UPMC Insurance Services Division Fast Facts
UPMC is a proven integrated delivery and finance system — the first of its kind in western Pennsylvania. The UPMC Insurance Services Division is leading the way with innovative health plans that deliver better quality and lower costs for virtually all segments of society.
In just over a decade, Insurance Services has grown from about 300,000 to more than 1.8 million members. The division provides health plans to employers and their employees and dependents, to individual members, as well as to those eligible for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
Insurance Services also offers workers’ compensation, disability management, and leave management services, as well as some of the most comprehensive health improvement, wellness, and workplace productivity programs anywhere in the United States. Insurance Services is also the largest behavioral health insurance provider in Pennsylvania, and operates two software development companies focused on helping health care providers and employers with efficient care and employee benefits.
By the Numbers
- More than 1.8 million total members served
- A network of more than 125 hospitals and other facilities and more than 11,500 physicians
- Serves more than 9,000 employers
- Behavioral health services provided by more than 10,000 clinicians in nearly 200 facilities
Commercial Insurance Products — Founded in 1998 on the premise that providers armed with complete data and evidence-based guidelines could produce the best clinical outcomes, the Insurance Services Division’s UPMC Health Plan has become one of the most innovative insurance plans in the nation. UPMC Health Plan offers traditional HMOs, PPOs, and EPOs, as well as consumer-directed health plans, along with Health Incentive Accounts, Health Savings Accounts, and Health Reimbursement Arrangements. UPMC Health Plan also offers an individual plan, UPMC Individual Advantage; provides dental coverage through its UPMC Dental Advantage plan; and provides vision coverage through its UPMC Vision Advantage plan.
UPMC Health Plan works with the region’s employers and providers to develop better ways to deliver health care. The Health Plan has designed programs and tools to help consumers manage their health on a day-to-day basis and has created programs for patients with chronic conditions such as congestive heart failure, asthma, and diabetes.
J.D. Power and Associates has recognized UPMC Health Plan’s call center three times since 2009 for providing “an outstanding customer service experience.” (For J.D. Power and Associates Certified Call Center ProgramSM information for 2012, visit www.jdpower.com). In 2012, UPMC Health Plan was named Global Call Center of the Year in the large call center category by the International Customer Management Institute (ICMI). In 2012, in its annual survey of health plans, Consumer Reports ranked UPMC Health Plan No. 1 in the region and in the top 16 of all commercial plans across America.
Worker Productivity and Health — Through UPMC WorkPartners, Insurance Services offers employers integrated productivity management programs, helping employers manage workers’ compensation, disability, and medical leave programs, including comprehensive health and wellness services. UPMC has been recognized by the National Business Group on Health for four consecutive years as one of America’s best employers for healthy lifestyles, thanks to the UPMC MyHealth initiative, an award-winning health and wellness program.
Employer Data Integration — Through its EBenefits, Insurance Services offers the most sophisticated tools for integrating health plan and worker productivity data to assist employers in managing recordkeeping and improving productivity and efficiency. The bottom line is significant savings to employers. EBenefits is an Internet-based human resources and benefits administration platform that serves clients throughout the United States.
Employee Assistance Program — LifeSolutions has been providing EAP services to address the emotional and physical concerns of employees — and positively impacting organizational productivity — for more than 30 years. By addressing these employee needs, LifeSolutions decreases absenteeism and reduces the impact of presenteeism or employees working while ill. Confidential services include personal counseling and coaching, chemical dependency triage, disability and leave management support programs, and access to work-life balance resources.
Medicare Advantage Plans — Insurance Services provides coverage to Medicare beneficiaries through its UPMC for Life program, which offers benefits beyond those of traditional Medicare at affordable rates. UPMC for Life experienced extraordinary growth in 2012, with a 13.6 percent increase in membership, more than four percentage points above the national average.
Medical Assistance — UPMC for You offers physical health care benefits to Medicaid recipients in 40 Pennsylvania counties. Recognized as a model program, UPMC for You was ranked eighth of all Medicaid programs in the United States in 2012, and was the top-ranked Medicaid plan in Pennsylvania for eight of the past nine years, according to the National Committee for Quality Assurance (NCQA).
Children’s Health Insurance Program (CHIP) — UPMC for Kids offers affordable plans to children in western Pennsylvania, no matter their family’s income level. UPMC for Kids is one of the fastest growing CHIP programs in Pennsylvania.
Behavioral Health — Community Care Behavioral Health Organization (Community Care), part of Insurance Services, is the largest not-for-profit behavioral health managed care organization in the country. Headquartered in Pittsburgh, Community Care manages mental health and substance abuse services for more than 650,000 members in Pennsylvania and coordinates behavioral health services in 16 New York counties. Community Care’s mission is to improve the health and well-being of the community through the delivery of effective, cost-efficient, and accessible behavioral health services. Community Care has been awarded “full” accreditation — the highest possible level — from the National Committee for Quality Assurance (NCQA) for its Medicaid products as well as its disease management program.
Askesis Development Group — Askesis is a leader in software solutions for the behavioral health, addictions treatment, and social services markets. Its flagship application, PsychConsult Provider, is an enterprise application and is designed to completely integrate organizations’ administrative tasks, clinical workflow, and revenue cycle management. Part of Insurance Services, Askesis has sold its software to behavioral health providers in more than 25 states.
Partners in Excellence Program for Physicians — The UPMC Health Plan Partners in Excellence Program adds exceptional value to the primary care experience. By putting the patient at the center of a team effort to support the doctor-patient relationship, with support from the family, the community, and UPMC Health Plan, the Excellence Program improves care and health outcomes.
Patient-Centered Medical Home – UPMC Health Plan partners with UPMC and community network providers in its Patient-Centered Medical Home program. The program uses a care-coordination team and practice-based managers who enable physicians to deliver continuous, accessible, high-quality, patient-oriented, population-based care. In the program’s first year, the overall hospital readmission rate for patients in medical home practices dropped 12.5 percent compared to other practices. In the second year, readmissions dropped 18.5 compared to other practices.
Innovations – In 2012, UPMC Health Plan became the first health plan in the nation to offer WebMD Digital Health Assistants, virtual health coaching programs that support and sustain health improvement and foster healthy lifestyle behaviors. The Health Plan also introduced a mobile phone application that allows commercial insurance members who download it to their smartphones to gain access to virtual member ID cards, a mobile Personal Health Record, and contact information for recently visited providers from a personalized list. Members also have the ability to check the status of their claims, and to view flexible spending account balances from their phones. UPMC Health Plan also has been a leader in the field of e-visits and home-monitoring telemedicine.