The health care sector contributes significantly to greenhouse gas (GHG) emissions, accounting for 8.5 % of total U.S. emissions. This study identifies leading strategies for health plans to reduce their carbon footprint and outlines a practical pathway for incremental implementation.

Using a modified Delphi approach, representatives of nine health plans were recruited via convenience sampling to evaluate 29 GHG reduction strategies. Participants rated each strategy using criteria adapted from the National Quality Forum (NQF) and provided qualitative feedback.

Seven top strategies emerged as the most impactful, with four in the Resource Conservation and Management domain, two in Governance and Building Capacity , and one in Government Policies . These strategies represent a focused starting point for health plans seeking to take meaningful climate action. Findings highlight the importance of integrating climate considerations into quality improvement initiatives to align with organizational priorities. Strategies within the direct control of health plans were deemed more actionable, and framing climate action as a population health issue was found to foster broader consensus across the sector.

Health plans have a unique opportunity to reduce GHG emissions while improving health outcomes, even without mandatory climate-related reporting requirements. As climate policy priorities shift, voluntary action remains a powerful lever for change. Focusing on these top seven strategies offers a clear, incremental pathway forward. Further research is needed to identify effective accountability mechanisms that support sustainable, measurable progress in health care decarbonization.