Client: American Diabetes Association (ADA)
Challenge: Membership had fallen from 20,000 to 10,000 over five years, averaging -8% annually; renewal rates had collapsed by 10-16 points; the value proposition hadn’t been revisited in thirteen years; and the organization had a 4% share of its own market
Outcome: Membership decline reversed and stabilized; retention rate improved dramatically; 5-6% revenue growth achieved; foundation built for group, international, and subscription-based growth
The Situation
The American Diabetes Association is the leading scientific and professional organization for diabetes care in the United States — the publisher of the Standards of Medical Care in Diabetes, the convener of the world’s largest diabetes scientific conference, and the organization trusted by more healthcare professionals in this field than any other.
And it was losing members at an alarming rate.
When ADA engaged Sequence Consulting in 2024, membership had fallen from a peak of 20,000 to just over 10,000 — a decline of nearly 50% — averaging -8% per year over the prior five-year period. Renewal rates had collapsed by 10-16 points over eight years, falling well below the 82% industry average for professional organizations and approaching territory that Sequence’s analysis identified as existential: if the trend continued, ADA professional membership would be unviable by 2029.
The causes were structural and interconnected. The value proposition hadn’t been revisited in thirteen years. The membership model was one-size-fits-all in a profession that required segmented approaches. Most of the ADA’s most valuable resources — journals, educational content, clinical guidelines — were freely accessible to non-members through institutional access, eliminating the incentive to pay for membership. Member communications were almost nonexistent. And the organization was siloed internally, with membership staff disconnected from the science, education, and publications teams whose work created the value members cared about.
ADA held a 4% share of its own primary market — meaning 96% of the professionals it existed to serve were not members. The opportunity was enormous. The urgency was real. And the organization had been watching the numbers decline for years without a strategic response.
What We Found
Sequence conducted a full research and analysis program — internal discovery interviews with seven senior ADA leaders, qualitative research with ten member and non-member voices including editors of ADA’s flagship journals, data analysis across member counts, renewal rates, lapsed member behavior, and segmentation, and best practice research across peer organizations including the AMA, American College of Rheumatology, American Society of Clinical Oncology, and American Nurses Association.
The diagnosis was precise.
The cost-value equation was untenable for most members. Lapsed members overwhelmingly cited high costs and low perceived value as their reasons for leaving. Nearly a third of lapsed members didn’t even know they had lapsed — a signal of failed engagement, not deliberate departure. Nearly two-thirds said they would consider renewing if the value were clearer. This wasn’t a market rejection of the ADA. It was members drifting away from an organization that had stopped communicating why they should stay.
Most of the value wasn’t tied to membership. Analysis of ADA’s resource portfolio revealed that only about 10% of career-relevant resources were fully gated for members. The majority of its most important offerings — journals, educational content, clinical guidelines — were freely accessible to non-members through institutional subscriptions. Members could, and did, access ADA’s value without paying for it. When membership isn’t required to receive value, joining becomes optional rather than necessary. As one member put it bluntly: “I don’t have to be a member to access what the ADA produces.”
The model served one segment and left the rest behind. ADA’s membership appealed strongly to senior institutional physicians and researchers who could justify the dues. It had almost nothing tailored for the 23% of members who were primary care physicians, for early-career professionals who needed mentorship and career development, for educators, for allied health professionals, or for the vast international community that wanted ADA’s content but couldn’t justify pricing designed for US healthcare professionals. Five distinct segments — clinicians, researchers, educators, academics, and early career — had meaningfully different unmet needs. ADA was serving all of them with a single undifferentiated offer.
Internal silos were making everything worse. Member communications were almost non-existent. There was no welcome stream, no structured engagement in the critical early months of membership, and no systematic outreach to members approaching lapse. Membership staff, publications staff, and science staff operated independently, which meant the content members valued most wasn’t being marketed to them as a membership benefit. One senior member voiced what many were thinking: “The meeting and the publications are the only thing left that professionals see the ADA brings value.” Another went further: “There was incredible strength and voice for professionals that does not exist anymore. I think the organization went through a stage where it might have actually disappeared as a representative professional organization.”
