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: Business Development Awards Categories
Nomination Sub Category: Business Development Achievement of the Year - Services Industries
 Nomination Title: UPMC Health Plan Business Development Achievement of the Year
- Briefly describe the nominated organization: its history and past performance (up to 200 words):
Total 200 words used.
UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania is owned by the University of Pittsburgh Medical Center, a world-renowned health care provider. Our Member Services team is built on the foundation of providing World Class experiences to our membership of 4.1M+, including Government Products:
- Medicaid – UPMC for You
- CHIP – UPMC for Kids
- Long Term Support Services – Community Health Choices
Our contact center has 450+ concierges, annually answering 3M inbound calls, 58K chats, 20K web messages and conducting 1.1M outreach calls. Focusing on people, processes, and technology, we drive enhancements across the organization, ensuring member satisfaction. This continuous improvement mindset is key to phenomenal growth throughout our history. Our Healthcare Concierge Service offers members service beyond traditional industry standards. We take pride in ensuring our members are completely cared for each time, by delivering First Call Resolution (FCR) and have a robust service recovery program to guarantee issues are resolved. We embrace a culture of kindness and caring, hiring team members who display a passion for helping others. Engaging with our team is top priority, providing them the resources and support they need to perform their best. We are a World Class Team Providing World Class Service.
- 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, 2021, 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.
- Outline the nominated achievement since July 1 2021 that you wish to bring to the judges' attention (up to 250 words):
Total 240 words used.
State Government Program contracts require expanded language support for Complaint & Grievance hearings. We must offer members hearings for grievances and adverse benefit decisions. The need for interpretation has increased due to Pittsburgh, PA's designation as the 12th Certified Welcoming Place for Immigrants, Refugees, and New Americans in 2021. Our Complaints & Grievance department recognized an increasing demand for interpretation services, particularly for members new to the country.
Our in-house Bilingual Health Care Concierges became integral in interpreting these hearings, leveraging their familiarity with the Complaint and Grievance Hearing process. The Operational Accuracy Team developed a user-friendly application that streamlined the process to schedule Complaint and Grievance hearings in Spanish, Nepali, Arabic, Russian, and French utilizing our internal Bilingual Team. This approach has significantly enhanced the hearing review process, ensuring a positive experience for both members and employees.
Since its launch in February 2022, the application has helped facilitate over 338 hearings in five languages. Noteworthy improvements include, Members have interpreters who are familiar with the organization and health care terminology, this increased our member satisfaction and efficiency of the overall hearing process and user-friendly scheduling of internal interpreters. This initiative not only showcases our commitment to improving the member experience but also highlights successful collaboration between departments, reducing wait times and dropped calls. With our government contract covering a significant membership, the success of this in-house solution is evident, particularly in addressing the language needs of our Nepali-speaking members.
- 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 248 words used.
Our Business Development Achievement in adhering to our Government Program Contracts is outlined in the attached Powerpoint.
- Slides 2-4 show range of products available, our Mission Statement, and Our Values. Slide 3 includes a video testimonial from a member about our plan. The Video on slide 4 illustrates how we prioritize and care for our members, bringing our mission and values to life in a meaningful and impactful way.
- Slide 5 provide an overview of key performance metrics from the year 2023.
- Slides 6-8 Describes Membership Growth in State Government Products.
- Slide 9 Provides certification information on Pittsburgh, Pa being named a Welcoming City for all of us to call Home.
- Slides 10-13 Details NCQA and Health Plan Accreditation requirements and Star Ratings.
- Slides 14-19 Illustrates an opportunity that was identified and how our internal solution was developed by the Operational Accuracy Team to schedule and manage interpretation requests for hearings.
- Slide 20 Presents the total hearings and the languages that our Bilingual Team assisted our members in 2022 and 2023.
- Side 21 Highlights comments from our Complaints and Grievances Department regarding our Bilingual Team and how it has improved the hearing experience for our members.
- Slide 22-23 provides an overview of performance metrics from the year 2023 for our internal Bilingual Team and their After Call Survey Comments.
- Slides 24-27 Presents our online multilingual resources and publications.
- Slide 28 A Testament to our company’s values from one of our Bilingual Healthcare Conciergesthat assists with our Hearing Interpretations.
- 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 250 words used.
This requirement is in lockstep with our values of creating an Inclusive and welcoming experience for our members. Our Bilingual team answered 71,484 calls in the past year with an Average Speed to Answer of 30 seconds. We take pride that our Spanish speaking members have rated the service with us at 94% and First Call Resolution at 96.9%. Aligned with our organizational goals of delivering world-class service, we identified an opportunity within our diverse structure to assist this population, particularly those on state-provided insurance plans. We have expanded our broadband media to include different languages, including our website and additional Multicultural Communications/Member Resources.
Department of Human Services, DHS, Government Contracts mandate NCQA Health Plan Accreditation, offering a framework for quality improvement measurements and gap analysis alignment. UPMC Health Plan, a leader in health equity, applied for and earned NCQA Health Equity Accreditation Plus, addressing social drivers of health and providing translation and interpretation services. UPMC is among nine organizations achieving both Health Equity Accreditation and Health Equity Accreditation Plus. We have earned 4.5 Stars with NCQA and are the top-rated Medicaid Plan in Pennsylvania with the largest Market Share for CHIP and Medicaid.
Our Government program products have earned $15.2B in revenue with $2.5B in ROI in 2023. Our Community Health Choices achieved highest member satisfaction scores among Pennsylvania competitors by 5+ points with 90.5% Overall Satisfaction, and in the 95th percentile for Medicaid plans nationally. CHIP has grown by 40.22%, 2023.
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