Musculoskeletal (MSK) conditions are a leading driver of disability and health care costs. But for employers, the problem doesn't stop there: Chronic pain is deeply connected to behavioral health issues such as anxiety, depression, and substance use disorders, all of which can lead to absenteeism, decreased workforce productivity, and compounding costs for businesses.

This perfect storm of poor physical health, poor mental health, and substance use can be found in every industry, but it's especially acute in construction, manufacturing, and other occupations that require intense physical work. In fact, construction workers have substance use rates that are nearly double the national average, often to deal with physical pain. And the risk of opioid use disorder (OUD) is especially high with work-related musculoskeletal disorders (WMSD), which are common in construction and related industries.

Employers, regardless of industry, must work to address physical health in conjunction with mental health, prioritizing solutions and engagement strategies that go beyond an immediate pain or injury. Proactive, holistic strategies that enable personalized MSK care, together with easy-to-access mental health support, can help improve health outcomes and lower medical costs.

Preventing the downstream impacts of MSK conditions

While acute injury treatment and long-term recovery support are crucial for those already navigating chronic pain, prevention is critical to addressing MSK issues before they become chronic – and costly.

"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, the health services division of The Cigna Group. "It comes down to offering more opportunities and ways for people to reach out for help, whether that's over the phone or virtually, and getting resources to them in a way that they're comfortable with."

Employers should consider how their work environment may be contributing to MSK conditions, mental health issues, and substance use. For example, the Centers for Disease Control and Prevention found that the social, organizational, and managerial aspects of the workplace environment affect worker’s feelings, attitudes, behaviors, and physiology. While the impact of these workplace features is somewhat abstract and often not easy to observe, they can result in negative physical or mental health impacts.

Furthermore, chronic stress – in any type of work, not just construction – can increase the risk of mental and physical health issues, from high blood pressure and diabetes, to exhaustion, depression and anxiety. All of this impacts a business' health, too.

With a solid understanding of the health challenges employees are facing, businesses can provide benefits tailored to the stresses and demands of their workers and their industry, with a focus on prevention and personalization.

Cigna Healthcare supports this approach with a suite of solutions that cover the full patient journey. Cigna Healthcare’s Pathwell Bone & Joint is the first line of defense against MSK issues, providing condition-specific care that guides employees with spine, hip, knee, or shoulder pain to the optimal treatment path for their needs. Leveraging state-of-the-art predictive models, we combine medical, behavioral, and pharmacy data to proactively identify optimal interventions across the MSK journey — identifying customers at risk for surgery up to a year in advance. Personalized guidance, expansive networks, and digital navigation tools empower customers to take charge of their health, resulting in better clinical outcomes, increased productivity, and lower total medical costs.

Rounding out our holistic coverage is Cigna Total Behavioral Health, an integrated solution that includes inpatient and outpatient case management; a full suite of specialty coaching and support programs (including substance use disorder, opioid and pain management); personalized navigation assistance to affordable and convenient virtual care options; and follow-up with every customer to ensure lasting behavioral change.

"We've got models that can tell us who's at risk of an overdose, who we should reach out to and engage with sooner rather than waiting for something to happen later or somebody to reach out," says Dr. Nemecek. "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."

Injury treatment and long-term support for substance use

Despite best efforts, prevention is not always enough. This is especially true when dealing with invisible health issues like substance use, or in workplaces that neglect to address stigmas associated with mental health treatment alongside chronic pain management.

Employees with MSK conditions often face a disconnected care experience. People with these conditions should receive personalized and coordinated care; MSK conditions cannot be treated in isolation. When emotional pain — including behavioral health conditions and substance use disorders from overuse of prescription opioids — accompany physical pain, treatment complexity and costs increase. Moreover, research from the American Journal of Public Health that tracked opioid prescribing trends among construction workers over a seven-year period found that the odds of a worker taking prescription opioids more than doubled if the worker also had an MSK injury.

When MSK issues do occur, there are several benefits employers can put in place to connect employees to the right resources and lower the risk of excessive opioid use and substance use.

Pathwell Bone & Joint, as already noted, can help reduce the need for surgery, and in turn, the potential for unnecessary opioid use. Patients also receive individualized care pathways based on advanced analytics and evidence-based clinical care guidelines, as well as dedicated support from Cigna Healthcare care advocates.

Our integration of medical and pharmacy benefits also enables real-time data collection to monitor, measure, and manage opioid use by:

• Limiting opioid coverage to a predetermined number of days
• Stepping in with first-time user education and controls
• Reducing quantity on hand and reviews for appropriate use through utilization management (UM)
• Deploying behavioral health experts quickly to support individuals in need
• Collaborating with network providers to monitor treatment, taper use, offer alternatives, and counsel patients

Finally, if an employee does develop opioid use disorder following an MSK injury or surgery, Cigna Healthcare's medication assisted treatment (MAT) program helps to reduce the risk of unintentional overdose. This includes one-on-one connections to specialized coaches with clinical expertise in opioids and co-existing behavioral and medical conditions like chronic pain.

Treating the whole person across the care continuum

When it comes to designing health benefits to address the needs of a modern workforce, employers need to consider the entirety of an employee's well-being – and how the collection of each individual's health adds up to organizational health and success as well.

"We know that when someone is not emotionally healthy, whether that's because of chronic pain or substance use, or another mental health concern, they're not as productive, they don't make good decisions, they aren't as connected to the work they do – and all of those things impact business results,” Dr. Nemecek said. "Making sure we address behavioral health issues for employees means we'll get them to be more productive, engaged, and connected, empowering them to drive better business outcomes."

The complex web of interactions between physical and behavioral health, especially when it comes to MSK conditions and substance use disorders, can only be untangled through a personalized, holistic approach. Learn more about how to tailor integrated benefits for your workforce by contacting your Cigna Healthcare representative or broker today.

*2023, American Addiction Centers

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