The Cigna Group · NYSE:CI
The Cigna — Veritas Collaborative — Investor Presentation (April 2013)
34 slides from The Cigna's investor presentation, April 2013
Slide 1: A Specialty Behavioral Health Hospital for Young People & Center of Excellence for Eating Disorders
A Specialty Behavioral Health Hospital for Young People & Center of Excellence for the Treatment of Eating Disorders Chase Bannister, MDIV, MSW, LCSW, CEDS Accredited by The Joint Commission Vice President & Chief Clinical Officer
Slide 2: Forward Together – Toward Informed Consumership of Eating Disorder Care
forward together – toward informed consumership of eating disorder care Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 3: Moi.
Moi. • Certified Eating Disorders Specialist (CEDS) • Clinical Training • Duke University Counseling & Psychological Services Eating Disorders & Body Image Concern Treatment Team • Duke University Medical Center Infectious Disease & Chronic Illness • Founding Clinician of residential eating disorder
Slide 4: My Father's Wisdom
My Father’s Wisdom “…Well, I suppose ya don’t know what ya don’t know. But once ya finally know thatcha don’t know what ya need to know, and ya know ya oughtta know it—then get to knowin’ it. That’s what I know.” Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 5: Upon Being a Rogerian
Upon Being a Rogerian • Humanistic Psychology • Often considered “Father” of Client– Centered approach to care • “[Rogers] consistently stood for an empirical evaluation of psychotherapy. He and his followers have demonstrated a humanistic approach to conducting therapy and a scientific approach to
Slide 6: Upon Being a Roger(s)ian
Upon Being a Roger(s)ian “I’ve always wanted to have a neighbor just like you.” — FMR Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 7: Saint Rogers of the Neighborhood
Saint Rogers of the Neighborhood • Importance of trust • Intensive study/mentoring in child psychology • Feelings – “Mentionable & Manageable” • “…as well as you can…” Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 8: Where Clinicians Hang their Hats
Where Clinicians Hang their Hats [Virtually] every person licensed to “hang a shingle” is beholden to some ethos of care • Psychologists – APA Code of Ethics • Nutritionists/Dietitians – AND Code of Ethics • Medical Providers – First, Do No Harm • Educators/Guidance Counselors – NEA Code of Ethics ‘
Slide 9: The National Association of Social Workers – Code of Ethics
The National Association of Social Workers – Code of Ethics “The mission of the social work profession is rooted in a set of core values. service social justice dignity and worth of the person importance of human relationships integrity competence Core values, and the principles that flow from them,
Slide 10: A Classification of All Animals
A Classification of All Animals* • Those that belong to the emperor • Those that are included in this classification • Embalmed ones • Those that tremble as if they were mad • Those that are trained • Innumerable ones • Suckling pigs • Those drawn with a very fine camel hair brus • Mermaids (or Sire
Slide 11: A Classification of All Therapies
A Classification of All Therapies* • Cognitive Behavioral • Family Systems • Rational Emotive • Play Therapy • Dialectical Behavior • Psychodrama • Psychodynamic • Gestalt • Psychoanalytic • Narrative • Humanistic • Solution-Focused • Existential • Transpersonal • Somatic • Interpersonal Process • A
Slide 12: Competence
Competence •Let’s air a common naïveté: “All mental health providers (or primary care physicians, nutritionists, psychiatrists) have training in eating disorders.” •Not about malicious intent! •Subspecialties and strengths Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Office
Slide 13: Breaking News – Clinicians Aren't Unicorns
Breaking News – Clinicians Aren’t Unicorns Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 14: ...But Sometimes We Think we Are!
…But Sometimes We Think we Are! In a 2012 study, mental health providers were asked to (a) compare their own overall clinical skill and performance to others in their profession, and (b) indicate the percentage of their clients who improved, remained the same, or deteriorated as a result of treatmen
Slide 15: Naked Emperors
Naked Emperors Results? •Nearly a third of respondents placed themselves at 90th percentile or above. •Zero respondents placed themselves at or below the 50th percentile. •Compared to peer-reviewed literature on clinical outcomes on patients, clinicians • overestimated improvement & • underestimated
Slide 16: Folie a Deux
Folie a Deux (A2) The clinician’s belief in her/his treatment, & (+ B2) The patient’s faith in his/her clinician exert (= C2) A “mutually reinforcing effect.” Skrabanek & McCormick (1998) Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 17: A Few (of many) Great Minds...
