for employees and employers, as managing these conditions and the costs of treatment have been long-time challenges,” said Dr. David Mino, national medical director of orthopedic surgery and spinal disorders at Cigna Healthcare. “A more guided approach to musculoskeletal condition care can have a significant impact on health outcomes and lower costs.”

This guided approach is central to Cigna Pathwell Bone & Joint, an enhanced condition-specific care program designed to help people easily navigate through the most appropriate and efficient treatment plan for their specific musculoskeletal condition throughout their treatment journey. The program uses advanced data and clinical expertise to develop a guided, personalized digital experience that connects patients to designated high-quality, cost-effective providers who help them gain better control of their conditions, alongside surgery and travel benefits if needed — which makes a tremendous difference in health and financial outcomes, for both the employee and the employer.

The patient-centered program supports employees across the continuum, helping them with health literacy to make informed decisions as they navigate their condition, treatment, and healthcare systems — ultimately helping to enable a healthier workforce for businesses. Low health literacy costs U.S. employers almost $5 billion annually, and almost 36% of adults in the U.S. have low health literacy.

We sat down with Dr. Mino to better understand the workplace issues around musculoskeletal conditions and how the Cigna Pathwell Bone & Joint program can benefit employers and their employees.

What should employers know about the impact musculoskeletal conditions have on their business?

Musculoskeletal issues can affect many types of businesses, not just the ones involving physical labor and repetitive physical tasks such as manufacturing and construction. People who work in jobs where they have to stand all day, like retail or food services, or sit all day behind a desk or a computer are also prone to develop joint pain and musculoskeletal conditions.

More than half of adults have a musculoskeletal condition, which can have a significant impact on employer costs. Research from Evernorth shows that these conditions accounted for $420 billion in health care spending in 2018 — more than any other class of chronic condition.

Musculoskeletal conditions can be excruciating, and they are the most frequent reason people are absent from work. In addition to the costs employers face due to absenteeism, lost productivity can be an issue when chronic pain affects an employee’s ability to work.

What is driving most of these costs?

The key issue is the fragmented care system. People with MSK conditions face a disconnected and uncoordinated care experience. This can lead to confusion about where they need to go for help, who they should see, and what kind of help they need. Patients spend a lot of time trying to better understand their condition and treatment options, which hinders early MSK detection and intervention.

Research has also found a connection between MSK conditions and mental health, which also can drive up health care costs and impact productivity. Our research has found that costs are 66% higher for our customers diagnosed with an MSK issue and an associated behavioral health condition than for customers with MSK who do not also have a behavioral condition.

Overtreatment also drives up costs. In fact, 25% to 40% of MSK care spend is wasted on inappropriate or ineffective treatments.

How does the Cigna Pathwell Bone & Joint program help employers and employees?

Cigna Pathwell Bone & Joint aims to help people with a musculoskeletal condition of the spine, shoulder, hip, or knee get on the right treatment path, reduce unnecessary surgeries, and reduce employer spend. The program uses data and analytics to identify the most appropriate individualized plan based on the employee’s specific condition and utilizes evidence-based clinical guidelines.

Advanced predictive analytics models help detect people who are at risk of preventable musculoskeletal conditions so we can support them early, before those conditions become more painful and more expensive to treat. The care plans are designed to guide people to the care that will provide the most long-term value in improving their health and workplace productivity, including physical therapy, chiropractic treatment, and pain management support. In some cases, the plan may involve opioid prevention and management. Surgery is considered only when absolutely necessary.

Cigna Pathwell Bone & Joint provides each employee with streamlined digital-first clinical navigation supported by a dedicated clinical care advocate, who is a licensed nurse or physical therapist. As the employee’s single point of contact, the care advocate works one-on-one with the employee to develop a personalized care plan, which includes screening for behavioral health issues and lifestyle management concerns, leveraging existing benefits to ensure people have the support they need. As part of this process, the care advocate helps them understand their treatment and provider options, guides them through the care plan, and offers care guidance and support every step of the way to keep them motivated and engaged.

Patients also have access to a personalized digital experience where they can learn more about their specific condition and treatment. They can also complete assessments and other personalized activities that support their care plan. This results in a powerful approach to customer care that combines clinical expertise, coordinated support, and intuitive digital tools to empower employees to take charge of their health.

Cigna Pathwell Bone & Joint connects people living with MSK conditions to the treatment they need as quickly as possible and continuously guides them on the path to manage their conditions so they can be more healthy and productive at work. The early identification and interventions driven by our predictive analytics prevents inappropriate treatment and wasted money. Combined with a designated provider network, the program reduces total cost of care, with savings of up to 25% off the market average per MSK surgical episode, according to an internal analysis of claims data.

Cigna Pathwell Bone & Joint is one more way Cigna Healthcare delivers value to our clients by addressing employee health challenges in order to improve clinical outcomes, increase workforce productivity, and lower total medical costs.

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