Beyond the Barriers: Unlocking the Full Potential of the MDPP

The rising tide of chronic diseases like type 2 diabetes represents one of the most significant challenges for the healthcare delivery system. We know that shifting focus from reactive treatment to proactive prevention is crucial to improving the health of populations. The Medicare Diabetes Prevention Program (MDPP) stands as a critical, real-world test case for implementing evidence-based prevention on a national scale. We shouldn’t overlook its core lessons, which would be a grave mistake for anyone committed to the future of VBC.

Why?

MDPP is built on a fundamental truth championed by VBC:

Meaningful health improvement, especially for chronic conditions, requires sustained behavior change, and behavior change hinges on effective patient engagement.

Background to the Medicare Diabetes Prevention Program (MDPP)

The Medicare Diabetes Prevention Program (MDDP) was developed after the National Institute of Health study called the Diabetes Prevention Program (DPP). The DPP has been tracking the impacts of lifestyle modification support vs. metformin to extend the time between pre-diabetes and the onset of diabetes.

While both demonstrated a delay in diabetes onset, the lifestyle modification support group was more successful, reducing the risk of diabetes onset by 58%, while metformin reduced the risk by 31%. Researchers have continued to follow individuals after the study in a program called the DPP Outcomes Study (DPPOS), although funding was cancelled for this work in March 2025 by the Trump Administration. The DPPOS has been showing continued benefits in delay of diabetes onset with additional cost benefits.

Here’s a Centers for Disease Control and Prevention (CDC) YouTube video highlighting a participant’s experience if you want to check it out: 👇️ 

The MDPP was developed based on learnings from the DPP and modified for the Medicare population. Its goal is to help participants lose at least 5% of their body weight to improve health, reduce the risk of type 2 diabetes, and reduce Medicare expenditures.

It is essentially a lifestyle change program. Participants work with the MDPP organization (supplier) on healthy food choices and portion control, physical activity, weight loss, and behavioral support strategies. More details:

• 16 weekly core group sessions over 6 months, followed by monthly sessions for the rest of the year

• Trained lifestyle coaches work with participants on behavior change techniques and support

• Live and virtual sessions

• No cost to qualifying participants

The Medicare Diabetes Prevention Program (MDPP) is not a permanent Medicare benefit. It was introduced as the first expanded model under the Centers for Medicare & Medicaid Services (CMS) Innovation Center. This means it was initially tested as a pilot program to evaluate its effectiveness in reducing diabetes risk and healthcare costs. Based on its success, it was expanded to be available nationwide. There are certain flexibilities in the MDPP that are funded through Congress, such as the telehealth waiver to allow virtual participation. This has been extended through 2027. The program will continue to be evaluated for its success in improving health and reducing costs.

Supplier Participation has been Lackluster

One of the downfalls of the program is the limited uptake of suppliers, or organizations who have applied to administer the program. They are most heavily concentrated in the Northeast. Fewer than 10,000 beneficiaries have been enrolled. The below is from the “MDPP Expanded Model: Findings at a Glance.”

Want to check out the full, 100-page evaluation report? Find it here.

So why has supplier participation been so low?

There are a number of reasons why relatively few suppliers have joined the Medicare Diabetes Prevention Program (MDPP):

1. The low and performance-based reimbursement rates: The reimbursement provided by Medicare for MDPP services is often considered insufficient to cover the costs of delivering the program. This includes expenses for staffing, facilities, and administrative tasks. The total reimbursement a supplier can receive for participants who attend all sessions and reach goals is only $768 per beneficiary.

2. The complex enrollment process: Becoming an MDPP supplier involves navigating a detailed and sometimes cumbersome enrollment process, which can deter potential participants.

3. The data reporting requirements: Suppliers are required to meet specific data reporting standards, which can be resource-intensive and challenging for smaller organizations.

   

   From the Evaluation of the MDPP

4. The limited awareness: Many organizations that could potentially serve as suppliers may not be aware of the MDPP or its benefits, leading to underrepresentation. CMS has not promoted it sufficiently.

5. The geographic and demographic challenges: Some areas, particularly rural regions, may lack the infrastructure or population density to support MDPP services effectively.

6. The uncertainty about the program’s continuation: Since the MDPP is not a permanent Medicare benefit, some organizations may hesitate to invest in becoming suppliers due to concerns about the program's long-term viability.

These limiting factors could be addressed to improve supplier participation. CMS has allowed many different types of organizations to be participants in the program, including community based organizations such as YMCAs. But to apply to the MDPP, organizations have to first achieve Centers for Disease Control and Prevention (CDC) recognition. They must have run similar successful programs in the past.

