Committed contracts: what happens after you take the pledge?

For years, hospitals played under shifting rules at the high-stakes purchasing table. Manufacturers, groups and providers all dealt and bluffed. Each made commitments to one another, but afterward the manufacturers would try to go in the back door if a competitor shut them out at the front, and hospitals would join multiple groups and shift loyalties at will to get the lowest price. Sure, all agreed that solid contract commitments would be better for everyone. But when it was time to ante up, what really mattered to each was getting the best deal. And "best" meant something different to each player.