Do you—or does know someone you know—suffer from back, knee, shoulder or hip pain?

Then you know it can range from dull to debilitating. People with chronic musculoskeletal (MSK) conditions may live in fear of injury, pain, missing work, or missing out on time with friends and family. And many see surgery at the end of the road.

Treating back pain without breaking the bank 

Musculoskeletal conditions affect more than 50% of Americans aged 18 and over¹ leading to an annual US spend of $505 billion on MSK treatment.²

Evernorth research found³ that many of the costs stem from ineffective forms of care such as:  

• Avoidable surgeries
• Poorly timed advanced imaging, including MRIs and CT scans
• Overuse of opioid and other controlled substances
• Lack of coordination between providers  

These costs may be avoidable. Patients whose plans give them the right guidance can find the treatment appropriate for them. That’s where the right solution comes in.

Predicting bone and joint problems before they start

Cigna Pathwell Bone & Joint^®, a condition-specific program, leverages advanced predictive models and adaptive AI to identify, with a high degree of accuracy, members at an elevated risk for MSK surgeries up to a year in advance.^4,5

The program guides members with spine, knee, hip, and shoulder conditions to the right path for care, one that can help them avoid or delay risky surgery. In fact, there is a $9,000 savings opportunity in average MSK surgical procedure costs when guiding members to providers who meet Cigna Healthcare’s quality standards.⁶

That’s one reason it is better by design. 

Avoiding risky surgery

People with MSK conditions often turn to surgery to ease their pain. But surgery may prove ineffective. And in many cases, can be avoided. Here’s how the plan can help: 

1. Focus on prevention. It’s key to avoiding the long-term pain and costs of chronic MSK conditions.
2. Prioritize emotional well-being. When emotional pain accompanies physical pain, treatment complexity and costs increase.
3. Coordinate care between providers and services. MSK conditions can’t be treated in isolation.

Achieving shared goals

Pathwell Bone & Joint helps each patient find and follow their unique care needs. Here’s what participants can expect:

• A care team member that offers guidance and works one-on-one with the patient to guide them through their wellness, treatment, and recovery. These live associates share their expertise as they listen, guide, and help.
• A guided digital experience based on insights and evidence-based guidelines. Patients get care through personalized activities, assessments, expert content, treatment guidance support, care navigation tools, and email reminders.
• Guidance to the right care at the right time to improve outcomes and reduce costs—goals shared by patients and their employers.  

If surgery is on the horizon …

Even when the goal is to avoid surgery, there will still be times when it’s necessary. If that happens, patients have access to designated surgeons who meet rigorous Cigna Healthcare criteria for quality, volume, outcomes, and affordability.

Surgery comes at no cost, or at low cost, to them. They also get pre- and post-surgery support, and a travel benefit (for surgery with designated provider >60 miles from home).⁷ The Pathwell Bone & Joint program has been shown to result in 25% savings per surgical episode.⁸

Here to support patients as people

People dealing with MSK conditions are suffering – and they deserve better experiences. Cigna Healthcare provides more guidance, more personalized programs, and stronger connections. That customized health care experience translates into better outcomes and lower costs.

Health care that’s better by design

Discover how Cigna Healthcare supports you in life’s ordinary and extraordinary health moments through predictive, personalized, and connected experiences.

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. Lee Hafner, Employee Benefit News. “36% of MSK surgeries are unnecessary, costing the workforce $90B”, July 2023
3. Evernorth, “Americans in Motion: The Total Cost of Managing Musculoskeletal Conditions”, Aug. 2022.
4. Based on proprietary Cigna Healthcare algorithms, data and claims analysis to assess potential health risks. Timing and results may vary.
5. Accuracy is an overall model performance measure where the model ranks people in the right order 80% of the time.
6. Cigna Healthcare book of business analysis, 2023 Results may vary.
7. Cost share can be as low as $0 to the customer (admission through discharge), program participation requirements must be met, deductible then cost share applies for HSA plans. For non-HSA plans, the employer’s plan pays 100% of eligible expenses. 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. 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.
8. Applies to specific procedures associated with Pathwell Bone & Joint surgery benefit and designated providers. Savings ranges from 5%, 15% or 25% varying by market and procedure. Subject to change.