SustainabilityUmbrella Hub Arrangements → Sustaining Umbrella Hub Arrangements


Sustaining Umbrella Hub Arrangements

A primary goal of an umbrella hub arrangement (UHA) is to create a sustainable arrangement for the umbrella hub organization (UHO) and each subsidiary. In the context of a UHA, sustainability typically refers to when the subsidiary organizations are receiving reimbursement for delivering the National Diabetes Prevention Program (National DPP) lifestyle change program from reliable reimbursement dollars that can be maintained over a protracted period of time, rather than relying on reimbursement from short-term funding, such as grant funding.

Having multiple health care payers for the National DPP lifestyle change program is essential for the sustainability of a UHA. UHOs are encouraged to enroll in the Medicare Diabetes Prevention Program (MDPP), Medicaid (if applicable), and contract with Medicaid managed care organizations (MCOs), Medicare Advantage (MA) plans, commercial health plans, and self-insured employers. To learn more, see the Reimbursement for Umbrella Hub Arrangements page of the Coverage Toolkit.

UHOs can also consider avenues to support the sustainability of the UHA in addition to contracting with health care payers. Organizations interested in applying to become a UHO are encouraged to develop and revisit a sustainability plan with their subsidiaries.

Below are considerations NACDD and Leavitt Partners identified that may contribute to the sustainability of the UHA.

Learnings from the Umbrella Hub Demonstration that correlate with this Coverage Toolkit page (learnings related to the sustainability of the UHA) are in the document titled, Learnings from the Umbrella Hub Demonstration – Sustainability. For all of the learnings from the Umbrella Hub Demonstration refer to the full document, Learnings from the Umbrella Hub Demonstration.


Retaining and Increasing Participants

UHOs can support their subsidiary organizations by increasing participant enrollment and retention in National DPP lifestyle change programs. For example, UHOs can work with health care providers to increase referrals to the subsidiary organizations’ programs. UHOs can also support subsidiary organizations with best practices to increase enrollment in programs, such as implementing effective strategies for outreach to eligible individuals. To improve retention, UHOs can support subsidiary organizations with best practices such as providing engaging and culturally relevant curricula. For more information on the recruitment and retention of National DPP lifestyle change program participants, see the Recruitment and Referral and the Retention pages of the Coverage Toolkit.

Identifying Additional Partners

Although UHAs are not required to have partner organizations, such organizations can contribute to the UHA’s sustainability. Partner organizations can include the state or local health departments, local diabetes advocacy and prevention organizations, health care providers, employers, private businesses, other community-based organizations (CBOs), or State Quality Specialists (SQS) (a network of specialists at the state level trained by CDC to provide technical assistance to organizations offering the National DPP lifestyle change program). Additionally, 1705 organizations, organizations funded by CDC to build out the National DPP infrastructure in currently underserved areas, can also provide valuable partnerships through the national reach they access. These partners can provide a variety of support to the UHA 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.

Additionally, because health-related social needs (HRSNs), 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. To learn more about addressing HRSNs in the context of the National DPP lifestyle change program, including how to partner with other organizations, and local or state initiatives, see the Health Equity and the National DPP page of the Coverage Toolkit. For example, partnerships with federally qualified health centers (FQHCs), which are comprehensive, community-based primary care providers that offer affordable care in areas with high need for health care, may help UHAs in addressing HRSNs. More information on this topic can be found on the Engaging Federally Qualified Health Centers page.

State public health departments and Medicaid agencies can help promote UHAs 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. Additionally, public health and Medicaid personnel can take a proactive approach in identifying CDC-recognized organizations that may be interested in serving as the UHO and/or organizations that might benefit from being subsidiaries or match potential UHOs with potential subsidiary organizations.

Recruiting and Retaining Subsidiary Organizations

Adding more subsidiary organizations to the UHA can increase the UHA’s appeal to health care payers, as they gain access to a network of CDC-recognized organizations by contracting with the UHO. UHOs should maintain consistent outreach to potential subsidiaries to continually develop the UHA. When identifying potential subsidiaries, it is recommended that UHOs begin by utilizing existing connections within their network. Because UHA partnerships are built on trust and communication, an existing relationship between organizations can help expedite UHA processes.

Finally, UHOs can retain existing subsidiaries by providing additional support. By understanding the needs and suggestions of subsidiary organizations, UHOs can help subsidiary organizations to increase their organizational capacity, such as by identifying additional lifestyle coaches or helping subsidiary staff access lifestyle coach training.

Considering Other Evidence-Based Programs

Adding evidence-based, reimbursable programs such as diabetes self-management education and support (DSMES) can increase revenue streams. Additional programs may also increase the UHA’s attractiveness to payers because payers can contract with one UHA rather than multiple organizations and give their members access to a variety of disease prevention and management services. Considerations for offering more programs include: the capacity of subsidiary organizations to deliver the programs, the cost of adding new programs, and the available reimbursement for those programs.

Engaging in Continuous Quality Improvements (CQI)

Continuous quality improvement (CQI) can strengthen the UHA and build payer and health care provider confidence in the arrangement. To engage in CQI, the UHO can assess the UHA’s challenges, areas for improvement, and opportunities for growth to improve the outcomes of the UHA’s National DPP lifestyle change programs. Areas for improvement may include lifestyle coach training and support and participant recruitment and enrollment. UHOs are advised to solicit their subsidiary organizations’ input into the quality improvement process to develop improvement actions that have the buy-in from all appropriate UHA participants.

Content Updated: May 10, 2023