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Centering health in energy efficiency program design

Liz Curry, Low-income & Multifamily Housing Consultant and Emily Levin, Innovative Programs Lead -

Health Consultation Image

The impacts of energy efficiency programs go beyond reduced electricity and fuel usage and lower energy bills. Improved indoor air quality is one of the most significant non-energy benefits of energy efficiency, and its importance has been emphasized by the U.S. Environmental Protection Agency (EPA) and U.S. Department of Energy (DOE). People spend approximately 69 percent of their time inside a home. Moisture, mold, pollutants, inadequate heat or cooling, and harmful air particulates from gas appliances and heating systems can trigger asthma attacks, wheezing, and other symptoms for those living with allergies and chronic respiratory illnesses.

A growing body of research demonstrates that energy efficiency retrofits advance Healthy Homes Principles, established by the U.S. Department of Housing and Urban Development (HUD). And evidence shows that improving indoor air quality improves health outcomes, particularly for people with weak respiratory systems.

Efficiency impacts on health flowchart

Acknowledging this clear connection between energy efficiency and health allows for new opportunities to collaborate across sectors.

Leveraging cross-sector resources for higher impact

The health care industry is undergoing a dramatic transformation from a fee-for-service model to a value-based reimbursement structure as the industry strives to reduce costs. The United States has the second-highest per-capita annual spending on health care of $9,536, and respiratory illnesses are the fourth highest expenditure category, according to the Kaiser Family Foundation. As health care practitioners learn more about the benefits of weatherization and efficiency for improving respiratory illnesses, they are seeing opportunities to leverage changes in health care payment structures to cover elements of treatment plans that include improvements to home environments.

Energy efficiency programs and contractors across the country are also increasing impact and reaching more customers through collaborations with health sector partners. The Building Performance Institute and other workforce training entities are now incorporating healthy homes principles into home assessment protocols performed by the energy efficiency workforce. Alongside these home evaluators, community health workers are documenting positive results for their asthma-patients, particularly for children, from energy efficiency upgrades. The quantification of health benefits from weatherization and other energy efficiency retrofits is leading to new program designs that blend health care and energy efficiency resources.

Energy efficiency programs can help to improve health outcomes by:

  • Providing networks of certified weatherization and home performance contractors trained by trusted programs with industry standards.
  • Conducting home assessments that generate insights on how patient’s home environment could reduce poor respiratory health symptoms, or trips and fall hazards for seniors.
  • Implementing scopes of work that achieve healthy homes principles with quality assurance that conforms with professional building science and engineering associations’ standards.
  • Supporting resident education about healthy home use and maintenance of heating, cooling, and ventilation systems, carbon monoxide detectors, and other energy equipment necessary for dry, comfortable and safe homes with healthy indoor air quality.

Several states are now advancing changes to Medicaid rules to enable Medicaid payments for in-home assessments, providing models for replication. An Energy-Plus-Health program design can benefit both energy efficiency administrators and health care providers by leveraging resources from both sectors to increase impact and reach more customers in need. For jurisdictions that are not ready to invest in full-scale Energy-Plus-Health programs, energy efficiency programs are coordinating with community organizations to address health and safety and reduce weatherization deferral rates.

Bringing the concept to life

Earlier this year, VEIC developed a resource to demonstrate the value of Energy-Plus-Health programs and to guide the design and implementation of these programs by Energy Efficiency Program Administrators. The Energy-Plus-Health Playbook was created with funding and support by E4TheFuture. It breaks program design into tiers 1, 2, and 3, each with an increasing level of involvement and integration with health care partners. The Playbook provides an extensive overview of research and data in support of stronger collaboration between the energy and health sectors and it gives examples of successful programs associated with each tier. One such program was designed by Efficiency Vermont, the statewide energy efficiency utility administered by VEIC.

Vermont Healthy Homes Initiative

Efficiency Vermont’s Healthy Homes Initiative is a partnership with the state’s Weatherization Assistance Project (WAP) partners and community-based organizations (CBOs) coordinated through the state Office of Economic Opportunity. The initiative utilizes an electronic platform called One Touch. A statewide coalition of energy, lead-hazard reduction, public health, and social service partners use the One Touch intake protocol to enter household referrals into the software tool through a ten-minute questionnaire. The tool captures multiple housing, health, and support service needs at one time during home visits performed by any of the participating organizations. While WAP home energy coaches are meeting with income-eligible families to discuss energy efficiency upgrades, they administer the survey and prompt referrals to go out to other coalition partners to contact the household to provide assistance. This initiative has surveyed 2,300 single-family homes and referred 20 percent of One Touch energy homes to health or housing partner services.

Efficiency Vermont is also conducting an Energy-Plus-Health pilot program that leverages funding through the WAPs, Department of Health, and hospitals to raise awareness with consumers, health care providers and contractors on the connections between indoor environmental quality, energy efficiency and health. Community Health Workers refer patients to the WAP, which trains contractors in healthy home evaluations and work-scopes. The Community Health Workers also document health outcomes to monetize both energy and health benefits.

Ongoing engagement

VEIC seeks opportunities to design, implement, and deliver Energy-Plus-Health pilots and programs for new and existing clients. We’re barely scratching the surface of potential for societal, environmental, and economic benefits from this approach to energy efficiency program delivery. Through increased information-sharing and the development of pilot programs across different regions and customer types, we will continue to learn and refine the model for successful and scalable Energy-Plus-Health services.

We are joining our Energy-Plus-Health Playbook partners, including Program Administrators that have implemented successful programs across the country, to provide an overview of this resource and examples of putting it into practice. Register for our September 9, 2019 webinar to join the conversation, and stay tuned for more events and presentations on this important and exciting topic.

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