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Managed Care
The Managed Care industry offers health insurance products for individual, commercial, Medicare and Medicaid members. Entities also provide administrative services and network access for self-funded insurance plans and manage pharmacy benefits. Enrolment in managed care traditionally has been correlated with employment rates, whereas revenue is driven by medical cost inflation. Legislative uncertainty and a focus on reducing health care costs may create downward pricing pressure and continue to drive industry consolidation. In addition, a focus on patient outcomes and plan performance continues to shape the industry’s sustainability risks and opportunities.
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Oil & Gas – Midstream
Oil & Gas - Midstream industry entities transport or store natural gas, crude oil and refined petroleum products. Midstream natural gas activities involve gathering, transporting and processing natural gas from the wellhead, such as the removal of impurities, production of natural gas liquids, storage, pipeline transport and shipping, liquefaction, or regasification of liquefied natural gas. Midstream oil activities mainly involve transporting crude oil and refined products using pipeline networks, truck and rail, and marine transport on tankers or barges. Entities that operate storage and distribution terminals, as well as those that manufacture and install storage tanks and pipelines, are also part of this industry.
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Relevant Issues for both Industries (10 of 26)

Why are some issues greyed out?

The SASB Standards vary by industry based on the different sustainability-related risks and opportunities within an industry. The issues in grey were not identified during the standard-setting process as the most likely to be useful to investors, so they are not included in the Standard. Over time, as the ISSB continues to receive market feedback, some issues may be added or removed from the Standard. Each company determines which sustainability-related risks and opportunities are relevant to its business. The Standard is designed for the typical company in an industry, but individual companies may choose to report on different sustainability-related risks and opportunities based on their unique business model.

