Scaling and Sustainability → Umbrella Hub Arrangements

 

Umbrella Hub Arrangements

 

Umbrella hub arrangements connect community-based organizations (CBOs) with health care payment systems to pursue sustainable reimbursement for the National Diabetes Prevention Program (National DPP) lifestyle change program. On this page, CBO is a broad term for organizations that are CDC-recognized and delivering the National DPP lifestyle change program in their local communities and can include Federally Qualified Health Centers, Area Agencies on Aging, pharmacies, tribes, local health departments, faith-based organizations, extension programs, small social service agencies, and/or other small health care providers. Throughout the Coverage Toolkit, CBOs participating in an umbrella hub arrangement will be referred to as subsidiary organizations, or subsidiaries. Each umbrella hub arrangement is convened by an umbrella hub organization, which is the lead organization in the arrangement. Umbrella hub arrangement is the overarching term that refers to the entire group, inclusive of the umbrella hub organization, subsidiaries, and the billing platform used to submit claims.

This page is divided into four sections:

  1. Objectives of Umbrella Hub Arrangements
  2. Considerations for Establishing Umbrella Hub Arrangements
  3. Role of Public Health and Medicaid
  4. Business Structure and Sustainability Considerations

Objectives of Umbrella Hub Arrangements

 

Umbrella hub arrangements can ease administrative burden for CDC-recognized organizations and allow these delivery organizations to focus on providing the National DPP lifestyle change program. For a one-page overview of umbrella hub arrangements and an umbrella hub arrangement terminology guide, please see the documents included on this page titled Umbrella Hub Arrangements One-Pager and Umbrella Hub Arrangement Terminology Guide.

Benefits of umbrella hub arrangements include the following:

  • Aggregate Diabetes Prevention Recognition Program (DPRP) data: While each subsidiary retains its individual identity as a CDC-recognized organization, all participants in an umbrella hub arrangement submit their DPRP participant data collectively with others in the arrangement. Small CDC-recognized organizations that experience challenges in recruiting enough qualifying participants to offer at least one cohort a year, which is a requirement for retaining their CDC recognition, can benefit from having their participant data pooled with other umbrella hub arrangement participants.
  • Share CDC recognition status: To join an umbrella hub arrangement, each subsidiary organization must have pending, preliminary, or full recognition; however, while participating in the arrangement, all subsidiaries assume the recognition status of the umbrella hub organization. This shared recognition status has several benefits, including enabling subsidiaries that entered the umbrella hub arrangement with pending recognition to access Medicare reimbursement through the umbrella hub organization’s recognition status, even though preliminary or full recognition is typically required for an organization to enroll in Medicare and submit claims.
  • Operate as one MDPP supplier: In an umbrella hub arrangement, the umbrella hub organization is the MDPP supplier; subsidiary organizations do not separately enroll as MDPP suppliers. However, subsidiaries participating in the umbrella hub arrangement can access Medicare reimbursement through the umbrella hub organization’s MDPP supplier status.
  • Streamline business and administrative support: A challenge many CDC-recognized organizations face is successfully billing Medicare and other payers to receive reimbursement. A key element of an umbrella hub arrangement is a single billing and claims submission platform used by all subsidiary organizations. For example, the billing and claims platform can either be an existing, in-house platform used by the umbrella hub organization that all subsidiary organizations can access, or it can be a contracted third-party platform.
  • Pursue sustainability and achieve scale: Participation in an umbrella hub arrangement can help CDC-recognized organizations work together to pursue sustainability and achieve benefits of scale. In the context of an umbrella hub arrangement, sustainability refers to when the subsidiary organizations are receiving reimbursement for delivering the National DPP lifestyle change program from reliable reimbursement dollars that can be maintained over a protracted period of time, rather than receiving reimbursement from short-term funding, such as grant funding. Benefits of scale occur as more subsidiary organizations join the umbrella hub arrangement, because umbrella hub arrangements can demonstrate network adequacy and greater collective impact, making the network more attractive to payers.
Definitions

Umbrella hub arrangements include the following participants and partners:

  • The umbrella hub organization has full or preliminary CDC recognition and agrees to serve as the sponsoring organization for a group of subsidiaries that have pending, preliminary, or full CDC recognition. The umbrella hub organization provides administrative support to subsidiary organizations so subsidiary organizations can focus on delivering the National DPP lifestyle change program. Administrative support includes but is not limited to: billing services; claims submission; payer contracting services; data management and reporting; and technical support such as lifestyle coach training, participant referral and retention.
  • Subsidiary organizations are CBOs that specialize in delivering the National DPP lifestyle change program in their communities but may not have the capacity or administrative infrastructure to submit claims for covered benefits for the National DPP lifestyle change program without the support of an umbrella hub organization.
  • A billing and claims platform is an electronic platform able to bill and receive payments from the Centers for Medicare and Medicaid Services (CMS) and other payers. In an umbrella hub arrangement, the billing and claims platform can either be an in-house platform used by the umbrella hub organization that all subsidiaries can access, or the umbrella hub organization can contract with a third-party vendor for these services.
  • Stakeholders may include state health departments, payers, and foundations and can help make the umbrella hub arrangement successful.


