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 copertina

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

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

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 Let us chat about today the inches all around us and also about how there is no market in healthcare all at once in this show. Today I am talking with Ivana Krajcinovic. And let me give you some examples of the inches. Two members of a plan get infusions at a hospital. And if these two members had gone down the street to get their infusions, the total cost of the two of them would have been $1 million less … $1 million less! How many inches is a million dollars? For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Or the examples Ivana Krajcinovic talks about coming up where an independent practice was charging $135 for a chemo infusion and the hospital down the street was charging for the same exact drug, by the way—the same exact infusion—$13,560 … $135 versus $13,560! We talk about affordability in this country? Member's paying coinsurance off that 13K, by the way. And if you're doing the math at home, that is a 10,000% markup. Or if we start from the Medicare price, it was a 40,000% markup. Then there's another example that Ivana talks about where a plan member went to a hospital and got a $90,000 bill for a series of infusions that, again, down the street would have been $185—all in. Inches much? So, it's pretty clear why the show is part of "The Inches Are All Around Us" series. Why do I say this is part of the "No Market" series? Because look, functioning markets rationalize prices. That's just what they do. So, if you have two places in the exact same geography and one of them is charging 500 times or whatever the other one, you don't have a market if they're both still in business a year later. Ongoing wild price variations is a big tell that there's no market to be had. Another tell, though, is that carrier networks, who are supposed to be the demand curve here—or at least that's what their marketing says or what we are all kind of led to believe—they advertise as high-value networks, right? The fact that any given network experiences essentially no business repercussions for spending a million dollars extra of its plan sponsors' (its customers') money—because that's who's paying for this, the self-insured employer or union, at the end of the day—and the network, the carrier network doesn't lose business as a result … Right? Listen to the show from last week with Jacob Asher, MD (Take Two: EP398) about the carrier nonmarket and why this is the case. But bottom line, if anyone is waiting on a market to constrain prices for them, that is very magical thinking. Where this whole thing is gonna wind up, by the way, is with my guest today, Ivana Krajcinovic, suggesting a roadmap to make a whole lot more likely that you'll pay $135 for an infusion instead of 13 grand. For more on this, do go back and listen to the show with Keith Hartman, RPh, by the way. We teed this off a couple of years ago. That was episode 369. But in Ivana's upcoming roadmap that you're gonna hear about (just doubling down on the spoilers—if I'm gonna do something, I might as well do it well), but in that roadmap, direct contracts with indie practices will feature a starring role. I'm telling you this because if you're one of those folks that listens to like 23 minutes of any given podcast and then bails, make sure you make it to around the 30-minute mark of the show. As I have said several times already, my guest today is the incomparable Ivana Krajcinovic, the outgoing vice president of healthcare delivery at UNITE HERE HEALTH. Ivana has just retired, but she spent over three decades with her team protecting the health and the hard-earned wages of 230,000 hospitality workers. She is exactly the kind of "dangerous expert" that we love to have on the show—someone with the wisdom about how the system actually works and the articulate willingness to talk about it. Okay … so, this conversation about the inches and the nonmarket for infusions specifically in this country, for more information, do go back and read the really excellent Bloomberg News exposé by John Tozzi. It's a really good article, and you'll see everything that we talk about today in writing with all the fact-checking that one would expect from Bloomberg News. So, okay … what we'll do in this episode is, first, we're gonna talk about the infusion nonmarket, the inches and its implications, such as an infusion costing 500 times Medicare when there are 1.5x Medicare options in the same exact health system. Sometimes I just can't even with some of this stuff. But another nonmarket tell, again, is that carrier networks are still in business. We talk all about that. What happens next in this episode is we deconstruct the roadmap that Ivana used to fight back, which starts with (no surprises) drilling into data and ends with direct contracting with independent doctors. And how that happens is by carving out utilization ...
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