UPMC Health Plan - Contact Center of the Year

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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 the region.
Nomination Category: Customer Service & Call Center Awards Team Categories
Nomination Sub Category: Contact Center of the Year (Over 100 Seats) - All Other Industries

Nomination Title: UPMC Health Plan

Tell the story about what this nominated contact center achieved since the beginning of July 2015 (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:

Our call center team is committed to our mission statement and have deployed this through our unique and well-established Health Care Concierge program, bringing a personalized touch to serving our members. This program partners the member with a Call Center representative who acts as his or her personal guide through the complex world of health care. The concierge teams are responsible for creating an experience that drives the feeling that there is someone at UPMC Health Plan who genuinely cares about the member, and their health and well-being. The Health Care Concierges help the member quickly resolve issues, act as an advocate, and connect the member to programs and resources they may not have known about.

When the member calls, our phone system recognizes the caller ID, searches our core system for the member who has this phone number and routes the call to the personal concierge. If the concierge is not available, it will route to another concierge on the team.

This approach to the member experience is what differentiates us along with a focus on First Call Resolution and Member Experience. Our Health Care Concierges have a goal: the call does not end until the problem does which increases member satisfaction. Our Concierges feel they have made a difference, and future volumes are reduced. Our Health Care Concierge Program also features High Touch Outreach Campaigns such as welcome calls, pharmacy authorization, birthday calls featuring preventative care needs and many others. Our call center has been so strong that our marketing team is able to use this outstanding experience that we are creating to advertise our business.

We are so passionate about ensuring we handle each call in the best way that we offer every member our After Call Survey. In 2015, we created a dedicated Member Satisfaction team that focuses on FCR and service recovery.

On our survey, if the member responds “No” to the FCR question, a work item is immediately routed to a Customer Satisfaction Specialist dedicated to FCR Service Recovery. The interaction is investigated and we call the member back to service recover them. We measure how quickly we call the member back and how many we have completed, with the goal of reaching back out to the member within two hours.

The key focus of this program is on root cause and preventing the same issue moving forward. The opportunities that we find may be coaching, training, improving a process, working with another department to change; with many of the improvements reaching far beyond the contact center. These are documented and followed up on with a report out to Sr. Leadership every week.

Through this VOC program, we have established and evolved our FCR achievements over the past year. Our First Call Resolution score measured by our after call survey is 97.2%, up from 95%. As measured by SQM, we moved from 72% on FCR in 2015 to 78% in 2016, while the average call center is 71%, and average for health care is 70%.

By living out our mission in the member experiences we are creating, we have created strong loyalty, allowing us to enjoy a strong member retention of 97% (compared to 92% for other healthcare companies). With the assurance we have established through the call handling and FCR dedication, our Health Care Concierge Program has become esteemed not only at our company, but is the brand that we deliver in the market to sell our business.

Our work affords our company to be a 4.5 STAR Medicare Advantage Plan this past year, earning 5 STARS in all of the Customer Service elements. This increased our revenue reimbursement by $85M. We are also one of seventeen contact centers that have achieved a JD Powers Call Center Certification. For 2016, we were highest ranked in the Pennsylvania region for Member Satisfaction for Commercial Health Plans, and the highest ranking in Customer Service.