Environment
- GHG Emissions
  The category addresses direct (Scope 1) greenhouse gas (GHG) emissions that a company generates through its operations. This includes GHG emissions from stationary (e.g., factories, power plants) and mobile sources (e.g., trucks, delivery vehicles, planes), whether a result of combustion of fuel or non-combusted direct releases during activities such as natural resource extraction, power generation, land use, or biogenic processes. The category further includes management of regulatory risks, environmental compliance, and reputational risks and opportunities, as they related to direct GHG emissions. The seven GHGs covered under the Kyoto Protocol are included within the category—carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), sulfur hexafluoride (SF6), and nitrogen trifluoride (NF3).
- Air Quality
  The category addresses management of air quality impacts resulting from stationary (e.g., factories, power plants) and mobile sources (e.g., trucks, delivery vehicles, planes) as well as industrial emissions. Relevant airborne pollutants include, but are not limited to, oxides of nitrogen (NOx), oxides of sulfur (SOx), volatile organic compounds (VOCs), heavy metals, particulate matter, and chlorofluorocarbons. The category does not include GHG emissions, which are addressed in a separate category.
- Energy Management
- Water & Wastewater Management
- Waste & Hazardous Materials Management
- Ecological Impacts
  The category addresses management of the company’s impacts on ecosystems and biodiversity through activities including, but not limited to, land use for exploration, natural resource extraction, and cultivation, as well as project development, construction, and siting. The impacts include, but are not limited to, biodiversity loss, habitat destruction, and deforestation at all stages – planning, land acquisition, permitting, development, operations, and site remediation. The category does not cover impacts of climate change on ecosystems and biodiversity.
Social Capital
- Human Rights & Community Relations
- Customer Privacy
- Data Security
  The category addresses management of risks related to collection, retention, and use of sensitive, confidential, and/or proprietary customer or user data. It includes social issues that may arise from incidents such as data breaches in which personally identifiable information (PII) and other user or customer data may be exposed. It addresses a company’s strategy, policies, and practices related to IT infrastructure, staff training, record keeping, cooperation with law enforcement, and other mechanisms used to ensure security of customer or user data.
- Access & Affordability
  The category addresses a company’s ability to ensure broad access to its products and services, specifically in the context of underserved markets and/or population groups. It includes the management of issues related to universal needs, such as the accessibility and affordability of health care, financial services, utilities, education, and telecommunications.
- Product Quality & Safety
  The category addresses issues involving unintended characteristics of products sold or services provided that may create health or safety risks to end-users. It addresses a company’s ability to offer manufactured products and/or services that meet customer expectations with respect to their health and safety characteristics. It includes, but is not limited to, issues involving liability, management of recalls and market withdrawals, product testing, and chemicals/content/ingredient management in products.
- Customer Welfare
  The category addresses customer welfare concerns over issues including, but not limited to, health and nutrition of foods and beverages, antibiotic use in animal production, and management of controlled substances. The category addresses the company’s ability to provide consumers with manufactured products and services that are aligned with societal expectations. It does not include issues directly related to quality and safety malfunctions of manufactured products and services, but instead addresses qualities inherent to the design and delivery of products and services where customer welfare may be in question. The scope of the category also captures companies’ ability to prevent counterfeit products.
- Selling Practices & Product Labeling
Human Capital
- Labour Practices
- Employee Health & Safety
- Employee Engagement, Diversity & Inclusion
Business Model and Innovation
- Product Design & Lifecycle Management
- Business Model Resilience
- Supply Chain Management
- Materials Sourcing & Efficiency
- Physical Impacts of Climate Change
  The category addresses the company’s ability to manage risks and opportunities associated with direct exposure of its owned or controlled assets and operations to actual or potential physical impacts of climate change. It captures environmental and social issues that may arise from operational disruptions due to physical impacts of climate change. It further captures socio-economic issues resulting from companies failing to incorporate climate change consideration in products and services sold, such as insurance policies and mortgages. The category relates to the company’s ability to adapt to increased frequency and severity of extreme weather, shifting climate, sea level risk, and other expected physical impacts of climate change. Management may involve enhancing resiliency of physical assets and/or surrounding infrastructure as well as incorporation of climate change-related considerations into key business activities (e.g., mortgage and insurance underwriting, planning and development of real estate projects).
Leadership and Governance
- Business Ethics
- Competitive Behaviour
  The category covers social issues associated with existence of monopolies, which may include, but are not limited to, excessive prices, poor quality of service, and inefficiencies. It addresses a company’s management of legal and social expectation around monopolistic and anti-competitive practices, including issues related to bargaining power, collusion, price fixing or manipulation, and protection of patents and intellectual property (IP).
- Management of the Legal & Regulatory Environment
- Critical Incident Risk Management
  The category addresses the company’s use of management systems and scenario planning to identify, understand, and prevent or minimize the occurrence of low-probability, high-impact accidents and emergencies with significant potential environmental and social externalities. It relates to the culture of safety at a company, its relevant safety management systems and technological controls, the potential human, environmental, and social implications of such events occurring, and the long-term effects to an organization, its workers, and society should these events occur.
- Systemic Risk Management

Disclosure Topics

What is the relationship between General Issue Category and Disclosure Topics?

The General Issue Category is an industry-agnostic version of the Disclosure Topics that appear in each SASB Standard. Disclosure topics represent the industry-specific impacts of General Issue Categories. The industry-specific Disclosure Topics ensure each SASB Standard is tailored to the industry, while the General Issue Categories enable comparability across industries. For example, Health & Nutrition is a disclosure topic in the Non-Alcoholic Beverages industry, representing an industry-specific measure of the general issue of Customer Welfare. The issue of Customer Welfare, however, manifests as the Counterfeit Drugs disclosure topic in the Biotechnology & Pharmaceuticals industry.

Managed Care Remove
Access Standard
- GHG Emissions
  The category addresses direct (Scope 1) greenhouse gas (GHG) emissions that a company generates through its operations. This includes GHG emissions from stationary (e.g., factories, power plants) and mobile sources (e.g., trucks, delivery vehicles, planes), whether a result of combustion of fuel or non-combusted direct releases during activities such as natural resource extraction, power generation, land use, or biogenic processes. The category further includes management of regulatory risks, environmental compliance, and reputational risks and opportunities, as they related to direct GHG emissions. The seven GHGs covered under the Kyoto Protocol are included within the category—carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), sulfur hexafluoride (SF6), and nitrogen trifluoride (NF3).
  
