When the National Committee for Quality Assurance (NCQA) contacted payers gauging interest in answering questions for a study looking at how health plans could reduce greenhouse gas emissions, the response was tepid.
Nine health plans did agree to participate, anonymously, but many insurers had reservations about the project.
“When we were looking for health plans to participate, there was a little bit of hesitancy in terms of becoming part of the study just because of the political climate and/or they weren’t necessarily looking at climate sustainability, so they weren’t sure that they could contribute to the study,” said Adrianna Nava, a research scientist at NCQA, in an interview with Fierce Healthcare.
The U.S. healthcare industry contributes to 8.5% of national greenhouse gas emissions, but President Donald Trump has spoken out against climate change policy from the Obama and Biden administrations. In 2022, the Department of Health and Human Services launched a climate pledge for the health sector, designed to get organizations to reduce greenhouse gas emissions by half by 2030.
During Trump’s first week in his second term, he signed an executive order pulling the country out of the Paris climate agreement for the second time. Government agencies warned federal employees to not use certain words—clean energy, climate science or pollution, for example—and to remove these phrases from public websites, reported The New York Times.
The Environmental Protection Agency, like many agencies, has seen a clearing out of staff. The EPA is planning to stop collecting greenhouse emissions data and quit warning that these gases threaten public health, according to multiple reports.
Of the nine health plans that did participate in the study, they are based in a variety of geographies, says Nava. Most participants are larger health plans with more than 100,000 members.
Insurers explained they wanted to look at strategies within their control, noting government policy on the issue is largely outside their purview. They said it’s hard to make progress on climate sustainability because there is not much publicly available, standardized guidance to follow.
Still, the health plans largely agreed upon a framework to think about these issues, with NCQA developing “The Resilient Health Systems Model.”
The group narrowed down seven top strategies for health plans from a list of 27 to help connect sustainability with quality goals. They are:
- Implementing a sustainability officer or team
- Implementing strategic planning through forecasting and modeling use cases
- Measuring scope 2 emissions (indirect greenhouse gases from the purchase of electricity, cooling, etc.) at health plan facilities
- Installing energy-efficient equipment
- Supporting the electrification of health plan buildings and equipment
- Utilizing renewable energy
- Imposing fines and penalties for not disclosing carbon emissions
Telehealth, delivery of at-home medical kits and other delivery system interventions were considered, but plans felt they needed to see these strategies succeed in case studies before determining if they could be applied broadly.
“In terms of looking at different incentives that health plans could do, whether it's shifting to focus on primary care or covering specific medications, there wasn't really much discussion there in terms of the impact they could have,” said Nava.
The report was funded by a grant from The Commonwealth Fund and presented at the annual AcademyHealth research meeting earlier this month. In addition to the HHS climate pledge, the model also builds off findings from the Agency for Healthcare Research and Quality’s decarbonization priorities.