Healthcare contributes to nearly 9% of U.S. greenhouse gas emissions. What strategies can help the industry address its climate footprint?
A new analysis tackles the topic in the latest Health Affairs issue, published this week, dedicated to climate, health and equity. Climate change poses clear risks to healthcare, it noted, from injuries to shortages. U.S. health systems need to act to support better outcomes and prevent further strain on the system, its authors wrote while laying out a number of potential strategies to do so.
Value-based reimbursement models can help align financial incentives to decarbonize healthcare, they suggested. Given that value-based care prioritizes outcomes, the approach can reduce low-value interventions, improve care coordination and reduce emissions through greater efficiency. Reducing emissions across all U.S. hospitals could yield over $5.4 billion in savings over five years, the Commonwealth Fund estimates.
CMS’ Hospital Value-Based Purchasing Program, which ties reimbursement to performance, could incorporate sustainability benchmarks into its performance metrics, they wrote. These could include intensity of energy use, green building certification or renewable energy procurement. CMS has also proposed the TEAM (Transforming Episode Accountability Model) Decarbonization & Resilience Initiative, which uses Energy Star benchmarking and reimbursement incentives to encourage hospitals to reduce emissions.
Payers could also link reimbursement to environmental performance, such as through carbon-sensitive payment adjustments or sustainability metrics embedded in contracts. This could promote lower-carbon modalities like telehealth or support transitioning hospital energy systems to electric alternatives.
The analysis highlighted the importance of mandatory emissions-reduction targets, such as those happening in England under the National Health Service (NHS). Conversely, U.S. efforts are all voluntary, from the Department of Health and Human Services' Health Sector Climate Pledge to the Joint Commission’s Sustainable Healthcare Certification.
“Without mandatory carbon accounting and transparent reporting, these programs risk greenwashing … and are unlikely to drive progress toward decarbonization goals in the way that the NHS model has,” the authors wrote in their analysis.
Once again, fee-for-service was called out as the wrong reimbursement structure to incentivize climate work. “Without aligned financial incentives, voluntary efforts are unlikely to result in meaningful benchmarking and emissions reduction,” the authors wrote.
Additionally, the U.S. cannot depend on federal leadership to make change, they said. Instead, progress could be sought through multistakeholder supply-chain coalitions. Health systems could aggregate their purchasing power and require suppliers to disclose emissions or conduct product life-cycle assessments, the authors recommended. Supply chains account for nearly three-quarters of the global healthcare sector’s total greenhouse gas emissions, according to the analysis. Policymakers could help this along by embedding climate criteria, like compliance with energy efficiency standards, into procurement regulations.
Circular economy principles were recommended to help reduce single-use items. Scaling these efforts requires education and workforce engagement. Challenges like regulations that favor disposables require policy reforms that incentivize reusable, durable and nonplastic alternatives, such as from the Food and Drug Administration or the Centers for Disease Control and Prevention. And, HHS and the Centers for Medicare and Medicaid Services can align procurement and reimbursement policies to make circular practices economically viable.
State and local policy can also be enacted without federal action. California’s SB 253 law, which requires organizations to disclose their greenhouse gas emissions annually, creates reporting norms that can drive systemic changes in healthcare. Washington’s Clean Buildings Act is another example, mandating reporting on energy performance.
For healthcare stakeholders, the authors recommended vulnerability and adaptation assessments and national health adaptation plans to evaluate risks. Stress tests and exercises involving hypothetical emergencies can help identify system vulnerabilities and build relationships with emergency and infrastructure partners.
“As disasters become more frequent and resources for recovery are increasingly stretched, these proactive interventions can dramatically improve health systems’ continuity of services and patient outcomes,” the analysis said.
Policymakers can also tie preparedness funding, accreditation, reimbursement and capital financing to interventions like climate-risk assessments, early warning system integration and climate-resilient building standards.
Finally, educating providers is crucial to effect change. A recent global survey of public health schools found substantial gaps in this area, the analysis noted. Institutional engagement is also key. Linking climate-health education to accreditation, resilience planning and decarbonization goals can encourage staff participation—and by extension, patient engagement.
“Value-based reimbursement models and mandatory carbon accounting provide powerful structural incentives,” the analysis concluded. “Embedding sustainability within the core definition of health care quality is the essential next step. Doing so would enable [stakeholders] to address upstream drivers of disease while strengthening the resilience of care delivery in an era of escalating climate risk.”