  None
- Air Quality
  The category addresses management of air quality impacts resulting from stationary (e.g., factories, power plants) and mobile sources (e.g., trucks, delivery vehicles, planes) as well as industrial emissions. Relevant airborne pollutants include, but are not limited to, oxides of nitrogen (NOx), oxides of sulfur (SOx), volatile organic compounds (VOCs), heavy metals, particulate matter, and chlorofluorocarbons. The category does not include GHG emissions, which are addressed in a separate category.
  
  None
- Ecological Impacts
  The category addresses management of the company’s impacts on ecosystems and biodiversity through activities including, but not limited to, land use for exploration, natural resource extraction, and cultivation, as well as project development, construction, and siting. The impacts include, but are not limited to, biodiversity loss, habitat destruction, and deforestation at all stages – planning, land acquisition, permitting, development, operations, and site remediation. The category does not cover impacts of climate change on ecosystems and biodiversity.
  
  None
- Data Security
  The category addresses management of risks related to collection, retention, and use of sensitive, confidential, and/or proprietary customer or user data. It includes social issues that may arise from incidents such as data breaches in which personally identifiable information (PII) and other user or customer data may be exposed. It addresses a company’s strategy, policies, and practices related to IT infrastructure, staff training, record keeping, cooperation with law enforcement, and other mechanisms used to ensure security of customer or user data.
  - Customer Privacy & Technology Standards
    Applicable jurisdictional laws or regulations may establish various data security requirements relating to the use, disclosure, storage and transmission of patient health information. Entities are required to develop policies and technical safeguards to protect patient health information. A failure to comply with these standards can lead to significant civil and criminal penalties. These risks are intensified by an increase in cyberattacks that target managed care entities.
- Access & Affordability
  The category addresses a company’s ability to ensure broad access to its products and services, specifically in the context of underserved markets and/or population groups. It includes the management of issues related to universal needs, such as the accessibility and affordability of health care, financial services, utilities, education, and telecommunications.
  - Access to Coverage
    Entities in the Managed Care industry may improve a population’s access to health care by limiting plan costs and rate increases for health insurance in jurisdictions where private health insurance is prevalent. These improvements most significantly affect segments of the population that tend to have lower rates of insurance coverage. These entities generally must also comply with regulations intended to control plan costs, including medical loss ratios, as well as ensuring all applicants have access to coverage regardless of health status, gender or pre-existing conditions. Increased regulatory focus on health care costs and compliance with evolving regulations continue to present challenges for the industry.
- Product Quality & Safety
  The category addresses issues involving unintended characteristics of products sold or services provided that may create health or safety risks to end-users. It addresses a company’s ability to offer manufactured products and/or services that meet customer expectations with respect to their health and safety characteristics. It includes, but is not limited to, issues involving liability, management of recalls and market withdrawals, product testing, and chemicals/content/ingredient management in products.
  - Plan Performance
    Managed care entities manage performance in areas such as responsiveness, complaints, voluntary disenrollment and customer service to maintain competitiveness. In some jurisdictions, performance on important metrics may be factored into reimbursement rates and bonus payments. Disclosure on specific indicators related to plan performance may allow investors to understand how entities protect enterprise value.
- Customer Welfare
  The category addresses customer welfare concerns over issues including, but not limited to, health and nutrition of foods and beverages, antibiotic use in animal production, and management of controlled substances. The category addresses the company’s ability to provide consumers with manufactured products and services that are aligned with societal expectations. It does not include issues directly related to quality and safety malfunctions of manufactured products and services, but instead addresses qualities inherent to the design and delivery of products and services where customer welfare may be in question. The scope of the category also captures companies’ ability to prevent counterfeit products.
  - Improved Outcomes
    Entities in the Managed Care industry can play a critical role in maintaining and improving the health of enrolees. Improved enrolee health can help entities develop a reputation for high-quality care, potentially leading to increased market share and improved margins. Some entities may participate in programmes that try to strengthen the relationship between enrolee health and entity value by linking employee performance to reimbursement rates and bonuses. Entities that take part in such programmes may develop a competitive advantage compared to those that do not. Entities that fail to deliver high-quality outcomes for enrolees may experience decreased market share, penalties such as fines and suspensions, and increased legal costs.
- Physical Impacts of Climate Change
  The category addresses the company’s ability to manage risks and opportunities associated with direct exposure of its owned or controlled assets and operations to actual or potential physical impacts of climate change. It captures environmental and social issues that may arise from operational disruptions due to physical impacts of climate change. It further captures socio-economic issues resulting from companies failing to incorporate climate change consideration in products and services sold, such as insurance policies and mortgages. The category relates to the company’s ability to adapt to increased frequency and severity of extreme weather, shifting climate, sea level risk, and other expected physical impacts of climate change. Management may involve enhancing resiliency of physical assets and/or surrounding infrastructure as well as incorporation of climate change-related considerations into key business activities (e.g., mortgage and insurance underwriting, planning and development of real estate projects).
  - Climate Change Impacts on Human Health
    An increase in extreme weather events associated with climate change could have significant health impacts. These events, coupled with the potential spread of infectious diseases and food and water scarcity, may present material implications for the Managed Care industry through an increase in encounters with the health care system. Entities that manage the risks posed by extreme weather events and potential changes in the incidence, morbidity and mortality of illnesses and diseases may protect shareholder value better.
- Competitive Behaviour
  The category covers social issues associated with existence of monopolies, which may include, but are not limited to, excessive prices, poor quality of service, and inefficiencies. It addresses a company’s management of legal and social expectation around monopolistic and anti-competitive practices, including issues related to bargaining power, collusion, price fixing or manipulation, and protection of patents and intellectual property (IP).
  
