December 18, 2024
December 18, 2024
Liz Fowler, director of the Centers for Medicare and Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (Innovation Center), is among the most influential leaders in U.S. health policy today. Her interest in the field first sparked during college. As the daughter and granddaughter of physicians, Fowler thought she’d follow in their footsteps. She initially planned to go the pre-med route in college but took a class in health care systems that revealed her passion for health policy and decided to dedicate her career to the field.
Over the years, this passion and dedication has taken Fowler to key policy roles on Capitol Hill with the Senate Finance Committee, and to the White House as a special assistant to President Obama on health care and economic policy at the National Economic Council. She helped develop game-changing health care legislation, such as the Affordable Care Act and Medicare Part D Drug Coverage. Fowler says her time with the White House was particularly instrumental in making her think more broadly about the health sector.
“Working in the White House really helped widen my aperture in looking at hospitals, health systems, and other providers, along with the role that they play at a societal level—not just in the health care arena,” she says.
It’s that broad-view approach that has also led to Fowler thinking extensively about the different ways in which climate change plays a critical role in the health care sector.
“I remember meeting with an integrated delivery system about climate change, and they conveyed the steps they had taken, and had planned to take, to become more energy efficient and reduce their carbon footprint,” she says. “I suppose that was the point where I began focusing on CMS, and how it is generally thought of as a health care payer—but how it might also be able to play a broader role in decarbonization.”
Fowler joined CMS in March 2021 as deputy administrator and director of the CMS Innovation Center and knew the agency could play a pivotal role in the climate and health space. Fowler notes that her role in the National Academy of Medicine’s (NAM) Action Collaborative on Decarbonizing the U.S. Health Sector (Climate Collaborative) has benefited the Innovation Center’s work. She serves as co-lead of the Policy, Financing, and Metrics Working Group, and says the Climate Collaborative has provided an invaluable forum.
That forum has been especially important in the Innovation Center’s development of a key component of the new CMS Transforming Episode Accountability Model (TEAM). Set to launch in January 2026 and run through December 2030, TEAM features the Decarbonization and Resilience Initiative: a voluntary program designed to promote health equity and tackle climate change, a major threat to national and global health.
The Decarbonization and Resilience Initiative is one of TEAM’s several innovative goals and has proven popular throughout the development process. Describing the feedback reported by health care providers and organizations, Fowler says that the response to the initiative has been overwhelmingly positive. “The Decarbonization and Resilience Initiative received more comments than any other part of the model, and a majority of commenters signaled excitement for CMS to take more action on climate change,” she says.
“Climate change, driven by greenhouse gas emissions, threatens patients’ health, and efforts to address these impacts could improve health outcomes and have the potential to reduce energy costs and directly contribute to Medicare savings.”
Fowler explains that the Climate Collaborative offered key access for the Innovation Center to learn from experts in the field. It also helped expand their audience and spread the word about the TEAM Decarbonization and Resilience Initiative.
“Dr. Victor Dzau deserves a lot of credit for pulling together the NAM Climate Collaborative and inviting stakeholders from across the health care ecosystem to join,” Fowler says. “It’s been a great way to become immersed for me personally in a set of issues I don’t work on every day, and so I’m not an expert by any means.”
“In the early days of conceptualizing the model, our team, led by Michael De La Guardia and Dilipan Sundaramoorthy, spoke with a number of NAM Collaborative members and leaders in climate change to better understand the field of greenhouse gas emissions reporting and the standards for health care providers,” Fowler adds.
She notes that engaging in climate change policy is a natural fit for the Innovation Center. Its core mission is to improve health care quality and reduce costs by testing new and innovative payment and delivery system reform models. “Climate change, driven by greenhouse gas emissions, threatens patients’ health,” Fowler emphasizes. “And efforts to address these impacts could improve health outcomes and have the potential to reduce energy costs and directly contribute to Medicare savings.”
The TEAM Decarbonization and Resilience Initiative is comprised of two elements: a voluntary greenhouse gas emissions reporting system and access to technical assistance and learning system support for participants as they implement decarbonization activities.