Considerations for Establishing Umbrella Hub Arrangements

 

There are several components to consider in establishing or supporting an umbrella hub arrangement. Certain actions must be completed in order; for example, subsidiaries must be identified before an organization can apply to become an umbrella hub organization. Other actions may happen concurrently or in a different order than outlined. Umbrella hub arrangements are encouraged to consider sustainability throughout the process. CDC will begin accepting applications for new umbrella hub arrangements after May 1, 2021. For more information on becoming an umbrella hub organization, please contact CDC through CDC’s National DPP Customer Service Center. For more information on becoming a subsidiary in an umbrella hub arrangement, please contact your state health department. For additional details on establishing an umbrella hub arrangement, please see the document included on this page titled Checklist to Help Organizations Establish an Umbrella Hub Arrangement.
 

Assess Readiness

Organizations interested in serving as an umbrella hub organization are advised to become familiar with the purpose and requirements for umbrella hub organizations and are encouraged to review CDC’s forthcoming guidance on umbrella hub arrangements. Moreover, organizations considering becoming an umbrella hub organization may want to assess their readiness. Readiness refers to the following:

  • Requirements and expectations of umbrella hub organizations: Organizations interested in becoming an umbrella hub organization must have full or preliminary CDC recognition. For more information on obtaining CDC recognition and the different levels of recognition, refer to the DPRP requirements. Umbrella hub organizations are encouraged to enroll as an MDPP supplier, in state Medicaid programs (when applicable), and to contract with additional payers.
  • Internal resources: Potential umbrella hub organizations are encouraged to inventory their internal resources, such as staffing, administrative capacity, and financial status, to ensure adequate internal capacity to effectively operate an umbrella hub arrangement.
  • Claims submission: A primary purpose of the umbrella hub arrangement is to submit claims on behalf of the subsidiaries. Organizations interested in serving as an umbrella hub organization can leverage an in-house platform that all subsidiaries can access or contract with a third-party vendor to submit claims.
  • Business acumen and financial sustainability: An umbrella hub organization with strong business skills can help set the umbrella hub arrangement up for success. Umbrella hub organizations are encouraged to assess the costs of standing up and operating an umbrella hub arrangement. The ability to pursue health care payer reimbursement from a variety of payers and obtain other funding streams can lead to long-term sustainability.
  • Core mission and culture: Alignment between the umbrella hub organization’s priorities, mission, and culture with the objectives of the umbrella hub arrangement can help provide stability to the umbrella hub arrangement.
  • Reach and relationships: Organizations that want to serve as an umbrella hub organization are encouraged to consider how many subsidiaries are interested in participating in the umbrella hub arrangement. With enough subsidiaries and cohorts offered, the umbrella hub arrangement can achieve advantages of scale.

 

Identify Participants and Partners

After assessing readiness, participants and partners can be identified.

Identifying Subsidiaries

Subsidiary organizations can benefit from participating in the umbrella hub arrangement by receiving administrative support (e.g., claims submission), shared DPRP recognition status, and leveraging economies of scale. When identifying subsidiaries, umbrella hub organizations are encouraged to consider subsidiary organizations’ needs for administrative support and willingness to enter into contractual agreements, including business associate agreements and data use agreements, before joining the umbrella hub arrangement.

CDC limits the initial number of subsidiaries to five per umbrella hub arrangement. This is intended to allow an umbrella hub organization time to gain experience and ensure the umbrella hub organization has the internal capacity to manage the subsidiary organizations. Subsidiary organizations can contribute to the umbrella hub arrangement’s sustainability by sharing the administrative costs of operating the arrangement. Also, an umbrella hub arrangement with several subsidiaries may be more attractive to payers as they gain access to a network of CDC-recognized organizations by contracting with the umbrella hub organization.