  None
- Critical Incident Risk Management
  The category addresses the company’s use of management systems and scenario planning to identify, understand, and prevent or minimize the occurrence of low-probability, high-impact accidents and emergencies with significant potential environmental and social externalities. It relates to the culture of safety at a company, its relevant safety management systems and technological controls, the potential human, environmental, and social implications of such events occurring, and the long-term effects to an organization, its workers, and society should these events occur.
  
  None
Oil & Gas – Midstream Remove
Access Standard
- GHG Emissions
  The category addresses direct (Scope 1) greenhouse gas (GHG) emissions that a company generates through its operations. This includes GHG emissions from stationary (e.g., factories, power plants) and mobile sources (e.g., trucks, delivery vehicles, planes), whether a result of combustion of fuel or non-combusted direct releases during activities such as natural resource extraction, power generation, land use, or biogenic processes. The category further includes management of regulatory risks, environmental compliance, and reputational risks and opportunities, as they related to direct GHG emissions. The seven GHGs covered under the Kyoto Protocol are included within the category—carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), sulfur hexafluoride (SF6), and nitrogen trifluoride (NF3).
  - Greenhouse Gas Emissions
    The Midstream industry generates significant greenhouse gases and other air emissions from compressor engine exhausts, oil and condensate tank vents, natural gas processing, and fugitive emissions, in addition to emissions from mobile sources. GHG emissions contribute to climate change and create incremental regulatory compliance costs and risks for Midstream entities. At the same time, the management of methane fugitive emissions has emerged as a significant operational, reputational and regulatory risk. Financial effects on entities will vary depending on the specific location of operations and prevailing emissions regulations, and they include increased operating or capital expenditures and regulatory or legal penalties. Entities that capture and monetise emissions, or cost-effectively reduce emissions by implementing innovative monitoring and mitigation efforts and fuel efficiency measures, may enjoy substantial financial benefits. Entities can reduce regulatory risks and realise operational efficiencies as regulatory and public concerns about air quality and climate change increase.
- Air Quality
  The category addresses management of air quality impacts resulting from stationary (e.g., factories, power plants) and mobile sources (e.g., trucks, delivery vehicles, planes) as well as industrial emissions. Relevant airborne pollutants include, but are not limited to, oxides of nitrogen (NOx), oxides of sulfur (SOx), volatile organic compounds (VOCs), heavy metals, particulate matter, and chlorofluorocarbons. The category does not include GHG emissions, which are addressed in a separate category.
  - Air Quality
    Air emissions from Oil & Gas – Midstream entities include air pollutants, which can create significant and localised environmental or health risks. Of particular concern are sulphur dioxide, nitrogen dioxide and volatile organic compound (VOC) emissions. The financial consequences entities face from air emissions vary depending on the specific locations of operations and the prevailing air emissions regulations. Amid increasing regulatory and public concerns about air quality, active air quality management through technological and process improvements could allow entities to mitigate the adverse financial effects of regulations. Entities could benefit from operational efficiencies that may result in a lower cost structure over time.
- Ecological Impacts
  The category addresses management of the company’s impacts on ecosystems and biodiversity through activities including, but not limited to, land use for exploration, natural resource extraction, and cultivation, as well as project development, construction, and siting. The impacts include, but are not limited to, biodiversity loss, habitat destruction, and deforestation at all stages – planning, land acquisition, permitting, development, operations, and site remediation. The category does not cover impacts of climate change on ecosystems and biodiversity.
  - Ecological Impacts
    The storage and transport of crude oil, natural gas and related products through a vast system of maritime transportation vehicles, pipelines, trains and trucks presents considerable risks to the environment and local communities. Leaks, accidental discharges, pipeline rights-of-way and open easements over ecologically sensitive land could negatively impact ecosystems in several ways, including natural habitat loss and changes in species movement. To protect endangered species and ecologically sensitive areas, jurisdictional legal and regulatory authorities may require development and decommissioning plans that mitigate or remediate potential ecological impacts prior to project approval. Together with regulatory compliance costs, these plans may require significant capital and operational expenditures. As concerns over ecological impacts increase, greenfield and existing developed sites may be designated as protected areas under new laws or the enforcement of existing laws. Entities that effectively manage ecological impacts may avoid project delays, remediation and litigation liabilities, and could gain easier access to new projects and sources of revenue.
- Data Security
  The category addresses management of risks related to collection, retention, and use of sensitive, confidential, and/or proprietary customer or user data. It includes social issues that may arise from incidents such as data breaches in which personally identifiable information (PII) and other user or customer data may be exposed. It addresses a company’s strategy, policies, and practices related to IT infrastructure, staff training, record keeping, cooperation with law enforcement, and other mechanisms used to ensure security of customer or user data.
  