A Few (of many) Great Minds… "Although no one can yet say for certain, new science is offering tantalizing clues. Doctors now compare anorexia to alcoholism and depression, potentially fatal diseases that may be set off by environmental factors such as stress or trauma, but have their roots in a com
Slide 18: With So Much at Stake...
With So Much at Stake… Eating disorders are the most lethal of all psychiatric illnesses. The mortality rate for persons with eating disorders is 12+ times that of their peers. The suicide rate is 19+ times. • 20% of eating disordered persons will die prematurely as a result of their illness. • The
Slide 19: ...Being an Informed Consumer is a MUST
…Being an Informed Consumer is a MUST Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 20: Rights of People with Eating Disorders & Carers
Rights of People with Eating Disorders & Carers Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 21: Evidence-Based Practice Guidelines
Evidence-Based Practice Guidelines Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 22: Evidence-based Treatments
Evidence-based Treatments • Dialectical Behavior Therapy • Mindfulness/Mentalization/Flexibility • Family Based Therapy for children & adolescents without severe medical complications – first line • Cognitive Behavioral Therapy • Psychotropic Interventions (limited) Chase Bannister, MDIV, MSW, LCSW,
Slide 23: Evidence-Based Practice Guidelines
Evidence-Based Practice Guidelines ACADEMY FOR EATING DISORDERS CLINICAL PRACTICE RECOMMENDATIONS FOR RESIDENTIAL AND INPATIENT EATING DISORDER PROGRAMS Release date: November 2012 The purpose of these guidelines is to promote high quality residential and inpatient treatment for eating disorders. Sp
Slide 24: Some things you may want to ask about
Some things you may want to ask about For Outpatient Providers For Higher Levels of Care •Certifications/Credentials •Facility license(s) •Training(s)/Modalities • Hospital? Residential? •License to Practice •Training(s)/Modalities used •Experience with EDs •Provisions for medical care, if needed •%
Slide 25: Some things you may want to ask about
Some things you may want to ask about Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 26: Conceptualizing Adequate Care
Conceptualizing Adequate Care • The “Revolving Door” is expensive, particularly to bodies • At least 50% of patients discharged from inpatient care before weight restoring readmit for further inpatient treatment. • Adequate care key to avoiding immediate relapse and readmission • “Patients discharge
Slide 27: Multi-disciplinary Approach
Multi-disciplinary Approach Multi-disciplinary interventions • Psychiatry • Internal Medicine • Psychotherapy & Family Therapy • Dietetics/Nutrition • Specialized Psychiatric/Med Nursing More and more we’re aware that eating disorders are likely biologically mediated mental illnesses (sometimes call
Slide 28: Central Coherence & Set Shifting
Central Coherence & Set Shifting Control Subject Brain Anorexic Brain • fMRI imaging shows diminished activity in the pre-frontal cortex in persons with anorexia as tasks become more complicated – Kaye et al, Int J Eat Disord 2011; 44:1–8 • Set-shifting & executive functioning deficits (Treasure, Ka
Slide 29: Receiving Care from Credentialed Providers
Receiving Care from Credentialed Providers • CEDS Certified Eating Disorder Specialist • CEDRD Certified Eating Disorder Registered Dietitian • CEDRN Certified Eating Disorder Registered Nurse www.iaedp.com Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 30: Caveats!
Caveats! First, Much is happening, and we still need more data. •Ask questions of providers about the evidence provided •Be a careful consumer of the concept of ‘success rates’ •Not everyone lives in areas with reasonable access to specialty providers or multidisciplinary teams •The therapeutic conn
Slide 31: Being Resourced
Being Resourced www.feast-ed.org www.nationaleatingdisorders.org www.normal-life.org Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 32: Being Advocates
Being Advocates www.eatingdisorderscoalition.org Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 33: If you will permit me
If you will permit me Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Slide 34: Questions or Comments?
Questions or Comments? (I probably talked the whole time). Chase Bannister, MDIV, MSW, LCSW, CEDS Vice President & Chief Clinical Officer
Veritas Collaborative — Investor Presentation (April 2013) on 6ix