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3 Things to Know About Cigna's New Complex Care Management Suite

Analysis  |  By Laura Beerman  
   September 30, 2022

Pathwell integrates Cigna and Evernorth capabilities to create personalized health journeys for biologics and musculoskeletal (MSK) customers.

Cigna's 2020 launch of Evernorth, its health services division, has generated multiple new products, services, and acquisitions. The newest is Pathwell, which targets high-cost specialty pharmacy and MSK conditions by linking the health plan's benefit designs and national provider networks with Evernorth's "analytics, clinical expertise, treatment planning, and personalized digital solutions."

In a press release for the announcement, Cigna SVP for U.S. solutions Heather Dlugolenski noted: "Our clients and customers are exhausted by the fragmented health care system. They want one place to go to get a personalized experience for their entire health care journey."

Touting the benefits for employer cost-control as well, Dlugolenski added: "Cigna Pathwell connects customers with the providers and therapies that are best suited to their unique health conditions and, through our unparalleled data and expertise, can help anticipate their future needs to help them recover faster."

Here are three things to know about the new Pathwell suite.

  1. The new suite includes two products with plans to expand to new markets and conditions.

Pathwell Specialty is for patients with complex or rare conditions that require infusions or injectable medicines. Pathwell Bone & Joint targets customers with "wear and tear" MSK conditions. Cigna plans to expand the products to more U.S. commercial clients throughout 2023. The suite will continue to evolve based on this navigating a range of complex health conditions based on a "flexible blueprint for innovation to support the needs of health plans and patients."

  1. Pathwell Specialty uses a concierge approach to coordinate medical and pharmacy benefits while reducing cost of care for patients and the plan.

"Biologic medicines can be life-changing for patients, but only if they can afford them," Dr. Ajani Nimmagadda, Cigna Pharmacy CMO, said in the Pathwell announcement, adding that they "account for 65 percent of drug spending even though only four percent of Cigna customers need them."

To address these issues, Pathwell Specialty will offer concierge care management services that will link patients to the quality, affordable infusion options in a variety of settings. This will include home infusions or injections that providers order for patients via the Cigna Pathwell Specialty network.

The Pathwell Specialty expansion will include behavioral, wellness and nutritional services; telehealth visits; and extended support via the Cigna Caregiver Bridge Program.

  1. Pathwell Bone & Joint addresses less acute MSK conditions to prevent high-cost surgeries.

A recent study from the Evernorth Research Institute found the following:

  • Nearly 25% of people seek care for strains and sprains.
  • These injuries represent nearly 66% of MSK utilization and spend.
  • Better approaches to intervention and care coordination can reduce that spend up to 40%.

Like Pathwell Specialty, Pathwell Bone & Joint combines Cigna provider networks and plans with Evernorth's tech capabilities—specifically its digital navigation and advanced predictive analytics capabilities to predict surgery risk and prevent it if possible. If surgery is required, Cigna benefits include "low or zero cost for surgery from admission through discharge."

That can anticipate a surgery up to a year in advance, create a holistic, integrated musculoskeletal solution that will improve health outcomes while reducing unnecessary surgeries which can lead to increased costs.

Laura Beerman is a contributing writer for HealthLeaders.

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