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 expanded as a Medicare-covered service for fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries.

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

MDPP is unique in many ways because it promotes health system transformation through a focus on preventive care and broadens the provider landscape by including a wider array of providers outside of the traditional health care setting.  Eligible providers include both clinical and non-clinical providers in community settings, thus expanding the access to the program to beneficiaries throughout their local communities.  

As of April 2024, there were 414 MDPP suppliers, of which 357 (86%) have enrolled at least one person in the program.  MDPP supplier organizations offer classes through 1,370 delivery sites in their respective communities. Most MDPP suppliers are health care organizations (66%), followed by community-based organizations (19%), state or local health departments (8%), and YMCAs (7%).

The figure below displays the geographic distribution of MDPP delivery sites throughout the United States by organizational type. Many of the delivery sites are in the Northeast. YMCAs have many more delivery sites in these areas, thus providing broader access in those communities. There is a notable lack of delivery sites in the Mountain West and Sunbelt regions. Proximity to MDPP suppliers is an important factor in determining how easily Medicare beneficiaries can access the program, particularly for in-person sessions. Overall, 64% of MDPP beneficiaries live within 25 miles of the closest delivery site of their assigned MDPP supplier.

Although MDPP started as a predominately in-person program, the COVID-19 Public Health Emergency led to an emergency expansion of the program, allowing virtual delivery. The option for virtual delivery has been renewed through 2027. Since the start of the program, most MDPP beneficiaries primarily participate in person (59%), 34% primarily participate through virtual options, and the remaining 7% participate through a mix of in-person and virtual delivery modes.

Among the 9,015 MDPP beneficiaries, about half were FFS, 76% were female, and 70% fell between the ages of 65 and 74. The demographics of MDPP FFS beneficiaries and MA beneficiaries were generally similar.

Evaluating MDPP Health and Claims Outcomes

Among MDPP beneficiaries who attended at least two sessions, the average weight loss was 4.9% of starting body weight. Average weight loss is strongly correlated with session attendance. Over the first 6 years of the program, more than half of beneficiaries (52.5%) achieved at least 5% weight loss, and 24.2% of beneficiaries achieved at least 9% weight loss. Among MDPP beneficiaries who lost at least 5% of their starting weight and stayed in the program, most (80%) maintained at least 5% weight loss or lost additional weight.

As part of the MDPP curriculum, lifestyle coaches work with beneficiaries to track how many physical activity minutes are completed each week of the program. The program’s goal is for beneficiaries to achieve at least 150 minutes of physical activity per week. The percentage of beneficiaries that reported that they met the physical activity goal of 150 minutes was 60% by Session 6, 69% by Session 16, and 72% by Session 22. MDPP beneficiaries also report a myriad of other shorter-term benefits in addition to weight loss and increased physical activity, including improved behavioral health and other health outcomes.

The expectation is that with better health, beneficiaries will need fewer expensive health care services, leading to reductions in Medicare spending. Beneficiaries’ self-selection into the program, however, make it difficult to assess impacts of the model such as changes in service use and Medicare spending. Compared with potentially eligible FFS Medicare beneficiaries, MDPP beneficiaries are more likely to be female; use less high-cost, acute medical care; use more preventive care; and have an indication of obesity or severe obesity in claims. Individuals with prediabetes are at high risk for developing diabetes. Among MDPP FFS beneficiaries, 15% developed diabetes. MDPP beneficiaries who met the 5% weight loss goal, however, had a 36% lower rate of diabetes incidence than MDPP beneficiaries who did not meet the 5% weight loss goal.

Conclusion

Overall, MDPP enrollment is lower than anticipated. Although enrollment numbers have rebounded to pre-pandemic rates. Delivery modes have shifted over time, with more beneficiaries participating through virtual delivery options. In addition, once beneficiaries enroll, attendance is high, and beneficiaries tend to complete the program regardless of delivery mode. Successful MDPP participation has lead to improved shorter-term outcomes, including weight loss, dietary improvements, and increased levels of physical activity. Once MDPP beneficiaries lose initial weight, they tend to maintain their weight loss throughout the program. 

Findings at a Glance and the Final Evaluation Report.