Medi-Cal DPP Engagement Is A Product of Meaningful Design

When it comes to Medi-Cal diabetes prevention programs (DPPs), it’s easy to assume that measurable health outcomes, like weight loss and A1c reduction, are the key indicators of meaningful program design and the drivers of sustained member engagement.

These health outcomes are certainly important. But if these clinical results are weak, they don’t quite tell you where to look if something isn’t working.

What if member engagement is both the true driver of positive health outcomes and the key to understanding if a DPP really works? 

For health leaders looking to improve health outcomes for their Medi-Cal patients through DPPs, this shift in thinking is crucial. Engagement is a leading indicator of program success, not just a byproduct. 

Low Engagement = Low Impact

DPPs are an excellent strategy for creating long-term positive health outcomes for those at risk for diabetes. Research has shown that patients who regularly participate in these programs experience significant reductions in several key health indicators, including weight, A1c, BMI, and lipid profiles.  

But these clinical results aren’t possible without sustained engagement. When members stay connected long term, evidence-based interventions have time to work. When they disconnect, even the most detailed programs can fail.

And the risk of member disconnection may be higher for Medi-Cal patient populations.  

Studies have shown that traditional DPPs have struggled to retain participants. High attrition rates have been noted for low-income and ethnically diverse populations. 

That should be concerning for health leaders hoping to create meaningful lifestyle changes in their at-risk patient populations. The very programs meant to help these communities are losing their interest before they have a chance to influence healthy behaviors.    

What Leads to Member Disengagement?

Programs risk losing members when they assume the one-size-fits-all design approach – that if it works for one group of people, it should work for everyone, without alterations. But that couldn’t be farther from the truth.

This approach ignores social determinants of health: the social, physical, and economic factors of everyday life that affect health outcomes. These can include an individual’s access to things like housing, nutritious foods, job opportunities with flexible schedules, reliable transportation, and digital tools.

When a program fails to keep these aspects of daily life in mind, it creates major barriers to member engagement.

For Medi-Cal members, language and cultural factors can also act as barriers to engagement. When programs don’t take into account the diversity of languages spoken in members’ communities, the cultural foods that can be found at every family gathering, or the spiritual practices that matter to them, high attrition may be inevitable. 

Programs need to foster trust in their participants by meeting them where they are, without ignoring who they are and what they care about.

Engagement-First Design Strategies

Meaningful engagement happens when programs intentionally implement health equity strategies that prioritize social determinants of health, cultural competency, and ease of usability. These can look like: 

• Cultural relevance strategies that acknowledge the foods and family dynamics that define a community’s cultural identity. Members shouldn’t need to abandon their culture for the sake of health; they should learn practical tools that work within them. 
• Language accessibility that considers language diversity and differences in health literacy across populations. Content that is available in an array of languages and in a relatable, patient-friendly manner is key.
• Digital accessibility that provides easy-to-access information while accounting for differences in digital tool access and digital literacy across populations. Programs should consider solutions that remove unnecessary digital barriers for their members.
• Real-life integration that seamlessly blends with the demands of everyday life. A program that members can access between work shifts, childcare demands, and doctors’ appointments will be much easier to engage with than a program that competes with daily schedules. 

When design strategies like these are used, fewer members drop off after enrollment and participation feels meaningful and manageable, rather than burdensome.

And for Medi-Cal plans focused on population health and quality outcomes, the engagement that follows thoughtful program design is a great indicator for program completion, risk reduction, and long-term costs.

The Bottom Line: Engagement Drives Outcomes

It’s tempting to evaluate the efficacy of DPPs by clinical measurements like weight loss or A1c reduction. Those health outcomes do matter, but they are lagging indicators. Sustained engagement is the leading indicator that signals that a program has successfully connected with participants and fostered positive health changes. 

If your team is assessing how to improve DPP participation in Medi-Cal populations, we’re happy to share how engagement-first program design works in practice. Yumlish partners with Medi-Cal plans to deliver culturally affirming, real-world DPPs that improve both engagement and outcomes.

Book a walkthrough to learn more about engagement-driven prevention in action.

References

Cannon, M. J., Masalovich, S., Ng, B. P., Soler, R. E., Jabrah, R., Ely, E. K., & Smith, B. D. (2020). Retention Among Participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012–2017. Diabetes Care, 43(9), 2042. https://doi.org/10.2337/dc19-2366

Sepah, S. C., Jiang, L., Ellis, R. J., McDermott, K., & Peters, A. L. (2017). Engagement and outcomes in a digital Diabetes Prevention Program: 3-year update. BMJ Open Diabetes Research & Care, 5(1), e000422. https://doi.org/10.1136/bmjdrc-2017-000422

Helal Salsa, G., Springer, A. E., Ranjit, N., McWhorter, J. W., & Reininger, B. M. (2026). The Effect of Virtual Versus In-Person Delivery on Behavior Changes Among Adults Enrolled in the Diabetes Prevention Program in the Rio Grande Valley, Texas: A Secondary Analysis. AJPM Focus, 5(2), 100457. https://doi.org/10.1016/j.focus.2025.100457