Company: UPMC Health Plan, Pittsburgh, PA
Company Description: UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania, is owned by the University of Pittsburgh Medical Center (UPMC), a world-renowned health care provider. An integrated health care delivery system, we are committed to providing our members better health, more financial security, and peace of mind. Our provider network includes 140 hospitals and 29,000+ physicians, serving 4M Members.
Nomination Category: Customer Service & Call Center Awards Achievement Categories
Nomination Sub Category: Achievement in Customer Experience
 Nomination Title: UPMC Health Plan 2023
- 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):
Total 234 words used.
In our supporting documentation, we provide a sampling of the tools and reporting options we have applied over the past year to ensure the voice of the member is heard and acted upon. Our survey data is one of our main priorities and we are constantly looking at new innovative ways to capture, analyze and put feedback into action to enhance the member’s experience. Surveys used are shown on slides 10-17.
To enhance the member’s experience, we also rely on the voice of our concierges who interact with our members daily. Slides 18-19, we feature the tool created internally to effectively collect team members’ feedback. The Trend Tracker and Bright Idea Tool have been instrumental in helping to collect necessary data to address the concern our concierges hear from our members.
Slides 20-21, reflect how we have worked to enhance our members web experience. With these changes we have empowered our members to self-serve based on their health insurance needs.
Slides 22-25, share how we use our speech analytics tool and all the hard work our team puts into creating our World Class Call Score. It also showcases the value we put on the voice of the member and their experience in every interaction.
We are proud of the enhancements and process improvements we have made and cannot wait to see how utilizing the voice of the member helps our organization continue to thrive.
- Briefly describe the nominated organization: its history and past performance (up to 200 words):
Total 199 words used.
UPMC Health Plan is well known for delivering world class service to our members. Since its inception in 1997, UPMC Health Plan has acquired 4+ million members and created a network that includes 140 hospitals and 29,000+ physicians. As a result of the service we provide, the Health Plan has been recognized with numerous honors and accolades throughout the years. These awards include Best in Class Contact Center award (IQPC Call Center Week), Best Large Contact Center of the Year (International Customer Management Institute (ICMI)), J.D. Power Certified Call Center, along with a Grand Stevie. UPMC Health Plan earns these awards because of the innovation and excellence it instills in the workforce as well as the communities we serve. The Health Plan partners with UPMC to deliver a unique, integrated healthcare delivery system, which enables us to provide our members the best healthcare at a reasonable cost. We are constantly working on new initiatives every day to ensure the Health Plan remains a top competitor in the industry. We focus on our people, processes, and technology to drive improvements across the organization that will guarantee our team has what they need to create a World Class Experience.
- Which will you submit for your nomination in this category, a video of up to five (5) minutes, explaining the nominated achievement since July 1, 2020, OR written answers to the questions? (Choose one):
Written answers to the questions
- Outline the nominated achievement since July 1 2020 that you wish to bring to the judges' attention (up to 250 words):
Total 250 words used.
UPMC Health Plan continuously creates innovative solutions utilizing the voice of the customer as our driving force behind all improvements. Over the past year and a half, we have changed the way we use the voice of the customer to ensure we are retaining and growing our business. We have many variations of our Member Experience Survey we use to collect data which is used to analyze our member’s experience. We collected 544,432 surveys in 2022, while achieving a 96% member satisfaction score, 98.1% for our Agent Helpfulness and 96% First call resolution.
With voice of the member being our top priority, we place a big focus on member experiences as they occur.We created and deployed a real time trend tracker for our Concierges to enter trends they are hearing on their calls/ chats. Trends are sent to management and support teams to draw immediate attention and identify a resolution to alleviate any additional negative impact to our membership and teams. Another was we do this is through our speech analytics tool. We use reporting and different verbiage or “Syntax” to identify trends and proactively implement solutions to reduce the need for other members to contact us.
With these tools capturing the voice of the member we make improvements that ensure we are providing World Class Service on every interaction. This helps us retain our membership and sell business to new members. We have a retention rate of 96% for Commercial membership and 97.13% for Medicare/SNP.
- 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.
- Explain why the achievement you have highlighted is unique or significant. If possible compare the achievement to the performance of other players in your industry and/or to the organization's past performance (up to 250 words):
Total 248 words used.
Tools we have developed and implemented over the past year have allowed us to ensure the voice of the member is our driving force. Capturing the voice of our members, we can share this data all throughout our organization. This allows us to enhance the plan benefits, while finding ways to reduce costs, and provide more value-added benefits at no cost to better the health and wellness of our members. In our recent JD Power Call Center Certification, 91% of our members indicated they would remain loyal to our UPMC Health Plan brand.
Positive changes that were made over the past year using voice of the member: Updates to our explanation of benefits to help members better understand the services they received and what their cost share is. This enhancement was called out in the 2021, JD Power Syndicated Member Study. We increased 14 points in billing and payments (EOB’s) and #1 in the region in that KPI.
Personalizing and improving our Web and Member portal to give our members more tools to self-serve. Members can proactively identify cost share for services, find and fill out forms, review available resources and chat on demand with a concierge.
Using our speech analytics tool to perform deeper dives into the voice of the member has contributed to reducing our call volume by 187,000+ which equates to a savings of over 1.1M. These improvements have had a remarkable impact on our members experience considering the complexity of members inquiries.
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