The emissions reporting system focuses on four priority areas. One of these areas refers to organizational structures while the other three focus on emissions associated with buildings and facilities, anesthetic gas usage, and transportation.
By foregrounding organizational structures, the initiative encourages hospitals or health systems to establish an executive sustainability team, set decarbonization goals within their organization, and implement a decarbonization plan.
“We’re also looking at building energy and emissions using the Energy Star portfolio manager program,” Fowler says. “Hospitals would report scope one and scope two greenhouse gas emission data, as well as their Energy Star score and
related data such as energy source and usage data and energy use intensity.”
The program would also encourage hospitals to track emissions from inhaled anesthetic gases and develop plans to lower the use of certain gases known to be contributors to higher levels of greenhouse gas emissions.
Furthermore, participating organizations would be tasked with reporting scope one transportation emissions. “Here we ask participating entities to create transportation emissions reduction plans, report on the plans to reduce their vehicle fleet emissions, report fuel consumption, and establish plans to implement an electric vehicle infrastructure,” Fowler explains.
In tandem with this reporting framework, the TEAM Decarbonization and Resilience Initiative also features the development and roll out of technical assistance and learning systems support for participants. “Some of these activities include accessing resources provided under the Inflation Reduction Act, compiling and disseminating best practices, and identifying and disseminating tools to help facilities more accurately report their emissions data through the initiative,” Fowler explains.
The voluntary reporting system included in the TEAM Decarbonization and Resilience Initiative is a groundbreaking program with significant implications. “This is the first time that the Department of Health and Human Services will collect emissions data from providers and represents an important step forward in tackling the health sector’s carbon footprint,” Fowler says.
She also notes that when conceptualizing the reporting system, a major priority was maintaining alignment with existing protocols for reporting and recommendations from industry thought leaders. “We also thought carefully about how to minimize the reporting burden, which is why we relied on the Environmental Protection Agency’s (EPA) Energy Star portfolio manager,” she adds. “And this is a nice step in what we hope will be a strong collaboration between CMS and EPA on health sector emissions.”
Fowler is winding down her time at the Innovation Center but is excited about what the future holds. “For now, our priority is to ensure that we put the best foot forward and the best possible first iteration of the initiative and TEAM so we can use that as a springboard to expand and scale the program” Fowler says.
As TEAM sets to launch, involvement with the Climate Collaborative continues to pay dividends. “Now that we’re focused on operationalizing the initiative, we’ve been in regular communication with Collaborative members for input on how to improve the model and for help networking with other experts,” Fowler notes.
“CMS plays an important role in establishing U.S. health policy and we think the agency could also play an important role in addressing climate change.”
Looking forward, Fowler expressed hope that the Innovation Center team can continue thinking about ways that TEAM may expand, including what kinds of emissions participants report. One set of goals for the Innovation Center’s future decarbonization efforts would be to reach more providers and expand beyond hospitals. “Our portfolio of models at the Innovation Center touches a broad spectrum of the health sector, including primary care and specialty care providers, post-acute care emergency departments, ambulatory care facilities, and more,” Fowler explains. “Some of these provider types have large facilities and vehicle footprints, and that makes them great candidates for future decarbonization policies that focus on emissions reductions.”
Fowler also notes that, as the Innovation Center learns from TEAM—and future TEAM iterations—there may be opportunities to explore stronger incentives for reporting and lowering emissions. “Perhaps in the future, CMS can partner with colleagues in other parts of CMS to see whether emissions reporting and monitoring for a broader set of providers might be possible,” she adds.
“I have a great deal of respect for CMS, their mission, and my colleagues here at the agency,” she says. “I also have great admiration for the outsized role that CMS has taken in setting U.S. health policy.”
Fowler says that puts the agency in an important position when it comes to climate and health. “CMS plays an important role in establishing U.S. health policy and we think the agency could also play an important role in addressing climate change,” she says.