UPMC Health Plan, Pittsburgh, PA

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Company: UPMC Health Plan, Pittsburgh, PA
Company Description: UPMC Health Plan, the second-largest health insurer in western Pennsylvania, is owned by UPMC, an integrated global health enterprise. Our products and services are utilized by nearly 2.3 million members. Our local provider network includes UPMC as well as community providers, totaling more than 125 hospitals and more than 11,500 physicians throughout Pennsylvania and other close regions.
Nomination Category: Customer Service & Call Center Awards Team Categories
Nomination Sub Category: Contact Center of the Year (Over 100 Seats) - Other Service Industries

Nomination Title: UPMC Health Plan Contact Center

Tell the story about what this nominated contact center achieved since the beginning of July 2013 (up to 650 words). Focus on specific accomplishments, and relate these accomplishments to past performance or industry norms. Be sure to mention obstacles overcome, innovations or discoveries made, and outcomes:

Please see the nomination form attached to assist with the supporting attachments, videos, etc...

UPMC Health Plan would like to be considered for the Contact Center of the Year. UPMC Health Plan is a regional health insurance plan with 1.2 million members in Western Pennsylvania. We pride ourself on having the leading value as Service Excellence. We strive to achieve this every day at every level with our contact center as the “heart” of our organization. We work continuously to improve every customer (member) contact as well as companywide processes to improve the customer experience in order to be a leader in our market. Kim Cepullio, Vice President of Sales said, “Our customers tell us all the time what excellent and personalized service they receive. For our company it is a huge selling differentiator.” At UPMC Health Plan, we do not only exceed industry contact center metrics (average speed of answer, abandoned call rate, call quality), we focus on providing “high touch” customer service and on the Voice of the Customer and Voice of the Employee.

We have a Health Care Concierge program that provides personalized and proactive service to members emphasizing access to care and helping them to live healthier lives. Each member is assigned a personal Healthcare Concierge.

Each concierge is trained to provide first call resolution, going above and beyond, by reaching out to healthcare providers for any claim issues, schedule appointments, assist in transferring medical records, facilitate prior authorizations, proactively share personal preventive care needs, and follow up in every way. Our Medicare Advantage member retention rate is 97%, above the industry average.

We continue to improve our program by leveraging technology and streamline processes, examples including:

• Custom CRM screen links the member to their health care concierge and provides personalized contact information to build a stronger customer connection
• Sophisticated call routing to the designated personal concierge based on the caller ID
• Minimal use of IVR allows for streamlined access to a live representative
• Personalized welcome letter and magnet; including concierge name
• Linkage to clinical gaps in care to support preventive care needs
• Outbound Birthday calls and Birthday cards to every member

We continually solicit customer feedback. Five times annually, an external third party completes a member survey. Where we do not score well, we analyze the data to identify root cause, then create and deploy an action plan to solve all problems. We then conduct outreach to the member for service recovery. We also utilize an after call survey (33% completion rate), which solicits feedback on every interaction; both voice and online chat, to determine customer satisfaction and first call resolution rate (FCR rate is 95%). Both initiatives support improvement efforts not only tied to the contact center but for our entire organization.

We strongly believe that customer satisfaction is tied to employee satisfaction. We work hard to build an engaged workforce. Our contact center had a 93% participation rate and an 81% engagement index when surveyed in April 2014. We continually strive to retain our top employees, and have done so by implementing a career path program in addition to many employee engagement initiatives. Our current employee turnover rate is 10.28%. Examples of initiatives include:

• Employee focus group feedback sharing accomplishments and improvement areas with Senior Leadership
• Open door policy, manage by walking around, and Senior Leadership rounding
• Monthly team meetings, department wide meetings quarterly with chief operating officer
• High level of recognition and rewards program
• Monthly career path meeting conducted with all staff
• Weekly coaching focused on growth and development
• Employee Satisfaction Survey twice annually targeting employee feedback and improvement areas
• Chief Operating Officer communicate to Board of Directors on department strategies and successes

At UPMC Health Plan, we are committed to a Service Excellence by deploying a robust comprehensive set of strategies targeting continuous process improvement, soliciting customer and employee feedback, and leveraging technology.

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