Cigna is launching a new concierge care platform that aims to harness both the strengths of its health plan and its sister company, Evernorth.
The new offering, called Pathwell, integrates Evernorth's data analytics, clinical expertise and digital solutions with the medical benefits and network of its health plan with the goal of providing a personalized, comprehensive care experience for members who are managing high-cost conditions. Pathwell will first target patients with musculoskeletal conditions and patients who take injectable or infused biologic drugs.
The Cigna team expects to build Pathwell out to other conditions in the future. The solution is now available in many U.S. commercial plans and will grow over the course of 2023.
Shawna Dodds, vice president of product development at Cigna, told Fierce Healthcare that combining the powers of the health plan and Evernorth allows the insurer to offer the choices members need to take charge of managing their own conditions.
"It's combining the strategic assets that exist across those two companies to really bring the integrated experience to the consumer," she said.
For patients who enroll in Cigna Pathwell Specialty, they will be connected with convenient, quality and affordable options for drug infusions through Cigna's provider network. Their treating physician still directs their care and can order infusion services from participating hospitals, infusion centers and doctors' offices as well as at home when possible. Doctors can also order injectable or infusion specialty drugs directly from an in-network Pathwell specialty pharmacy, Cigna said.
The insurer plans to expand this program to offer other services to patients using injectable biologics, such as behavioral health, nutrition and virtual visits. Members' caregivers can also access supports through Cigna's Caregiver Bridge program.
Pathwell Bone & Joint connects patients to Cigna's provider network as well as personalized benefit designs, physical therapy options both virtually and in person, behavioral health and peer support. Through Evernorth's analytics, the insurer said it can predict potential surgeries up to a year in advance, and the offering is designed to offer holistic care while also decreasing unnecessary surgeries that can drive up costs.
When surgery is necessary, the members' benefits will cover the procedure at low to no cost from admission to discharge, Cigna said.
Dodds told Fierce that specialty pharmacy and musculoskeletal conditions were a logical starting point for Pathwell as they're both major areas of cost concern from employers and plan sponsors. She said the two topics "continuously cropped up" in conversations with Cigna clients.
Specialty pharmacy, for example, can at times be covered under the member's pharmacy benefit and in other scenarios be covered under the medical benefit, she said. Costs related to specialty drugs are on the rise, and there's no shortage of new specialty therapies coming through the drug development pipeline.
Musculoskeletal, meanwhile, is a high-cost area where a significant number of patients are using low-value care that drives up spend.
Dodds said the Cigna team is eyeing other areas for expansion for Pathwell and is considering other conditions that have significant costs attached to them or are highly variable in their associated costs, such as oncology and kidney disease. They are also weighing ways to manage the overlap between high-cost chronic conditions for patients who have more than one need.
"It's all about helping the customer make the right choices in managing their condition," she said.