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Turning Down the Heat: Measuring the Effects of Climate Change to Improve Health Equity
As climate change continues to affect weather patterns and increase the likelihood of extreme weather events, health care leaders are increasingly concerned about its impact on health and the health care system. The Lancet asserts that climate change is the greatest global health threat facing the world this century. In August 2021, the US Department of Health and Human Services (HHS) established the Office of Climate Change and Health Equity. In April 2022, HHS issued a request for proposal asking for input by mid-May on their Environmental Justice Strategy and Implementation Plan draft outline.
In this post, we explore the intersection between climate change and health equity and discuss opportunities to leverage quality measurement and value-based payment incentives to drive climate action and mitigate impacts on health equity. Opportunities include:
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Improving data collection to capture climate-sensitive health impacts;
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Integrating climate change into measurement and value-based payment; and
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Ensuring health equity plans address potential climate-related impacts on health care quality and outcomes.
Background
In December 2020, Health Affairs published a climate and health theme issue, highlighting topics such as the health sector’s contribution to carbon emissions and pollution; harmful health effects from experiencing natural disasters; climate change’s effect on communities, and how they are learning to adapt; and policy opportunities to prevent further damage. Select examples of climate change impacts on various aspects of public health and health care are synthesized in Table 1. Unchecked, challenges posed by climate change can compound already existing health disparities.
Table 1: Examples of Climate-Change Related Health Impacts as Described by Salas et al.
| Challenge | Detail |
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Access |
Escalating climate crises could lead to widespread health care disruption (eg, hospital closures in already resource-scarce areas, transportation disruptions, reduction/displacement of the health care workforce). |
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Cost |
Increased burden due to certain diseases (eg, malaria) has been connected to climate crises leading to financial strains among health systems, payers, and patients. For example, chronic conditions can be negatively affected by natural disasters, such as hurricanes, due to disruption of critical public health, health care, water and sanitation, and food distribution systems. |
|
Quality |
Climate crises could lead to hospital overcrowding and medical supply shortages, which may negatively affect quality of care provided. |
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Data Exchange and Interoperable Information Flow |
Health care organizations are gearing up to transition data collection and exchange to a fully digital environment. However, current data systems are not optimized to ensure continuity of medical records should an adverse climate event impact the health care system. |
Climate Change and Health Equity
Climate change is a health equity issue. Considering social determinants of health, climate change can amplify disparities in access to quality care. For example, one prospective study of predominantly low-income, Black patients who were impacted by Hurricane Katrina found that those with preexisting health conditions were at much higher risk of experiencing health care lapses the week following the hurricane when compared with Black patients without preexisting conditions.
Adverse climate change events are likely to have the greatest impact on marginalized communities that experience greater climate-sensitive health risks such as increased morbidity and mortality related to extreme events, food and water insecurity, and loss of livelihoods and resource conflicts.Leading health organizations, including the National Network of Public Health Institutes and the American Public Health Association, have already raised awareness of environmental health justice issues arising from climate change, such as poor air quality that is particularly harmful to vulnerable groups—including children, people with respiratory illnesses, and older adults—as a public health priority.
Quality measures can drive positive change by identifying and monitoring gaps in care and assessing interventions to close the gaps.There is an opportunity to address the intersection of climate change and health equity to support efforts to reduce disparities and mitigate climate-related health impacts, harnessing momentum from recent movements.
Improving Data Collection to Capture Climate-Sensitive Health Impacts
There are quality measurement-related challenges that pertain to both health equity and climate change. Data collection for measuring climate-related public health threats will need to start with improved coding to capture climate-sensitive health impacts (eg, extreme heat, drought, storms, fires, flooding) to better identify emerging trends in climate-related health impacts and opportunities to target and mitigate these impacts.
Improved data collection also can include important demographic and socioeconomic factors to help stratify measures by population and understand the disproportionate effect of climate change and any drivers of climate-related health impacts on different populations. HHS has outlined enhancements for research and data collection, analysis, and utilization as part of its priority actions in the 2022 Environmental Justice Strategy and Implementation Plan Draft Outline.
Integrating Climate Change into Measurement and Value-Based Payment Efforts
While developing climate change-focused measures (eg, assessing the risk of hospital admission related to extreme heat in older adults) will not reverse the impacts of climate change, they can help identify effects on public health and ways to mitigate the health-related aftermaths of natural disasters, changing weather systems, pollution, and other extreme weather events. These measures can be integrated into new and existing health care payment models to incentivize mitigating disparities related to climate change. HHS has also noted performance measures to be a priority in the 2022 Environmental Justice Strategy and Implementation Plan draft outline.
