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UPMC Health Plan: Best Use of Technology in Customer Service

Gold Stevie Award Winner 2018, Click to Enter The 2019 Stevie Awards for Sales and Customer Service

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 2.9 million members.
Nomination Category: Customer Service & Call Center Awards Achievement Categories
Nomination Sub Category: Best Use of Technology in Customer Service - Other Service Industries

Nomination Title: UPMC Health Plan: Best Use of Technology in Customer Service

Tell the story about how technology has improved your customer service initiatives since the beginning of July 2016 (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:

At UPMC Health Plan when the Affordable Care Act (ACA) was implemented, our growth was explosive:

2014: 10,354 individual members
2015: 43,472 individual members
2016: 108,244 individual members
2017: 142,353 individual members
2018: 156,723 individual members

The expansion happened so fast, we were challenged to adjust to the volume of the contacts we were receiving from these members. One of the biggest challenges we experienced was individual billing and collection of payments; members had to pay to activate their plan, many lived on a paycheck to paycheck basis and often waited until the final due date (or past). Since they had to wait for so long on funds, they would call consistently to make the payment vs. sending in a check or paying on line. The surge of calls we were receiving related to payments, particularly around the due date, was unmanageable. Wait times for this product line soared, and we were challenged with working the staff many hours of overtime and bringing in temporary employees.

Beginning in July 2016, we worked diligently to leverage an IVR solution for telephonic payments. We worked with our finance, IT, and telecom teams. Obstacles we experienced were with our finance team not feeling the urgency to set up the banking accounts and transfer of funds. We overcame this by meeting with them weekly and consistently encouraging them to find time to do the next step. We also enlisted the help of our Assistant Treasurer who was more familiar with setting up new payment accounts. With the Call Center leadership leading the charge, we ensured we accounted for a seamless member experience with ease of use. We personalized the IVR for specific product lines, as well as member status. Members can make an activation payment on the IVR, where in the past, this had to be done with a person, couldn’t even be done on line.

This technology added a convenience to our members as they can make a payment 24/7. They have the comfort of being able to wait until the final due date, without waiting for a CSR to answer their call. Multiple payments can be made on one call. This was particularly convenient for Medicare members with husband and wife each having a plan, and even more so for our Children’s Health Insurance Program (CHIP) where a family has more than one child with a plan. Payments are posted daily, and we have the ability to report at any time of the day our progress. We can measure IVR success rate at any time and have made real time tweaks to the technology.

The IVR has been a huge win for us. Since implementation in November 2016, we have successfully taken 145,028 payments on the IVR, collecting $34,226,864 of premium payments, for a savings of $797,654 for the year, and an ROI of $692,654.

Implementing our new payment IVR had a tremendous impact on our Member Experience. We realized a 23% reduction in calls per member per month, affording us a 34 second reduction in Average Speed of Answer.

Team members are relieved that our members now have this option. We havereducded the OT for the team by 18% saving $189,998.16, further supporting a work life balance for our team. We have smoothed the surge of calls that we take close to and on the due dates. The high fluctuation we were receiving around specific days of the month made staffing unmanageable. The IVR reduces the possibility of human error when taking payments, as well as ensuring PCI compliance. Our Finance team receives daily reporting from the company and the bank and are able to add the funds to the correct member account more timely.

Our new payment IVR has been a big success for our members, our team, our Operations and Finance departments, and our financial outcomes.