By Thomas Vincz, Public Relations Manager

Don Liss, MD, the new Chief Medical Officer at Horizon Blue Cross and Blue Shield of New Jersey (Horizon BCBSNJ), has been a physician for more than 30 years. But, according to his children, he’s not the “real doctor” in the household.

That honor goes to his wife, a primary care internist and, in a sense, he agrees. “Every day I witness her go through the trials and tribulations of delivering care,” Liss said.

Don Liss, MD

It’s this appreciation for doctors – combined with his own history of being one himself – that promises to shape Liss’ role overseeing medical policy for the State’s largest health insurer.

In his new role since July 2019, following positions at CVS Health and Independence Blue Cross in Philadelphia, Liss already has a good idea of the challenges and opportunities facing Horizon BCBSNJ and its health care partners in New Jersey: balancing the needs of members who deserve top-notch medical care and affordability.

On the one hand, science has brought incredible medical advances. From hepatitis C treatment to immunotherapies to robotic surgery and the emergence of genetic therapy, quantum improvements are benefiting our patients and becoming more accessible. “What was once only available in academic centers can now be found in many community hospitals,” said Liss.

On the other hand, these advances come with tremendous complexities and cost. Highly specialized treatments are “consuming an ever-increasing share of health care resources,” said Liss, which in turn drives up costs across the board. Those higher costs can make sense when they are connected to a better outcome, but that’s not always the case.

Aligning quality and cost has long been the perennial challenge of any health insurer. The nearly universal acceptance of value-based care models from the federal government down to private employers who fund their own health plans, has engaged doctors, hospitals, and other health professionals in the effort more than ever. Liss says it’s a challenge that won’t be solved overnight, “but it starts with having a dialogue among health care professionals that is thoughtful, deliberative and mutually beneficial. Both parties need to recognize we’re in this together. We are connected by virtue of sharing a common customer – Horizon BCBSNJ's member is their patient. And our customer doesn’t just want us to work together, they’re frankly demanding it.”

Aligning on value

Liss cites value-based care as one area where both parties have come together to contain and even slow health care spending. By paying for quality instead of the number of procedures or tests performed, health insurers like Horizon BCBSNJ do more than simply try to contain cost. They give more control of care decisions to doctors.

“Value-based care moves the decision-making much closer to the bedside, where it belongs,” said Liss.

These goals are brought to life in Horizon BCBSNJ’s OMNIA Health Plans, which are built around the OMNIA Health Alliance. This alliance is a first-of-its-kind partnership in New Jersey that brings Horizon BCBSNJ together with leading health systems and physician groups on behalf of patients. OMNIA creates real incentives for doctors and hospitals to deliver better care, not just more care.

These partnerships are so important because Liss views it as his duty – and an essential part of Horizon BCBSNJ’s larger mission – to help doctors and hospitals deliver better care not just to Horizon BCBSNJ’s members, but to all health consumers in New Jersey. This can range from Horizon BCBSNJ helping to make information about prescription drug costs more available to consumers to promoting preventive care.

Indeed, one of the main reasons Liss, born and educated in Philadelphia, decided to move to New Jersey was the opportunity to make an impact on a state-wide level.

“With our presence across New Jersey and relationships with nearly every physician in the state, Horizon BCBSNJ has an opportunity and the ability that few health insurers have to improve how health care is delivered in such a big, important part of the world,” said Liss. “You don’t get that opportunity very often in your life.”

Even with an expansive vision for what Horizon  BCBSNJ can accomplish, Liss doesn’t forget that the foundation of health care delivery starts at the bedside.

“At the end of the day, I’m a doctor,” Liss said. “In building collaborations with my peers in health care, I appreciate that they have patients in front of them every day and they’re advocating on their behalf.”