Building Forward: Resilient Teams, Transformed Work, Unified Purpose

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 3.6 million members.

Briefly describe the nominated team: history and past performance (up to 1,250 characters):

UPMC Health Plan, headquartered in Pittsburgh, Pennsylvania, is among the nation's top ranked health plans. Owned by the University of Pittsburgh Medical Center (UPMC), a world-renowned health care provider and integrated health care delivery system, UPMC Health Plan is committed to providing its members with better health, more financial security, and the peace of mind they deserve. Our back-office Enrollment & Coordination of Benefits (COB) teams are responsible for the onboarding and maintenance of our membership to ensure critical access to care. This team's continued successful work in accelerating excellence initiatives showcases the strengths of collaboration amongst our organization and highlights our resilient nature. It is about understanding how our work impacts our members and taking action to care for them as people. We exceed industry standards through care, efficiency and automation through agile methodology, while always aiming for a positive member experience. Initiatives are designed to leverage cutting-edge technologies, streamline processes, and empower our employees with the skills needed for tomorrow's challenges while we adapt to a rapidly changing industry. Our approach is to anticipate our members' future questions and issues. We strive to be proactive, going above and beyond to help each member live a healthier life.

Outline the team's achievements since July 1, 2023 that you wish to bring to the judges' attention (up to 1,500 characters):

Amidst extraordinary challenges and a rapidly evolving industry landscape, UPMC's Back-Office Enrollment & Coordination of Benefits Teams have emerged as pillars of resilience, innovation, and purpose. By investing in people, reimagining workflows, and aligning actions with our mission to serve members with integrity and care, we continue building future-ready operations that reflect what it means to build forward. No longer just the engine behind the scenes, our back-office teams are architects of change, champions of resilience, and stewards of purpose. UPMC has shown operational excellence goes beyond efficiency. It is about empowering people, embracing innovation, and staying true to our mission. We consistently deliver outstanding service, set industry benchmarks, and have positioned the organization for sustained success. Below are highlights of our achievements we invite you to explore:

• Steadfast system transformation to modernize our operations achieved by launching five new systems in less than 9 months across Medicare Enrollment and Sales.
• Improved the employee and member experience by enhancing HIPAA data visibility through the HIPAA Table, which streamlined data entry and reduced delays in processing.
• Strengthened partnerships with Coordination of Benefits Vendors on medical cost avoidance. ($936M)
• Elevated Coordination of Benefits member communications by introducing proactive text messaging offering faster and convenient communication which reduced call volumes.
• UPMC and GoHealth Urgent Care announced the opening of 81 new urgent care locations across Pennsylvania and West Virginia, significantly expanding access for members.
• Unified State Product Teams under one enrollment structure has improved efficiency and alignment, enabling cohesive scalable growth.

Explain why the achievements you have highlighted are unique or significant. If possible compare the achievements to the performance of other players in your industry and/or to the organization's past performance (up to 1,500 characters):

These achievements are unique because they represent a holistic approach to enhancing both employee and member experiences in our industry. Together, these initiatives create a robust framework that not only drives success but also sets new standards in the industry.

Strategic acceleration of system implementations launching five new systems in under nine months showcases the exceptional innovation, speed, and collaboration amongst these teams and the tireless dedication they have for caring for our members. Transforming the backend systems to enhance both the employee and member experience reflects a bold commitment to modernizing the industry and staying true to our mission.

Making HIPAA Management Simpler and More Effective has led to measurable improvements in the member experience by streamlining data entry and organization. The tool enables faster alert generation and reduces processing delays. The chronological layout enhances visibility, strengthens compliance, and empowers our representatives in their service delivery.

Driving cost efficiency through enhanced Coordination of Benefits Partnerships reflects a proactive, collaborative approach to managing healthcare costs by deepening partnerships in an integrated and strategic framework for identifying and preventing unnecessary medical expenses. This goes beyond standard Coordination of Benefits practice by focusing on early intervention and shared accountability.

Strategic growth in community health represents a bold, coordinated effort to bring high-quality, on-demand care directly into communities, many of which may have previously faced limited access to timely medical services throughout Pennsylvania and West Virginia. This not only enhances patient satisfaction but also supports better health outcomes and more sustainable healthcare delivery.

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 1,500 characters):

UPMC has submitted a comprehensive presentation detailing our achievements and strategic focus on building forward, all while ensuring that we continue to care for our members and our employees. The presentation includes:

• Delivery of positive customer experiences through our 5-Star NCQA Accreditation of our Commercial HMO plans and number one member satisfaction ranking from J.D. Power, all while focusing on member onboarding, surpassing industry benchmarks with a 4.5-Star Rating from CMS on our UPMC for Life Medicare Plans, and driving excellence through employee engagement, culture, and collaboration initiatives. Slides 3-4, 19-21
• Transforming how we work in the back office through innovation and modernization, building forward with purpose through collaborating with our partners, communicating with our members, and revolutionizing our internal systems to position ourselves as a market leader. Slides 5, 6, 14-18
• Leveraging AI to reshape how our teams work through enhancing productivity and decision making. Integrating tools across workflows to streamline operations, reduce manual involvement, and empowering our team to focus on high-value work which boosts performance and fosters a culture of innovation and agility across our industry. Slides 7-13
• Showcasing the resiliency of our team as they navigated uncharted territory, showing up and caring for members when a disastrous storm swept through our region. Many enrollment team members lost power for days. Despite these obstacles, they demonstrated incredible dedication commuting into the city to continue supporting members. Leadership provided on-site support and meals to keep morale strong those days. Slide 22