Everyone agrees health care should reward better outcomes at lower cost. So why hasn't it happened? The answer isn't payment models or policy. It comes down to the everyday choices individual clinicians make, and whether anyone can actually see them. Jeanne Cohen, a health care analytics founder and CEO, argues that the value in value-based care lives in the quality of each clinical decision, not the contract structure around it. This episode is based on her article "The real reason value-based care has not delivered," published on KevinMD. You will hear why roughly a quarter of U.S. health care spending traces back to unwarranted variation, how ordering an unnecessary scan exposes patients to harm and pushes organizations out of financial alignment, and why the data infrastructure to fix this finally exists. Cohen also explains where AI can help, where it can't, and why it won't lower costs on its own. If you want to understand what actually stands between the health care system and the outcomes it keeps promising, this conversation names it directly.

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