Company: UPMC Health Plan, Pittsburgh, PA
Company Description: UPMC Health Plan is among the nation's fastest-growing health plans. It is owned by UPMC, a world-renowned health care provider. The UPMC Insurance Services Division offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services to over 3.6 million members.
Nomination Category: Customer Service & Call Center Awards Team Categories
Nomination Sub Category: Back-Office Customer Service Team of the Year - Other Service Industries
 Nomination Title: Doing the Right Thing
- Which will you submit for your nomination in this category, a video of up to five (5) minutes, explaining the achievements since July 1, 2020 of the nominated team, OR written answers to the questions? (Choose one):
Written answers to the questions
- If you are submitting a video of up to five (5) minutes in length, provide the URL of the video here, OR attach it to your entry via the "Add Attachments, Videos, or Links to This Entry" link above, through which you may also upload a copy of your video. If you are submitting written answers to the questions for this category, provide them in the spaces below.
- Briefly describe the nominated team: its history and past performance (up to 200 words):
Total 197 words used.
UPMC Health Plan is committed to delivering the highest quality and excellence, so every patient gets the right care, in the right way, at the right time, every time. We are ranked highly by the National Committee of Quality Assurance (NCQA); three of our Commercial plans earned 5-star ratings. Our Medicare Advantage Health Plans were recognized by U.S. News & World Report as one of the best Medicare Advantage plans in Pennsylvania and our HMO & PPO plans earned CMS 5-star ratings. We believe World Class Services, our overarching value, starts with our Enrollment & Coordination of Benefits (COB) teams.
Doing things right ensures members get the critical access to care that they need when they need it. Whether filling a sick child’s prescription or obtaining a potentially lifesaving mammogram, our teams get it right. To us, our work is not just “back-office”; it’s someone’s life, and how we care for it can make a difference.
Key Business Results:
- Consistently maintaining KPIs, meeting performance guarantees, and adhering to state/federal regulations while experiencing YOY membership growth
- $1B+ in Medical/Pharmacy COB Savings (2022)
- Operational Excellence & Continuous Process Improvement ($8.9M annual savings)
- Strong Employee Retention & Engagement
- Outline the team's achievements since July 1 2020 that you wish to bring to the judges' attention (up to 250 words):
Total 250 words used.
Focusing on excellence & innovation, we consistently achieve outstanding results:
- Supporting our expansion of Out of Network care, Enrollment developed and implemented databases to ensure consistently accurate membership data and access to care, ultimately reducing enrollment data discrepancies by over 33%!
- Trending calls to our back-office Enrollment Help Desk, we recognized an opportunity to improve internal self-service among Member Services, Clinical, and Pharmacy teams. By sharing key training and tools and partnering with Call Center Strategy & IT teams to improve system views, we reduced Help Desk calls by 13%!
- Implementing Agile Methodology and using Microsoft Power BI & Power App technology, Enrollment Experts/Analysts across teams developed and deployed new views and tools to support employee experiences, increase visibility of quality outcomes to drive change, and translate Enrollment/COB data into meaningful information to drive strategic organizational business decisions.
- Partnering with UPMC IT Developers, Enrollment optimized the EmployerPlace portal, reducing manual steps, improving accuracy, and ultimately increasing process efficiency by 26.5%!
- Workforce Management efforts to improve workbin management, deploy interdepartmental work distribution, reducing manual work through Smart QA strategies, and creating an inventory/staffing forecasting model has resulted in many efficiencies, including a 45% reduction in Returned Mail inventory!
- Streamlining the Group Non-Pay Termination process, over 7,000 records were automatically reinstated with no lapse in coverage, ultimately improving the process for Enrollment and our Account Management and Member Services partners.
- Focusing on vendor data management in 2022 resulted in several key process improvements resulting a seamless experience for our membership.
- Reference any attachments of supporting materials throughout this nomination and how they provide evidence of the claims you have made in this nomination (up to 250 words):
- Explain why the achievements you have highlighted are unique or significant. If possible compare the achievements to the performance of other players in your industry and/or to the team's past performance (up to 250 words):
Total 245 words used.
We know our success is a direct result of our team members’ care, compassion, and overall engagement. Post COVID employee turnover is a real challenge for all industries; however, our Enrollment/COB teams have a retention rate of 90.8%, an improvement of 4.36% (2021/2022, 257 employees). Our average employee tenure is over 5 years and 39% of them received a promotion in 2022! Focusing on people delivers a cost savings of ~$382k annually; clearly an illustration of our commitment to our people!
By taking care of our team members first, they take care of our members! Through this thought leadership, we recruit, train, and retain team members who truly care about the work they do and the people they serve. Key 2022 Accomplishments to support this include:
- NEW Peer Interviews and Employee Coaching models
- NEW Peer Mentoring Program for Leaders
- NEW Analyst Mentoring Program
- Robust onboarding & Career Path Opportunities
- Remote Work & Flexible Scheduling
- Focus on Individual Mental Health & Well Being
- Creating Connection Opportunities in a Virtual World
- Consistently Celebrating Success & Growth
By focusing on the people first, and leading from our hearts, we have achieved outstanding operational results. This is evidenced by Sherlock Reports, an independent organization who evaluates Health Plan administrative cost performance. According to the 2022 Report, UPMC Health Plan Enrollment & COB Services operates 21.5% more efficiently than the average benchmark as compared to other plans.
At UPMC, it is our People who set us apart!
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