Fifty million Americans live with chronic pain and almost 40% of these individuals report experiencing high-impact chronic pain that interferes with daily life or work activities. With these numbers on the rise year-over-year, Cigna is focused on finding solutions that identify at-risk individuals and intervene early.
Two Cigna experts on chronic pain, Dr. David Mino, national medical director of orthopedic surgery and spinal disorders, and Shawna Dodds, vice president of product development, discuss how employers can better support employees to overcome musculoskeletal (MSK) pain. MSK conditions are those impacting the bones, joints, nerves and muscles.
1. What challenges exist when it comes to MSK care, and how is Cigna approaching solutions to help address those challenges?
Dr. David Mino: With the prevalence of MSK conditions on the rise over the past two decades – especially for those ages 45 to 64 – it is important to identify individuals at risk, intervene early and change the course of this rising trend.
From an employer perspective, workers with MSK conditions lose an average of 10 days of work and have more lost work days than those with any other major health condition.
We also know that individuals with acute and chronic pain experience significant challenges in obtaining adequate care, resulting in profound physical, emotional and societal costs. MSK conditions are often accompanied by weight issues, depression and anxiety, which can exacerbate pain. Depression increases the severity and intensity of pain, and chronic musculoskeletal pain increases the risk for depression..
At Cigna, we take a proactive approach to help people get the care they need. We are creating an evidence-based path, and have developed workflows that help deliver better health outcomes and decrease the costs and risks related to a fragmented approach to managing chronic pain.
2. What Cigna programs help employers keep their employees healthy and keep MSK costs down?
Shawna Dodds: Our approach begins before an acute injury occurs and stays with people throughout their health journey. We use predictive analytics to identify customers at risk of hip, knee and back surgery up to a year in advance. Through new virtual and digital physical therapy programs and bundled payments we are able to help people get healthy and keep costs down. Along the way, our clinical and customer service teams help direct customers to the right care at the right time, connecting the full breadth of our capabilities to help eliminate fragmentation and curate seamless care delivery. We know health care can be challenging to navigate but our team helps take the challenge out, allowing customers to focus on their care.
Helping people manage pain effectively can also help reduce inappropriate opioid use. We support those predicted to be at risk through integrated pain management approaches, coordination of care and use of cognitive behavioral therapy.
3. Cigna recently teamed up with RecoveryOne, a digital MSK program. Can you share more on that recent collaboration and plans for the future?
Dodds: Only one in 10 people whose health could benefit from physical therapy actually get it – cost, inconvenience and lack of local availability puts this type of care out of reach for many. To help address that, Cigna Ventures began investing in RecoveryOne, a digital MSK program, in May of 2019.
RecoveryOne has traditionally worked with health care providers who prescribe a program via a doctor portal, which allows the doctor to monitor and update care plans for each patient. Cigna is the first health plan to pilot and rollout the use of RecoveryOne as a consumer tool. We are currently in pilot with a group of large Cigna Medical clients and as of May 1, 2021 expanded RecoveryOne to include even more clients. In addition to reaching more customers, we are also enhancing the service to include video consultation with licensed physical therapists.
Why is this important? RecoveryOne's digital MSK solution aligns with our work to make health care more affordable, predictable, and simple for our clients and customers. The solution is designed to drive earlier clinical intervention and save costs over the long term. Members in the pilot have experienced 35% to 40% improvements in pain and 7% to 8% improvements in functional outcomes. It's also affordable ($0 out-of-pocket cost for customers), convenient, comprehensive, and personalized. RecoveryOne combines the power of digital with human touch by connecting people to one of 200 evidence-based care programs for MSK conditions and supporting them along their journey. The solution covers the whole person and can be accessed anytime, anywhere on nearly any device. They also plan to make this available in Spanish in 2022. With this approach, RecoveryOne addresses the significant gap between actual and desired outcomes achieved through traditional care.
4. How does virtual access play a role in helping us better serve our customers and clients?
Dr. Mino: Our goal is to create a comprehensive solution that helps our customers throughout the MSK journey, and virtual programs will allow us to create a more comprehensive approach to help our customers at a specific point in time – whether it’s the start of pain or recovery from major surgery.
With the recent dramatic and permanent shift in how we access care, and the increased desire for alternative care delivery options, we believe there is an opportunity for our virtual care partners to create a better, more simple, more affordable and more connected experience -- empowering whole person health and advocating for people along the care journey.
Customers expect more convenient care interactions, and COVID-19 has rapidly accelerated this need. Cigna is ready to answer this call.
 Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146950/.
 The Hidden Impact of Musculoskeletal Disorders on Americans, 4th Edition, The Bone and Joint Initiative USA, 2018. https://www.boneandjointburden.org/docs/BMUS%20Impact%20of%20MSK%20on%20Americans%20booklet_4th%20Edition%20(2018).pdf.
 Cigna Moment Model – internal predictive analytics evaluation 2019–2020.
 U.S. Department of Health and Human Services (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019.pdf.
 Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and Pain Comorbidity; A Literature Review. Arch Intern Med. 2003; 163(20): 2433–2445. doi:10.1001/archinte.163.20.2433.
 Cigna Opioid Epidemic Client-Broker Fact Sheet. November 2018.
 ”Medical Expenditures Panel Survey.” Agency for Healthcare Research and Quality, US Department of Health and Human Services
 This program is now available to all Cigna Medical Clients with less than 500 employees
 Based on patient reported outcomes measures captured by RecoveryOne