  None
- Access & Affordability
  The category addresses a company’s ability to ensure broad access to its products and services, specifically in the context of underserved markets and/or population groups. It includes the management of issues related to universal needs, such as the accessibility and affordability of health care, financial services, utilities, education, and telecommunications.
  
  None
- Product Quality & Safety
  The category addresses issues involving unintended characteristics of products sold or services provided that may create health or safety risks to end-users. It addresses a company’s ability to offer manufactured products and/or services that meet customer expectations with respect to their health and safety characteristics. It includes, but is not limited to, issues involving liability, management of recalls and market withdrawals, product testing, and chemicals/content/ingredient management in products.
  
  None
- Customer Welfare
  The category addresses customer welfare concerns over issues including, but not limited to, health and nutrition of foods and beverages, antibiotic use in animal production, and management of controlled substances. The category addresses the company’s ability to provide consumers with manufactured products and services that are aligned with societal expectations. It does not include issues directly related to quality and safety malfunctions of manufactured products and services, but instead addresses qualities inherent to the design and delivery of products and services where customer welfare may be in question. The scope of the category also captures companies’ ability to prevent counterfeit products.
  
  None
- Physical Impacts of Climate Change
  The category addresses the company’s ability to manage risks and opportunities associated with direct exposure of its owned or controlled assets and operations to actual or potential physical impacts of climate change. It captures environmental and social issues that may arise from operational disruptions due to physical impacts of climate change. It further captures socio-economic issues resulting from companies failing to incorporate climate change consideration in products and services sold, such as insurance policies and mortgages. The category relates to the company’s ability to adapt to increased frequency and severity of extreme weather, shifting climate, sea level risk, and other expected physical impacts of climate change. Management may involve enhancing resiliency of physical assets and/or surrounding infrastructure as well as incorporation of climate change-related considerations into key business activities (e.g., mortgage and insurance underwriting, planning and development of real estate projects).
  