The strategic direction was unclear even to the people inside. Qualitative research with members and leaders revealed a deeper problem: ADA was seen as having shifted its focus toward consumer diabetes patients and away from healthcare professionals, leaving professional members confused about who the organization was actually for. “Everybody knows what direction the ADA is going,” said one leader. “The challenge is that I couldn’t articulate it.” Another member was more direct: “It doesn’t represent me in a way that it used to. And everywhere around me, there are other associations that are starting to speak more for me than the ADA speaks for me.”
These weren’t fringe views. They were consistent themes across the research — member voices, leadership interviews, and data analysis all pointing to the same structural failures.
The Approach
Sequence designed and facilitated a full value proposition and membership strategy engagement — producing both a strategic findings and insights report and a concrete membership goals, objectives, and product bundling framework.
1. Defined the ADA’s Way to Play. Using Sequence’s proprietary Way to Play℠ framework, the engagement identified ADA’s unique assets — what it owns or can do that would be difficult or impossible for others to replicate. These included its flagship journals and standards of care, its convening power at Scientific Sessions, its grants and fellowship programs, its advocacy infrastructure, and its credibility as the unbiased, science-based voice in diabetes care. Mapped against the unmet needs of each member segment, this produced a clear value proposition: The American Diabetes Association empowers the diabetes care community to drive change and improve lives — by championing policies, providing comprehensive education, funding groundbreaking research, and fostering collaboration to advance care delivery, prevention, and a cure for diabetes.
2. Established shared membership goals and objectives. One of the most important outcomes of the engagement was aligning ADA’s leadership around shared membership objectives — something the organization had lacked. Four goals emerged: grow and diversify membership (reversing decline, expanding into primary care, international markets, and younger members); increase membership value and engagement (more members-only benefits, group membership infrastructure); strengthen member communications and participation; and increase event participation and grassroots engagement.
3. Developed product bundling criteria. Sequence built a framework for ADA to evaluate which resources should be member-exclusive, which should be broadly available, and which should be packaged into bundled offers for different segments. This addressed the core structural problem: ADA needed to make the value of membership visible, distinctive, and tied to the decision to join — not freely available to anyone with institutional access.
4. Designed the retention and winback architecture. Renewal communication strategy was identified as the most urgent immediate priority — reaching members before they lapsed with messages focused on the benefits most relevant to their specific segment, and creating a structured winback approach for recently lapsed members. Sequence designed the segmented communication approach built around what each member type actually valued: professional development and standards of care for clinicians, research funding and collaboration for researchers, career support and mentorship for early-career members.
5. Identified the international and group membership opportunity. Sequence identified international expansion and group membership as the primary paths to rapid membership growth — the “wholesale vs. retail” shift that had driven record membership at AMA and significant growth at organizations across the profession. World Bank–tiered international pricing ($10–$35 per member vs. the previous $99 price point), subscription-based entry for international healthcare professionals, and institutional subscription marketing were identified as high-leverage near-term moves.
The Result
The work began producing results within months of the engagement — and the trajectory that had been declining for years reversed.
Membership decline stabilized — ending years of consistent losses averaging -8% annually. Retention improved to over 65% and continued improving, with Q3 2024 showing particularly strong lift attributed directly to the winback and engagement communications Sequence had designed. The improvement in retention mattered enormously: for an organization that had watched renewal rates collapse by 10-16 points over eight years, stabilization was not a small achievement.
Revenue grew 5-6% — meaningful progress for an organization that had been contracting and a direct result of the pricing restructure, international strategy, and improved retention working together.
The international strategy produced immediate results: emerging market membership grew from 67 to 151 members within months of launching World Bank–tiered pricing ($10-$35 replacing the previous $99 price point), nearly tripling the base. Webinars were generating 3,000 registrations and 2,000 attendees — a new capture mechanism for non-members being converted to membership. The ADA’s Scientific Sessions — independently reported as drawing over 11,000 attendees from 115 countries in 2024 — showed the underlying event engagement strength that the membership model was now being rebuilt to capture and convert. Group membership conversations with large health systems and primary care networks were underway, modeled on the AMA health system approach.
Crucially, the ADA also achieved something that numbers alone don’t capture: internal alignment. For the first time, membership, education, publications, and advocacy teams were working from shared goals. The silos that had let member value go uncommunicated for years were breaking down.