Identifying Partners

Although umbrella hub arrangements are not required to have partner organizations, such organizations can contribute to the umbrella hub arrangement’s sustainability. Partner organizations can include the state or local health departments, local diabetes advocacy and prevention organizations, health care providers, employers, private businesses, and other CBOs. These partners can provide a variety of support to the umbrella hub arrangement such as additional funding or publicity, referrals of eligible individuals, or offering services that can support participants’ retention in the National DPP lifestyle change program.
 

Complete the Umbrella Hub Arrangement Application

CDC will begin accepting applications for new umbrella hub arrangements after May 1, 2021. For more information on becoming an umbrella hub organization, please contact CDC through CDC’s National DPP Customer Service Center. For more information on becoming a subsidiary in an umbrella hub arrangement, please contact your state health department.


Role of Public Health and Medicaid

Although the primary participants in umbrella hub arrangements are the umbrella hub organization, subsidiary organizations, and a billing and claims platform, there is a role for state public health departments and Medicaid agencies. Both can promote umbrella hub arrangements as a way to increase uptake of the National DPP lifestyle change program across the state and foster sustainability. State public health departments and Medicaid agencies often partner to host meetings and webinars for CDC-recognized organizations, Medicaid managed care organizations (MCOs), health care providers, and other stakeholders on how to engage with the National DPP lifestyle change program. These meetings and webinars can include information on umbrella hub arrangements. Additionally, public health and Medicaid personnel can take a proactive approach in identifying CDC-recognized organizations that may be interested in serving as the umbrella hub organizations and/or organizations that might benefit from being subsidiaries or match potential umbrella hub organizations with potential subsidiary organizations.


Business Structure and Sustainability Considerations

 

 

A primary goal of an umbrella hub arrangement is to create a sustainable arrangement for the umbrella hub organization and each subsidiary. In the context of an umbrella hub arrangement, sustainability refers to when the subsidiary organizations are receiving reimbursement for delivering the National DPP lifestyle change program from reliable reimbursement dollars that can be maintained over a protracted period of time, rather than receiving reimbursement from short-term funding, such as grant funding. Organizations interested in applying to become an umbrella hub organization are encouraged to develop and continue to revisit a sustainability plan with their subsidiaries.

To work towards sustainability and maintain financial health for both the umbrella hub organization and the subsidiary organizations, the umbrella hub organization will likely charge the subsidiary organizations a fee for the administrative services. How much the umbrella hub organization charges, when to initiate those charges, and how to collect the funds is determined by the umbrella hub organization and subsidiaries. The umbrella hub organization can benefit from grant funding or another source of funding to start-up the umbrella hub arrangement until access to health care payer reimbursement is realized.

Below are some considerations for how the umbrella hub organization can support the umbrella hub arrangement’s sustainability:

  • Establish revenue sources: Positioning the umbrella hub arrangement to capture health care payer reimbursement is an important step towards achieving sustainability. By enrolling as an MDPP supplier and Medicaid provider—in states where the National DPP lifestyle change program is a covered Medicaid benefit—and by contracting with Medicare Advantage plans, Medicaid MCOs, other commercial payers, and self-insured employers, the umbrella hub organization can position the subsidiaries to access a wide array of payer reimbursement.
  • Increase organizational capacity: The umbrella hub organization can help the subsidiary organizations increase their capacity to deliver the National DPP lifestyle change program. For example, the umbrella hub organization can help recruit additional lifestyle coaches and provide training for current lifestyle coaches to grow subsidiary organizations’ programs and reach more individuals.
  • Seek partnerships: The umbrella hub organization can pursue partnerships with health care providers to generate referrals for the subsidiary organizations. Additionally, because social determinant of health factors, such as transportation or childcare, can influence whether an individual enrolls and remains in the program, strategic partnerships providing wrap around services can help increase participant enrollment and retention.
  • Encourage sustainability through charters and contracts: Charters and contracts help bind the umbrella hub arrangement together. The charter can capture the umbrella hub arrangement’s shared mission, objectives, and goals. Contracts can detail the expectations, roles, and responsibilities for each entity in the umbrella hub arrangement. For example, a contract can outline financial commitments for the administrative services the umbrella hub organization provides. For examples of charters between an umbrella hub organization and subsidiaries and BAAs between all umbrella hub arrangement participants, please see the two sample charters and two sample BAAs included on this page. For an example of how the different contracts and agreements can join an umbrella hub arrangement together, please see the Diagram of Contracting in the Umbrella Hub Demonstration included on this page. These resources are provided from the CDC-funded Umbrella Hub Demonstration project.

Resources for Umbrella Hub Arrangements

 

Content Updated: March 4, 2021