  None
- Competitive Behaviour
  The category covers social issues associated with existence of monopolies, which may include, but are not limited to, excessive prices, poor quality of service, and inefficiencies. It addresses a company’s management of legal and social expectation around monopolistic and anti-competitive practices, including issues related to bargaining power, collusion, price fixing or manipulation, and protection of patents and intellectual property (IP).
  - Competitive Behaviour
    Entities that own natural gas pipelines and storage facilities face numerous and constantly changing regulations in all aspects of their operations, including the rates charged, common carrier access and new facility siting and construction. Many pipelines and terminals enjoy natural monopolies, and regulations ensure that entities do not abuse this position through unfair pricing, discriminatory service or by other means. Because of concerns about the effects of oil and gas market distortions on consumers and businesses, market manipulation regulations could also affect entities in the Midstream industry. Prospective rate changes, compensation payments or regulatory penalties for violating regulations governing competitive behaviour may adversely affect entities. Midstream entities face uncertainty regarding their ability to change the rates charged, which could affect their ability to recover higher costs.
- Critical Incident Risk Management
  The category addresses the company’s use of management systems and scenario planning to identify, understand, and prevent or minimize the occurrence of low-probability, high-impact accidents and emergencies with significant potential environmental and social externalities. It relates to the culture of safety at a company, its relevant safety management systems and technological controls, the potential human, environmental, and social implications of such events occurring, and the long-term effects to an organization, its workers, and society should these events occur.
  - Operational Safety, Emergency Preparedness & Response
    Entities in the Oil & Gas – Midstream industry operate a vast network of assets at risk of spills and accidents. Any incident that results in unintended hydrocarbon releases could have severe impacts on the environment, employees and local communities. Because of these concerns, applicable jurisdictional legal and regulatory authorities may implement new safety regulations related to pipeline and rail operations. Significant events may result in large one-time costs from fines and corrective actions, and contingent liabilities for remediation or legal damages. These factors also could impair an entity’s social licence to operate. As demonstrated by investigations of past incidents, an entity that develops a strong safety culture and establishes a thorough and systematic approach to safety and risk management may minimise such risks. This includes emergency preparedness and response and operational integrity within the entity and in its external relationships with contractors.

General Issue Category

Remove Managed Care Access Standard

Remove Oil & Gas – Midstream Access Standard

GHG Emissions

Greenhouse Gas Emissions
The Midstream industry generates significant greenhouse gases and other air emissions from compressor engine exhausts, oil and condensate tank vents, natural gas processing, and fugitive emissions, in addition to emissions from mobile sources. GHG emissions contribute to climate change and create incremental regulatory compliance costs and risks for Midstream entities. At the same time, the management of methane fugitive emissions has emerged as a significant operational, reputational and regulatory risk. Financial effects on entities will vary depending on the specific location of operations and prevailing emissions regulations, and they include increased operating or capital expenditures and regulatory or legal penalties. Entities that capture and monetise emissions, or cost-effectively reduce emissions by implementing innovative monitoring and mitigation efforts and fuel efficiency measures, may enjoy substantial financial benefits. Entities can reduce regulatory risks and realise operational efficiencies as regulatory and public concerns about air quality and climate change increase.

Air Quality

Air Quality
Air emissions from Oil & Gas – Midstream entities include air pollutants, which can create significant and localised environmental or health risks. Of particular concern are sulphur dioxide, nitrogen dioxide and volatile organic compound (VOC) emissions. The financial consequences entities face from air emissions vary depending on the specific locations of operations and the prevailing air emissions regulations. Amid increasing regulatory and public concerns about air quality, active air quality management through technological and process improvements could allow entities to mitigate the adverse financial effects of regulations. Entities could benefit from operational efficiencies that may result in a lower cost structure over time.

Ecological Impacts

Ecological Impacts
The storage and transport of crude oil, natural gas and related products through a vast system of maritime transportation vehicles, pipelines, trains and trucks presents considerable risks to the environment and local communities. Leaks, accidental discharges, pipeline rights-of-way and open easements over ecologically sensitive land could negatively impact ecosystems in several ways, including natural habitat loss and changes in species movement. To protect endangered species and ecologically sensitive areas, jurisdictional legal and regulatory authorities may require development and decommissioning plans that mitigate or remediate potential ecological impacts prior to project approval. Together with regulatory compliance costs, these plans may require significant capital and operational expenditures. As concerns over ecological impacts increase, greenfield and existing developed sites may be designated as protected areas under new laws or the enforcement of existing laws. Entities that effectively manage ecological impacts may avoid project delays, remediation and litigation liabilities, and could gain easier access to new projects and sources of revenue.

