Speaking of Infusions, Do You Want To Pay $135 or Pay $13,560 for the Exact Same Drug?

Описание: Episode 501 of Relentless Health Value features Stacey Richter interviewing Ivana Krajcinovic, outgoing Vice President of Healthcare Delivery at Unite Here Health, about extreme and persistent price variation for medical infusions as evidence of a “no market” in healthcare. They cite examples where the same chemotherapy drug (Oxaliplatin), long off patent, cost Medicare about $35 (or $185 for a series), an independent practice about $135, but a hospital in Chicago charged $13,560 and a hospital in Monterey billed $90,000 for a series—markups described as up to nearly 500x and far beyond Medicare.

The discussion highlights how these prices create major member affordability problems through co-insurance and reduce funds available for wages, with one Monterey analysis showing nearly $1 million in annual savings by moving just two patients to an independent oncology practice.

They argue that functioning markets would rationalize prices and that carrier networks often fail as a demand curve, showing apathy and relying on broad “discount” negotiations even when prices differ by hundreds of times, including cases within the same health system.

Krajcinovic describes a roadmap to fight back: drill into claims data, push back on providers and networks, use benefit design to steer site of care, carve out utilization management and case management to support member navigation, and pursue direct contracts with independent practices.

They also discuss the “whack-a-mole” dynamic of hospital pricing and the value of collective action, media attention and regulatory forums such as California’s Office of Health Care Affordability.

=== LINKS ===
🔗 Show Notes with all mentioned links:
https://bit.ly/Episode501

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00:00 $135 vs $13,560: The Infusion Price Shock That Kicks Off the Episode
01:58 Why This Proves There’s No Real Healthcare Market (and Why Waiting for One Is ‘Magical Thinking’)
06:37 Inside the Infusion Non‑Market: Wild Drug Price Variations in Real Claims Data
10:03 The Human Cost: Coinsurance, Medical Debt, and Wages Eaten by Hospital Markups
13:43 Tell #2: ‘Lazy Networks’ and the Discount Game That Lets Overpricing Persist
19:55 Whack‑a‑Mole: Spotting Overcharges, Hospital Excuses, and Transparency File Games
22:38 The Roadmap to Fight Back: Data — Benefit Design — Site‑of‑Care Steerage
26:37 Direct Contracting with Independent Practices: A Win‑Win at 150% of Medicare
31:15 Carving Out UM/CM: Member Outreach That Actually Works (Language, Timing, Trust)
33:23 Pushback + Public Pressure: Media, Regulators, and Changing the Community Dynamic
37:14 Final Takeaways: Collective Action, Stay ‘Enraged,’ and Where to Learn More

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