EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD
Relentless Health Value
Carving out utilization management and case management
Ivana explains using an external UM/CM vendor to steer members to higher-value sites of care.
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: How infusion drug prices play into the "Inches All Around Us" series.
02:02 How infusion drug pricing fits into the "No Market" series.
03:19 A roadmap and more episodes on this topic.
04:36 Introducing this week's expert, Ivana Krajcinovic, PhD.
05:10 A must-read Bloomberg News article on infusion pricing.
05:33 An overview of what to expect from this episode.
06:54 The first tell of the infusion nonmarket.
07:41 The price variations that Ivana has seen in the infusion nonmarket.
11:39 How hospital spend affects wage increases affects patients and employees twice over.
12:04 EP373 with Cora Opsahl.
13:43 The second tell of the infusion nonmarket.
14:33 Take Two: EP398 with Jacob Asher, MD.
14:55 EP483 with Jonathan Baran.
16:15 Why networks are apathetic to this pricing discrepancy.
17:55 The factors that play into the nonmarket issue of infusion drug pricing variations.
18:26 EP475 with Peter Hayes.
19:18 EP370 with Erik Davis and Autumn Yongchu.
19:45 Are pricing discrepancies easy to spot?
22:38 Where we have power in a nonmarket situation.
23:22 A recap of the advice in the show so far.
23:39 EP493 with John Quinn.
23:41 EP496 with Mark Newman.
25:51 How you place pricing pressure on an entity.
28:47 EP482 with Preston Alexander.
29:34 How an improved market creates time for better care coordination.
30:52 EP486 with Stan Schwartz, MD.
33:23 The fourth part of the roadmap.
36:41 EP492 and EP490 with Sam Flanders, MD, and Shane Cerone.
36:49 Why serving the community and being fiscally responsible should go hand in hand.
38:05 EP500 with Stacey.
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