Opportunities and obstacles associated with the Medicare Diabetes Prevention Program

CMS has provided full coverage of the Medicare Diabetes Prevention Program (MDPP) since 2018. However, the MDPP's potential to impact public health has been limited by the lack of program suppliers and participants. This study describes the opportunities and obstacles associated with MDPP implementation from the novel perspective of program coordinators across the US.

We conducted a qualitative study with a sample of program coordinators from MDPP suppliers listed in the CMS database.

We conducted individual interviews with 12 program coordinators to learn about their experiences becoming a Medicare-designated program supplier and delivering the MDPP. Data were analyzed using the Rapid Group Analysis Process.

Six themes emerged: 2 about opportunities and 4 about obstacles. Opportunity themes reflected (1) supportive organizational cultures and (2) committed staff who were passionate about and invested in offering the MDPP. Obstacle themes revealed (1) challenges around obtaining Medicare designation, (2) logistics of submitting claims and receiving reimbursement, (3) insufficient payment associated with the pay-for-performance model and Medicare Advantage plans, and (4) overwhelming and conflicting government requirements. Program coordinators offered recommendations to support organizations in providing the MDPP, including peer mentors for onboarding and continued assistance and a more traditional fee-for-service payment model.

These findings highlight organizational culture as a strength for MDPP implementation and suggest policy changes to address MDPP obstacles. Wider program dissemination is urgently needed to prevent type 2 diabetes among the approximately 5.2 million eligible Medicare beneficiaries.