Clinical Support

Rethinking Diabetes Prevention: Six Pillars for Value-Based Success

As a payer, you face rising costs from diabetes and its complications, along with pressure to improve quality, close care gaps, and meet HEDIS/Stars requirements. Every year, diabetes costs in the U.S. total $306 billion in direct medical expenses and $106.3 billion in lost productivity cost to employers from absenteeism, presenteeism, disability, and premature mortality. 

The Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Program (National DPP) lifestyle change program has proven it can reduce diabetes incidence by 58% (71% for those 60 and older)—but payers need more than evidence. You need a prevention strategy that is scalable, measurable, and aligned to your value-based contracts.

That’s why the Diabetes Prevention Alliance (DPA) of the American Diabetes Association® (ADA) exists. We bring together delivery organizations, health care professionals, and employers under a framework designed for payers: diabetes prevention that is compliant, integrated, and proven to deliver return on investment.

What We Offer Payers: Six Pillars of Value

1. Population Activation: Closing the Prevention Gap

We help you identify and activate your at-risk members by:

  • Mining claims, electronic health record (EHR), and lab data to flag prediabetes earlier.
  • Using culturally tailored outreach across primary care, pharmacies, and employers.
  • Offering incentive strategies (premium reductions, HSA contributions, wellness credits).

Benefit for payers: Broader engagement of high-risk members reduces future claims costs.

2. Clinician Integration: Aligning Prevention with Quality Measures

Through the ADA’s Primary Care Alliance, we embed prevention directly into clinical workflows:

  • Automated referrals and eligibility checks.
  • Demonstrated impact on HEDIS/Stars measures (BMI, A1C, blood pressure).
  • Reduced burden on clinicians while strengthening your clinician network.

Benefit for payers: Higher quality scores, lower clinical friction, better population health.

3. Value-Based Reimbursement: Contract Models That Work for Payers

We move beyond fee-for-service G-codes with payer-aligned options:

  • Shared savings- and outcomes-based reimbursement.
  • Bundled payments/value-based agreements tied to weight loss and risk reduction.
  • Flexible models that scale across commercial, Medicare Advantage, and Medicaid lines of business.

Benefit for payers: Payment structures that ensure return on investment (ROI) and reward measurable impact.

4. Data & Interoperability: Real-Time ROI Visibility

Our DPP Express platform and Fast Healthcare Interoperability Resources (FHIR)-enabled tools ensure:

  • Seamless data exchange with claims and EHR systems.
  • Population-level dashboards showing outcomes, engagement, and cost savings.
  • National benchmarking to prove and compare impact.

Benefit for payers: Transparent, actionable data that proves prevention is working.

5. Governance & Compliance: Reducing Payer Risk

Prevention contracts raise compliance complexities. We simplify them with:

  • Standardized governance frameworks and model contracts.
  • Agreements with built in HIPAA and anti-kickback safeguards.
  • Clear structures for outcomes-based and shared savings arrangements.

Benefit for payers: Confidence that prevention can scale safely and compliantly.

6. Implementation & Change Management: Making Prevention Stick

We help payers move beyond pilots with:

  • Tailored implementation for diverse populations (rural, urban, employer-based).
  • Ongoing change management support for delivery partners.
  • Strategies to embed prevention as a standard covered benefit.

Benefit for payers: Sustainable, system-wide adoption that drives long-term cost savings.

Why partner with the DPA?

  • National credibility: Backed by the ADA.
  • Delivery network: A vetted group of CDC-recognized Lifestyle Change providers across geographies.
  • Proven infrastructure: Tools, governance, and contract models ready to implement.
  • Aligned incentives: Designed to meet payer priorities for cost, quality, and compliance.

Bottom Line for Payers

Diabetes prevention is no longer a “nice-to-have.” It is a proven cost-savings strategy that strengthens quality performance and reduces long-term financial risk.

By partnering with the DPA, payers gain a turnkey prevention infrastructure that is:

  • Scalable across markets
  • Compliant with federal and state regulations
  • Proven to reduce risk and cost

The DPA offers payers prevention that pays off.

Source: Emily D. Parker, Janice Lin, Troy Mahoney, Nwanneamaka Ume, Grace Yang, Robert A. Gabbay, Nuha A. ElSayed, Raveendhara R. Bannuru; Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care 2 January 2024; 47 (1): 26–43. https://doi.org/10.2337/dci23-0085