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: Best Return on Customer Service Investment
 Nomination Title: UPMC Health Plan
- 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.
Since Speech Analytics implementation, our Analytics team has many achievements with some examples below:
- Reduction in Quality Audit staff - $580K annually
- QA – focus on Benefit Quoting
- 2022 was 97.44% vs. 2023 was 99.24%
- Savings $126,908
- Monitoring Concierge call avoidance behaviors
- Reduced “short” calls 10.33%
- Reduced staff terminations, team turnover 14.79% (compared to 38% in industry)
- Call trending across organization and Sr. Leadership
- Reduction in Commercial calls 33%, Annual Savings $2.07M
- Reduction Repeat Callers
- Achieving 21.19% vs. 32% in the industry according to Dialpad Ai Case Study
- Annual Savings $2,172,377
- Manage vendors, driving improvements
- Manage Medicaid BPO earning 4.5 Stars in National Rankings, Health Equity Accreditation
- Durable Medical Equipment service ensuring care
- Earned 5 Stars for Medicare, 6% of plans in the industry
- Drive operational improvements across the organization
- Identified need to build IVR application for Medicare Cards
- Leave Absence Bookings implemented
- Increased Customer Satisfaction
- Savings in 6 months $10,588
- Drove Flu Shot completion
- 122,008 Flu Encouragement
- Achieved 4/5 Stars from the NCQA for 4 product lines
- Autopay Enrollment
- After Call/Chat Survey Comments
- Automation of feedback for coaching/recognition
- Member Satisfaction score 98% /FCR 96.1%
- Member Retention 97.8% Medicare (industry 84%), 94.3% Marketplace (industry 83%)
- World Class Call Score
- Driving Digital adoption
- 19% increased enrollment
- 121% increased Mobile App utilization
- $10M+ Cost Avoidance
- Increased Coaching Capabilities
- 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.
- 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 243 words used.
The speech Analytics team has made such wonderful strides in the work that the Call Center is doing and continues to do each and every day. We have been able to really work on enhancing the most important things to us as an organization and our biggest selling factor in our market, which is our member and employee experience. The team is unmatched with the amount of time and effort they put into all initiatives they work on. They are constantly thinking outside of the box to ensure we are constantly improving and are not happy with just meeting a goal but making sure they exceed it. we are so proud of all the obstacles and achievements our speech analytics team has had over the past year and cannot wait to see where we get to in 2024.
In the presentation attached we highlight our achievements the speech analytics team had over the past year. We showcase all of our improvements specifically around our member experience while driving continuous improvement across the organization.
We support all initiatives we champion and show a variety of the ways we achieve that in our contact center. We love to engage and have fun with our teams and that is one of the core things we center our initiatives around.
Our team doesn’t settle for status quo and we are very proud to share all of our awards and 2023 successes at the end of the presentation.
- 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 (UPMC), a world-renowned health care provider. Our Member Services foundation is providing World Class experiences to 4.1M+ members. Our contact center has 450+ concierges, annually answering 3M inbound calls, 58K chats, 20K web messages and conducting 1.6M outreach calls. Focusing on people, processes, and technology, we drive enhancements across the organization ensuring member satisfaction and driving growth. Our Healthcare Concierge Service offers service beyond traditional industry standards, taking pride ensuring our members are cared for, delivering First Call Resolution (FCR) and a robust service recovery program to guarantee issues are resolved.
Our commitment to excellence is unwavering, and implementation of our Speech Analytics Tool in 2020 has been instrumental achieving our goals. The success belongs to the Speech Analytics Team, who all began their career as a concierge; no new positions added. Working tirelessly and leveraging this tool, we identified areas for improvement and made meaningful changes to our operations, enabling us to consistently gain efficiencies while delivering the exceptional experiences that we promise our members. We continue to use this tool to drive innovation and ensure we are providing quality service.
- 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.
Our amazing Analytics Team works wonders with our Speech Analytics Tool. We pay ~$400K annually for the tool, the benefits our team has made with the tool results in $9,802,759 savings, an ROI of 2350%, and additional cost avoidance of $10M for driving digital utilization.
The team works hard ensuring we deliver a world-class experience on every call. Our “World Class Call Score” created within our speech analytics tool provides Concierges with a comprehensive view of performance on the metrics we deem the most important in creating a meaningful experience on 100% of their calls. By ensuring our Member Experience is outstanding, we have been able to earn 5 Stars on our Medicare Plan and 4.5 Stars on our Specialty Needs Plan. Only 6% of Medicare Advantage plans have earned this distinction, so not only are we able to sell our Medicare Plan all year, we were able to maximize revenue on the Stars for $552M.
Our Analytics Team has become an integral part of our company’s operations, enabling us to work more efficiently and effectively. By analyzing call data, we identify key process improvements and ensure that we are delivering the best possible experience to our members. Our Speech Analytics Tool has helped us achieve significant improvements in our call center operations. In 2023, we came in 6.4% under budget for a savings of $2,242,834. We earned the highest in Member Satisfaction with JD Power for Medicare Advantage Plans in Pennsylvania and nation!
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