New NCQA Research: What Health Plan Leaders Can Do to Reduce Climate Impact

The U.S. healthcare sector accounts for roughly 8.5% of total greenhouse gas (GHG) emissions, driven largely by energy use, supply chains, transportation and waste. While much of the conversation about healthcare decarbonization has focused on hospitals and clinical care, health plans play a powerful—and often overlooked—role in shaping how care is delivered and how resources are used.

To better understand how health plans can meaningfully reduce their climate impact, NCQA conducted new research to identify practical, evidence-informed strategies that health plans can implement today, even in a shifting policy environment.

Why We Did This Research

Existing research on healthcare decarbonization has largely centered on delivery systems, highlighting strategies such as care coordination, appropriate prescribing, telemedicine and avoiding unnecessary testing. These efforts matter—and the rapid expansion of virtual care during the COVID‑19 pandemic demonstrated real climate benefits. For example, one California health system avoided an estimated 17,000 metric tons of GHG emissions over three years by increasing virtual visits.

What has been missing is a comparable focus on health plans. Health plans influence care delivery through benefit design, provider contracting, network management and investment decisions. Yet there is limited guidance on where plans should start, which strategies are most feasible and how sustainability efforts can align with existing quality and performance goals. Our study was designed to help fill that gap.

How the Study Worked

NCQA used a structured, consensus-building research method to identify leading decarbonization strategies for health plans. We brought together health plan leaders from across the U.S., representing commercial, Medicare, Medicaid and Exchange lines of business, as well as both for-profit and not-for-profit organizations. Between August and October 2024, participants completed two surveys and joined a panel discussion that was convened between the two survey rounds.

Participants evaluated 29 potential decarbonization strategies across three criteria:

• How critical the strategy is for reducing emissions.
• Whether health plans can realistically use the strategy.
• Whether the strategy can be implemented without undue burden.

This approach allowed us to move beyond theory and focus on strategies that health plan leaders see as actionable in real‑world operations.

Key Insights

Three themes emerged consistently across the two surveys and the panel discussion.

1. Climate progress depends on the broader policy environment—but plans do not have to wait.

Participants were clear that government leadership and national climate narratives influence how quickly organizations act. At the same time, there was strong agreement that health plans can—and should—take action within their control, regardless of shifting federal priorities.

2. Strategies within a plan’s direct control rise to the top.

The highest‑rated strategies focused on areas that health plans directly own or manage, especially facilities, energy use and internal governance. These areas allow plans to act, measure progress and demonstrate impact without relying on external partners.

3. Climate action gains traction when aligned with quality goals.

When sustainability strategies align with goals that health plans already prioritize—such as access, efficiency, equity and affordability—they are more likely to be adopted and sustained. Telemedicine emerged as a strong example because it reduces emissions while improving access to care.

The Most Actionable Strategies for Health Plans

Participants identified seven priority strategies for health plans:

• Appointing a dedicated sustainability officer or team.
• Integrating climate considerations into strategic planning and forecasting.
• Investing in energy‑efficient lighting, heating, cooling and equipment in plan‑owned or controlled buildings.
• Electrifying building systems where feasible.
• Increasing use of renewable energy at plan facilities.
• Measuring and tracking Scope 2 emissions (energy-related emissions).
• Supporting government accountability mechanisms for emissions reporting.

For health plans, the takeaway is clear: you do not need to solve everything at once. By focusing on high‑impact, controllable strategies, health plans can make meaningful progress today and help shape a more sustainable healthcare system for the future.

Learn More

Read the full study, Top Consensus-Based Strategies for Health Plan Decarbonization: A Modified Delphi Study, published in the Journal of Climate Change and Health, here: https://www.sciencedirect.com/science/article/pii/S2667278225001385.

Acknowledgements

This research was made possible with support from the Commonwealth Fund (Grant Number 23-23436, 2023-2025).