How Organizations Sustain the National Diabetes Prevention Program: Real-world Strategies for Financing and Cost Control.

The National Diabetes Prevention Program (NDPP) is an evidence-based lifestyle intervention that has been adopted by over 3,000 organizations, but over half have since discontinued services, often due to challenges with financial sustainability. To identify successful strategies for financial sustainability, we analyzed data from interviewing 21 program coordinators at organizations that had sustained NDPP delivery for 5 or more years and planned to continue delivery. These organizations had delivered the NDPP for 8.5 years on average. Rather than relying on a single source of program financing, they layered multiple funding sources, including billing, grant funding, in-kind organizational support, and charitable donations. Organizations utilized the expertise of billing and finance professionals to submit claims and manage payer contracts. They also controlled delivery costs with efficient operations, using proven recruitment strategies, minimum group sizes, virtual delivery, and lower-cost staffing models. Finally, they reduced administrative costs by partnering with external service providers for administrative support and to facilitate compliance with regulatory requirements. Despite expanding payer coverage, grant funding and in-kind support remained critical, highlighting the gap between reimbursement rates and delivery costs. These strategies may help other organizations strengthen and sustain access to the NDPP while reimbursement models continue to evolve.