MDPP Program Results

In the most recent Evaluation Report of the MDPP in March 2025, CMS shared the positive results. Here’s what the program accomplished, even as it has only reached under 10,000 beneficiaries sine 2018.

Imagine the impact of even just 10X-ing that? The total number of qualifying beneficiaries is around 16 million!

Weight Loss

• Over half of beneficiaries (52-53%) lost at least 5% of their body weight. Remember, to qualify for the program you need to have a BMI of 25 at a minimum (23 if Asian).

• 22-24.5% of participations lost at least 9% of their body weight.

• More weight loss was strongly correlated with session attendance.

  

  From the March 2025 Evaluation Report

Physical Activity

• The percentage meeting the goal of 150 minutes per week increased throughout the program, reaching 69% by session 16 and 72% by session 22.

Diabetes Incidence

• Among MDPP Fee-For-Service beneficiaries, program participants who met the 5% weight loss goal had a 36% lower rate of developing diabetes compared to participants who did not meet the goal. (Note: The original DPP trial showed lifestyle changes reduced diabetes risk by 58% overall and 71% for those 60+).

Additional Benefits:

• Participants report improvements in behavioral health. In fact, many find the group-based nature supportive. Telehealth delivery has been found to be feasible, acceptable, and effective for older adults.

We Must Amplify the Results to Expand the Reach of the MDPP

The Danger of Success that Isn’t Disseminated

It doesn’t matter what role you happen to play in healthcare. I hope you share the success of the MDPP.

Herein lies the critical risk if we don’t: we might wrongly interpret the limited reach and consequent limited overall population impact of the MDPP as a failure of the concept itself, leaving it at risk for being terminated. If low enrollment numbers, driven by the barriers above, lead us to conclude that "prevention programs like this don't work well enough," we miss the vital point. The MDPP's struggles are largely rooted in lack of awareness, implementation friction, and an inadequate system support, not in the evidence-based power of engaged behavior change.

Dismissing the MDPP or failing to learn from its rollout challenges jeopardizes more than just diabetes prevention. It risks dampening enthusiasm and investment in all VBC initiatives that rely on proactive patient engagement and behavior modification – which is to say, most of them. If we can't successfully implement and scale a program with such strong foundational evidence, how can we expect to succeed with other complex VBC models targeting chronic conditions?

What We Must Learn and Do: A Call to Action

The MDPP experience provides a vital blueprint – both of what works and what needs fixing. Here’s what healthcare providers, health systems, payers, and community organizations should take away:

Prioritize Provider Education & Streamlined Referrals: We need targeted efforts to educate PCPs and other ALL other clinicians about prediabetes screening and the value of MDPP. Referral processes must also be simplified and integrated into clinical workflows (e.g., via EHR prompts).

If you are a dietician or a PT or an OT or a behavioral health provider or a physician specialist, etc. and you are aware of or suspect they could qualify for the program per the above qualifications, then for Pete’s sake—tell them about the program and why they should consider participation.

…If there’s a supplier by you, of course. If there isn’t? Consider starting one or partnering with other community providers to help one get approved by the CDC!

Why? Recommendation to attend by their healthcare professional was the top motivator for beneficiary enrollment in the MDPP.

By far. 👇️ 

Address Program Complexity: Simplified beneficiary enrollment and program delivery requirements to reduce administrative burden without sacrificing core effective components would likely help.

Active Prevention Programs that Address Chronic Diseases Need Sustainable Reimbursement: Payers, including CMS, must recognize that effective, intensive lifestyle change programs require adequate funding to be sustainable and accessible. Reimbursement models should reward engagement and outcomes appropriately. Programs like this may benefit from initial start-up finding by payers to build the infrastructure to support long-term participation.

Foster Stronger Clinical-Community Linkages: Health systems and clinics need robust partnerships with community-based organizations equipped to deliver lifestyle interventions effectively, reaching patients where they live.

Accountable Care Organizations can raise awareness of the program and partner with a local organization to develop and implement it. A full-risk advanced primary care practice might want to develop their own for their patients and to attract new patients at high risk of developing diabetes.

Embed Patient Engagement as a Core VBC Strategy: Patient engagement is time-intensive and resource intensive, but it works. The central lesson is clear: achieving better health of populations at lower costs demands activating patients. We must invest in the tools, techniques, and program designs (like those exemplified by the DPP/MDPP model) that foster deep, sustained engagement.

What do you think? Will you check out who the MDPP suppliers are in the area?

Will you consider referring patients or telling friend/family?

Will you let your primary care provider or your fellow healthcare professionals know about the program?