“We’ve done really well this year from a membership perspective. We’re ending the year at about 5-6% growth in revenue. Our membership growth is probably going to be flat year to year — which is awesome because we’ve been declining for a while. We have diversification in membership, which is good too.” — Traver McLaughlin, VP Marketing, Programs & Partnerships, American Diabetes Association
The comment about “flat” growth deserves context. Coming from an organization that had been losing 8% of membership annually for five years, flat is not a failure. Flat is an 8-point swing. It’s stopping a fall that, if unchecked, would have rendered professional membership unviable by 2029. The foundation is now in place to build from.
“We’ve done really well this year from a membership perspective. We’re ending the year at about 5-6% growth in revenue. Our membership growth is probably going to be flat year to year — which is awesome because we’ve been declining for a while. We have diversification in membership, which is good too.” — Traver McLaughlin, VP Marketing, Programs & Partnerships, American Diabetes Association
The comment about “flat” growth deserves context. Coming from an organization that had been losing 8% of membership annually for five years, flat is not a failure. Flat is an 8-point swing. It’s stopping a fall that, if unchecked, would have rendered professional membership unviable by 2029. The foundation is now in place to build from.
What This Means for Your Association
The ADA story is one of the most common patterns Sequence encounters in mature professional associations: an organization with extraordinary assets — world-class content, unmatched clinical authority, a trusted brand — that has stopped connecting those assets to the decision to join.
The instinct when membership declines is to look for acquisition solutions: more marketing, better campaigns, new channels. What the ADA’s diagnosis revealed was that acquisition wasn’t the problem. The value proposition hadn’t been revisited in thirteen years. The model served one segment and alienated the rest. The content members cared about most was free to everyone. And the communications infrastructure to tell members what they were getting — and remind them before they left — didn’t exist.
Fixing those things didn’t require building new assets. ADA already had extraordinary ones. It required making the assets visible, tying them to membership, communicating them in ways that reached each segment where they were, and building the operational infrastructure to prevent members from drifting away before ADA had a chance to show them what they’d joined.
Four questions worth asking about your own association:
When did you last revisit your value proposition? A value proposition built for the membership environment of five or ten years ago may be structurally misaligned with today’s members, who have different career stages, different access to information, and different reasons to belong. ADA’s hadn’t been touched in thirteen years. Most professional associations that Sequence diagnoses are working from propositions at least that old.
Is your most valuable content tied to membership — or available to everyone? This is the question most associations are afraid to answer honestly. If the resources members care most about are freely accessible through institutional subscriptions, Google Scholar, or your own public website, membership isn’t providing exclusive value — it’s providing convenience. That’s a much weaker reason to pay. The fix isn’t to lock everything down. It’s to identify the highest-value assets and make them genuinely member-exclusive. ADA had only 10% of its career-relevant resources fully gated. The gap between what membership promised and what it actually required was the gap that caused people to leave.
Are you serving your full member spectrum, or one segment of it? ADA’s model worked for senior institutional researchers and physicians. It had almost nothing for primary care, early career, international, or allied health members. Each of those underserved segments represents a growth opportunity that a segmented value proposition and tiered pricing model can unlock — and in ADA’s case, the international segment tripled within months of getting pricing right.
Do your membership, content, and communications teams share goals? ADA’s silos weren’t unusual. In most associations, the people who create the value members care about and the people responsible for membership operate in parallel rather than together. The result is that member-relevant content doesn’t get communicated as a membership benefit, new members don’t get onboarded into the resources they joined to access, and lapsing members don’t get reached before they leave. Alignment across those teams is as important as any strategic initiative.
The ADA’s membership decline wasn’t inevitable. It was the predictable result of a model that hadn’t adapted to a changed market. The reversal — stabilized membership, improved retention, revenue growth, and a platform for accelerated growth — came from making the right diagnosis and building the right infrastructure to act on it.
About Sequence Consulting Sequence Consulting works exclusively with professional and trade associations to grow membership, strengthen revenue, and clarify strategy. Founded in 2001 by Chris Vaughan, PhD and Lisa Vaughan, Sequence brings the rigor of Big Strategy consulting to mission-driven organizations. Trusted by 12 of the top 20 U.S. associations.
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