Episode 501

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. EP501

Feb 26, 2026

39:57

Episode Description

How a $135 Infusion Becomes a $13,560 Bill—and the Direct-Contracting Fix for It. Episode 501.

Ivana Krajcinovic, PhD, recently retired vice president for healthcare delivery at UNITE HERE HEALTH, a Taft-Hartley fund that purchases healthcare for over 200,000 unionized hospitality workers and their families, joins Stacey Richter to unpack a jaw-dropping price variation: the same infusion that cost $135 at an independent practice ran $13,560 for the identical drug at the hospital down the street—a 10,000% markup off the billed price, or 40,000% off the Medicare rate. Ivana walks through why carrier networks face zero business consequences for such wild price variation, and lays out the roadmap her team used to fight back, built around data, site-of-care steerage, and direct contracting with independent practices.

WHAT YOU'LL LEARN

✅ Why two members getting infusions at the same hospital instead of down the street cost their plan $1 million more combined—and why that kind of price variation is itself proof there's no real market

✅ How an independent practice charged $135 for a chemo infusion while a hospital charged $13,560 for the exact same drug and infusion—a 10,000% markup over the billed price, or 40,000% over Medicare

✅ Why carrier networks face no business consequences for letting a plan sponsor overspend by a million dollars, since the network itself doesn't lose business as a result

✅ The roadmap UNITE HERE HEALTH used to fight infusion cost variation, from drilling into claims data to carving out utilization management for site-of-care steerage

✅ Why direct contracts with independent practices play a starring role in bringing infusion costs down, and how that strategy ties fiduciary duty, transparency, and collective bargaining power together

WHY THIS MATTERS When a health plan can pay $135 or $13,560 for the identical infusion depending only on which door the patient walks through, that is not a pricing problem—it's proof that no real market exists to rationalize the cost. As Stacey puts it, if you're waiting on a market to constrain these prices for you, that's magical thinking; every dollar wasted on wild price variation is a dollar that could have gone to wages for the hospitality workers UNITE HERE HEALTH exists to protect.

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