Data Security

Customer Privacy & Technology Standards
Applicable jurisdictional laws or regulations may establish various data security requirements relating to the use, disclosure, storage and transmission of patient health information. Entities are required to develop policies and technical safeguards to protect patient health information. A failure to comply with these standards can lead to significant civil and criminal penalties. These risks are intensified by an increase in cyberattacks that target managed care entities.

Access & Affordability

Access to Coverage
Entities in the Managed Care industry may improve a population’s access to health care by limiting plan costs and rate increases for health insurance in jurisdictions where private health insurance is prevalent. These improvements most significantly affect segments of the population that tend to have lower rates of insurance coverage. These entities generally must also comply with regulations intended to control plan costs, including medical loss ratios, as well as ensuring all applicants have access to coverage regardless of health status, gender or pre-existing conditions. Increased regulatory focus on health care costs and compliance with evolving regulations continue to present challenges for the industry.

Product Quality & Safety

Plan Performance
Managed care entities manage performance in areas such as responsiveness, complaints, voluntary disenrollment and customer service to maintain competitiveness. In some jurisdictions, performance on important metrics may be factored into reimbursement rates and bonus payments. Disclosure on specific indicators related to plan performance may allow investors to understand how entities protect enterprise value.

Customer Welfare

Improved Outcomes
Entities in the Managed Care industry can play a critical role in maintaining and improving the health of enrolees. Improved enrolee health can help entities develop a reputation for high-quality care, potentially leading to increased market share and improved margins. Some entities may participate in programmes that try to strengthen the relationship between enrolee health and entity value by linking employee performance to reimbursement rates and bonuses. Entities that take part in such programmes may develop a competitive advantage compared to those that do not. Entities that fail to deliver high-quality outcomes for enrolees may experience decreased market share, penalties such as fines and suspensions, and increased legal costs.

Physical Impacts of Climate Change

Climate Change Impacts on Human Health
An increase in extreme weather events associated with climate change could have significant health impacts. These events, coupled with the potential spread of infectious diseases and food and water scarcity, may present material implications for the Managed Care industry through an increase in encounters with the health care system. Entities that manage the risks posed by extreme weather events and potential changes in the incidence, morbidity and mortality of illnesses and diseases may protect shareholder value better.

Competitive Behaviour

Competitive Behaviour
Entities that own natural gas pipelines and storage facilities face numerous and constantly changing regulations in all aspects of their operations, including the rates charged, common carrier access and new facility siting and construction. Many pipelines and terminals enjoy natural monopolies, and regulations ensure that entities do not abuse this position through unfair pricing, discriminatory service or by other means. Because of concerns about the effects of oil and gas market distortions on consumers and businesses, market manipulation regulations could also affect entities in the Midstream industry. Prospective rate changes, compensation payments or regulatory penalties for violating regulations governing competitive behaviour may adversely affect entities. Midstream entities face uncertainty regarding their ability to change the rates charged, which could affect their ability to recover higher costs.

Critical Incident Risk Management

Operational Safety, Emergency Preparedness & Response
Entities in the Oil & Gas – Midstream industry operate a vast network of assets at risk of spills and accidents. Any incident that results in unintended hydrocarbon releases could have severe impacts on the environment, employees and local communities. Because of these concerns, applicable jurisdictional legal and regulatory authorities may implement new safety regulations related to pipeline and rail operations. Significant events may result in large one-time costs from fines and corrective actions, and contingent liabilities for remediation or legal damages. These factors also could impair an entity’s social licence to operate. As demonstrated by investigations of past incidents, an entity that develops a strong safety culture and establishes a thorough and systematic approach to safety and risk management may minimise such risks. This includes emergency preparedness and response and operational integrity within the entity and in its external relationships with contractors.

Relevant Issues for both Industries (10 of 26)

Select up to 4 industries