About this episode
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 ?? Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe ? Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe ? Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 ? Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue ? Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ? LinkedIn https://www.linkedin.com/company/relentless-health-value/ ? Threads https://www.threads.net/@relentlesshealthvalue/ ? Bluesky https://bsky.app/profile/relentleshealth.bsky.social ? X https://twitter.com/relentleshealth/ 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.
