Evaluation of the Medicare Diabetes Prevention Program

What is the Medicare Diabetes Prevention Program (MDPP)?

The Medicare Diabetes Prevention Program (MDPP) is an evidence-based lifestyle intervention with the long-term goal of preventing type 2 diabetes in Medicare beneficiaries with prediabetes. The MDPP was the first preventive service model tested by the Center for Medicare and Medicaid Innovation (CMMI) that was approved as a Medicare-covered service for beneficiaries with Part B coverage.

How Does the MDPP Work?

The MDPP targets weight loss and physical activity through 16 core sessions in months 1 through 6 followed by monthly core maintenance sessions in months 7 through 12. The primary short-term goal of the program is to help individuals lose at least 5% of their weight, which in previous studies was associated with a clinically significant reduction in risk for type 2 diabetes.

MDPP Locations and Beneficiary Enrollment

As of December 2021, the program had 305 MDPP enrolled suppliers and 1,059 supplier locations. The MDPP was designed to be delivered through a series of in-person classes. MDPP supplier locations are primarily clustered around large urban areas with far fewer supplier locations in rural areas. Only four states (Nevada, Rhode Island, South Dakota, and Vermont) have no MDPP supplier locations. Despite the shortage of MDPP supplier locations in some states, beneficiary access to the MDPP continues to improve with an average of six MDPP suppliers and 10 supplier locations added each month.

Beneficiary enrollment in the MDPP declined significantly during the COVID-19 public health emergency (PHE) and had not fully recovered as of December 31, 2021. Of the 4,848 Medicare beneficiaries who have enrolled in the program since 2018, 1,877 enrollees are Medicare Fee-For-Service beneficiaries and 1,894 are Medicare Advantage beneficiaries. Approximately 75% of MDPP beneficiaries are women, 68% are aged 65 to 74, 77% are white, and 84% are non-Hispanic. Overall, MDPP participants are younger and more likely to be female than the Medicare population as a whole. 

Evaluating MDPP Health and Claims Outcomes

RTI International is using a combination of data from MDPP suppliers, information on MDPP participants provided by the Centers for Disease Control and Prevention (CDC), and Medicare claims to evaluate the impact of the MDPP. RTI is analyzing data on attendance, weight loss, and physical activity for MDPP participants and comparing Medicare expenditures for MDPP participants and a matched comparison group of Medicare beneficiaries with similar characteristics who did not participate in the program. A difference-in-difference approach is used to compare expenditures between MDPP participants and the comparison group.

RTI’s Second Evaluation Report shows the impact of the MDPP from its start in April 2018 through December 31, 2021.

• Medicare Beneficiary Participation and Attendance. As of December 31, 2021, 4,848 Medicare beneficiaries have participated in the program, attending an average of 17 classes. The COVID-19 PHE significantly impacted supplier and beneficiary participation in the MDPP. The MDPP was originally designed for in-person delivery, but CMS quickly allowed suppliers and beneficiaries to pause the program and resume sessions later. CMS also permitted suppliers to offer sessions virtually to participants. Most suppliers opted to offer distance learning, a type of virtual delivery wherein a lifestyle coach leads sessions in one location and beneficiaries attend via telephone or videoconference from their homes. Some beneficiaries dropped out after the PHE began, but most continued after pauses of varying lengths. New enrollment dropped to nearly zero early in the PHE and has slowly recovered since then. As of December 31, 2021, most sessions were still being delivered virtually, although some suppliers offered a mix of virtual and in-person delivery.
• Weight Loss and Physical Activity. On average, MDPP participants attending at least two sessions lost 5.1% of their body weight, consistent with the program’s short-term goal of 5% weight loss. More than half (53%) of participants met the 5% weight loss goal for the program, and almost 25% met a secondary 9% weight-loss goal. Most participants reported meeting the 150-minute per-week goal for physical activity.
• Medicare Expenditures. The change in expenditures before and after MDPP enrollment was not significantly different between MDPP participants and the comparison groups. However, the sample size is still relatively small, which makes it difficult to detect differences in total spending before and after participation.
• Diabetes Onset. The MDPP pathway to better health and lower costs assumes that weight loss will lead to absolute reductions in diabetes incidence. It is too early to assess diabetes onset using Medicare claims data given the relatively small number of participants who have data for more than 1 year after participating in the program.

The MDPP’s association with weight loss is promising; however, the sample size and evaluation periods are insufficient to determine whether the MDPP lowers the incidence of diabetes or other long-term health outcomes for individual participants. CMS recognizes the importance of increasing supplier and beneficiary participation in the program and has sought to identify best practices for increasing MDPP participation by the Medicare population in general and by vulnerable populations in particular.

RTI’s evaluation is designed to examine whether MDPP participation results in weight loss, improved health outcomes (e.g., fewer cases of diabetes), and lower Medicare expenditures. The evaluation will continue until March 2025, with expanded analysis of utilization and expenditures. The increased sample size and number of participants completing the program will allow us to make more definitive conclusions about diabetes onset and expenditures. Results of the evaluation will be used to determine the future scope of the program.