There is also an opportunity to integrate climate-related topics into proposed and existing quality measures. For example, the Centers for Medicare & Medicaid Services’ (CMS) annual List of Measures Under Consideration from December 2021 includes two health-equity focused measures, Screening for Social Drivers of Health and Screen Positive Rate for Social Drivers of Health, recommended for use in the Merit-Based Incentive Payment System (MIPS) and Hospital Inpatient Quality Reporting Program (HIQR). These measures are intended to evaluate the percent of beneficiaries 18 years and older who are screened and those who screen positive for food insecurity, housing instability, transportation needs, utility assistance, or interpersonal violence. The proposed measures fulfill a need for patient-level demographic and standardized social needs data that CMS highlighted as a key to embedding equity in its models and demonstrations. Modifying these measures to accommodate screening for additional climate change-related factors such as living in areas prone to high rates of air pollution, extreme temperatures, and other climate-related events (eg, natural disasters) could promote the capture of more robust patient-level data addressing climate change impacts on health and health care.
Ensuring Health Equity Initiatives Address Potential Climate-Related Impacts on Health Care Quality and Outcomes
CMS’ Center for Medicare and Medicaid Innovation (CMMI) Director, Liz Fowler, shared that creating a health equity plan will be a permanent requirement for participants in CMMI’s value-based payment (VBP) models moving forward. Health equity plans must identify underserved communities and design new initiatives to reduce health disparities. The health equity plan requirement has already been integrated into the recently launched ACO REACH payment model, a refurbishment of the Direct Contracting model. Model participants developing health equity plans could address the intersection between equity and climate health by identifying populations at higher risk of experiencing worse health care quality and outcomes (eg, people living in areas at risk of food or housing insecurity) because of adverse climate events, to inform quality improvement interventions.
Conclusion
As payers, including CMS, continue to refine value-based payment models and HHS drafts its 2022 Environmental Justice Strategy and Implementation Plan this year, there are opportunities to leverage climate change in measurement efforts to mitigate health disparities. Health equity plans should also address potential climate-related impacts on health care quality to help improve health outcomes.
About the Quality Outlook Commentary Series
Breakthrough treatments in cancer care, including precision therapies tailored to specific patient factors, are driving rapid changes in the definitions of oncology quality and value. Efforts to implement value-based care models in oncology must meet the demands of evolving science, new best care practices, and shifting patient priorities. Quality measures must be up-to-date and relevant. Payment models must recognize the challenges and costs of managing complex patient populations with diverse needs. In this JCP blog series, Quality Outlook, Discern Health will explore key issues in oncology quality and value through posts focused on measurement, value-based payment, and quality improvement.
About Jan Ileto, MSPH
Jan Ileto, MSPH, is a Project Analyst at Discern Health, part of Real Chemistry, with experience in community health research, immigrant health, and health care disparities. Before joining Discern, Jan worked with HCBS Strategies on improving home and community-based services at the state level and with Centro SOL on evaluating a program to improve insurance access among Latinx families in Baltimore. She currently supports projects related to quality of care and value-based processes.
About Jacqlyn Riposo, MBA
Jacqlyn Riposo, MBA, is a Director at Discern Health, part of Real Chemistry. She has over a decade of experience in health care policy with a diverse portfolio of federal agencies and nongovernmental clients. She leverages her background in quality measures, evidence-based medicine, and project management to help Discern clients and partners achieve their goals.
About Alexis Malfesi, MSHS
Alexis Malfesi, MSHS is a Director at Real Chemistry. She works with stakeholders across the healthcare system to improve patient and caregiver outcomes and develop strategies for success in value-based environments. Alexis has expertise in quality measure development, patient and family engagement, and practice transformation.
Blog Editor
About Tom Valuck, MD, JD
Tom Valuck is a Partner at Discern Health, part of Real Chemistry. He is a thought leader on health care system transformation and helps lead the firm’s focus on achieving better health and health care outcomes at a lower cost. Tom’s work at Discern includes facilitating the exploration of next-generation measurement and accountability models for health care delivery systems. He also helps clients develop strategies to achieve success within the value-based marketplace.
About Discern Health
Discern Health, part of Real Chemistry, uses research and strategic advisory services to help our clients improve health and health care through value-based payment and delivery models. These models align performance with incentives by rewarding doctors, hospitals, suppliers, and patients for working together to improve quality while lowering total costs. Real Chemistry is an independent provider of analytics-driven, digital-first research, marketing services, and communications to the healthcare sector.
