Help them get back to better. Cigna Pathwell Bone & Joint
More than one in two adults have a musculoskeletal (MSK) condition of the spine, shoulder, hip or knee. 1 Behavioral and other chronic conditions are often connected. Add the confusion of what to do and it’s no wonder that MSK conditions can add up to poor health outcomes and increased costs for employers. 2 Cigna Pathwell Bone & Joint ® , a Condition-Specific Care program, helps members with spine, hip, knee or shoulder pain get on the right treatment path, reduce unnecessary surgeries and reduce your organization’s spend. Members will have access to designated providers who meet quality and cost criteria, a clinical navigation experience supported by a Clinical Care Advocate, 3 and benefit design that rewards them for optimal choices in their care.
Getting ahead of high costs. Using advanced predictive analytics, we can identify members at risk for spine, knee, hip or shoulder surgery up to a year in advance 4 and proactively reach out to encourage enrollment in the Pathwell Bone & Joint program for support along their care journey. Engaging and empowering. We help members take greater control of their MSK pain with our guided digital experience. Powered by an intelligence engine 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 more. Personalized guidance and support. A dedicated Clinical Care Advocate will work one-on-one with your members via digital messaging or over the phone. Based on insights and assessment responses, they will customize the program to each member's unique needs, while guiding, motivating and encouraging their success.
Guiding to the right care at the right time. When care is needed, we help members get connected with the right provider – both in-person and virtual options, and help optimize available benefits. Members are also connected to available programs that support their medical, behavioral or lifestyle needs throughout their MSK journey. Providing a surgery benefit. If faced with surgery, members will work with a Benefit Specialist to understand the program benefits and to get access to designated orthopedic surgeons and neurosurgeons that meet rigorous Cigna Healthcare SM affordability and quality, volume and clinical outcomes criteria. The benefit includes zero- or low-cost surgery, 5 pre- and post-surgery support, and a travel benefit when applicable. 6
All sources and disclosures appear at the end of this document
Offered by Cigna Health and Life Insurance Company
980852 a 08/24
You’ll be happy with the outcomes. Cigna Pathwell Bone & Joint helps members get on the right treatment path, reduce unnecessary surgeries and reduce your organization’s spend. Seamless customer experience. Leveraging advanced data and analytics, our proactive approach helps deliver better outcomes. Lower total medical costs. Our clinical expertise and care guidance support help to reduce the need for unnecessary interventions. Reduce unnecessary surgery. By addressing your members’ whole health and offering behavioral screenings, physical therapy, and pre- and post- surgery support, we can reduce unnecessary procedures and mitigate costs. Increased productivity.
And best of all, improved quality of life for your members. Members with MSK conditions account for: # 1
2.4 x higher cost than MSK cost
61% higher spend with patients who have MSK and an identified behavioral health condition 8
chronic condition spend category 7
alone for MSK patients who have a substance abuse disorder 8
Start creating healthier growth by helping your members feel their best. Contact your Cigna Healthcare Representative to learn more about Cigna Pathwell Bone & Joint.
1. Clinically Speaking: The Health Care Total Cost of Musculoskeletal Conditions, Evernorth August 2022. https://www.evernorth.com/articles/clinically-speaking-health-care-total-cost-musculoskeletal-conditions. 2. Cigna Healthcare News and Insights.“Relieving the Burden of Musculoskeletal Conditions.”https://newsroom.cigna.com/relieving-the-burden-of-musculoskeletal-conditions?elqTrackId=e080f26e 5ba14c03ae1e3b0eadb4e342&elq=cd1f69328c564c999ab88d8f46cb3751&elqaid=43585&elqat=1&elqCampaignId=40298. Cigna Healthcare, 2024. 3. Clinical Care Advocates are nurses and physical therapists holding a current licensure in a minimum of one state but do not practice nursing or physical therapy or provide medical advice in any capacity as a care advocate. 4. Based on proprietary Cigna Healthcare algorithms, data and claims analysis to assess potential health risks. Timing and results may vary. 5. When program participation requirements are met for covered surgeries. For non-HSA plans, the employer’s plan pays 100% of eligible expenses. For HSA plans, plan pays 100% after deductible is met. 6. 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. 7. Cigna Healthcare book of business 2022 analysis for 2021 full-year medical and pharmacy claims. Subject to change. 8. Cigna Healthcare 2023 study of risk adjusted total medical costs by behavioral health and chronic condition using claims based on 12 month period for 1/1/2022–12/31/2022 for customers with continuous medical, pharmacy and behavioral eligibility. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, contact a Cigna Healthcare representative. All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company (CHLIC) (Bloomfield, CT) and Evernorth Behavioral Health, Inc., Evernorth Health Services or their affiliates. In Utah, all products and services are provided by Cigna Health and Life Insurance Company (Bloomfield, CT). Policy forms: OK – HP-APP-1 et al., OR – HP-POL38 02-13, TN – HP-POL43/HC-CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN). 980852 a 08/24 © 2024 Cigna Healthcare. Some content provided under license.
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