Article

Closing the operations gap: Protecting the value you negotiated

Why health systems need to move from detecting transactional leakage after it happens to protecting negotiated value as it moves from contract to payment, and how AI is making that possible.

VizientArticle
By Bill Selles
7 min readNov 10, 2026
Supply chain and cost management
Key points
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From fragmented spend to managed opportunity banner

Health systems invest substantially in negotiating favorable prices and contract terms. But the financial value of those agreements ultimately depends on something much more routine: what actually happens when the organization buys and pays for a product or service.

Between contract and payment, information passes among item masters, purchasing systems, purchase orders, invoices, and other workflows. Each system has a job to do. When the information flowing among them doesn't align, the price an organization negotiated may not be the price it ultimately pays. For example, a contract price could be entered incorrectly in an item file or a rebate could be missed. The transaction may still move successfully through the procure-to-pay process without delivering the financial result leaders expected.

Item-master errors, invoice discrepancies, missed rebates, and prompt-pay discounts are just a few examples of where that value can erode. A health system can negotiate effectively and process invoices efficiently and still fail to realize all the financial value expected from its contracts.

That's the operations gap: the difference between the value an organization negotiates and the value preserved as those terms move through operational execution. Closing it has historically meant manual review, but AI and intelligent orchestration are changing what health systems can see and how early they can act.

Your 60-second read
  • A strong contract creates the opportunity for savings, but execution determines whether that value is preserved. Pricing discrepancies, invoice inaccuracies, missed rebates, and workflow breakdowns can erode negotiated value between contract and payment.
  • The operations gap is highly manual. In Vizient-commissioned research, 85% of participants described price and invoice issue detection and resolution as manual or person-dependent.
  • Advances in AI and technology are creating an opportunity to analyze transactions at greater scale, connecting contract, purchasing, and invoice data to identify exceptions, uncover recurring patterns, and ultimately prevent more leakage before it occurs.

Why small discrepancies become an enterprise problem

An individual price discrepancy may not seem material, but health systems manage purchasing across thousands of products and transactions involving countless suppliers, departments, facilities, and sites of care.

At that scale, isolated exceptions can become patterns, and identifying those patterns requires significant human effort.

In Vizient-commissioned qualitative research across 62 C-suite and vice president-level leaders in healthcare, 85% of participants described their current process for identifying and resolving price and invoice issues as manual or person-dependent. Thirty-four percent said they don’t have any standardized process, while 27% use spot checks and reactive discovery.

That dependence on manual intervention creates two problems. First, teams have finite capacity to review transactions, investigate discrepancies, assemble supporting information, and pursue resolution. Second, fixing an individual transaction doesn't necessarily fix what caused it.

An organization can identify an incorrect invoice, recover an overpayment, and consider the issue resolved, but if the contract, item, supplier, or purchasing data that contributed to the discrepancy remain unchanged, the same issue can appear again.

85%
described price and invoice issue detection and resolution as manual or person-dependent.
34%
of research participants said they don’t have a standardized process.
27%
use spot checks and reactive discovery.

These recurring problems have several sources. In Vizient research, 32% of participants identified contract price mismatches as the single greatest challenge, followed by invoice or billing errors at 25% and substitutions or conversions at 23%.

Because no single source of leakage explains the operations gap, organizations need to connect what should have happened with what actually happened and analyze those differences across thousands of transactions—not one at a time.

Technology is beginning to make that possible.

32%
of participants identified contract price mismatches as the single greatest challenge.

Technology is changing what health systems can see

For years, the limiting factor wasn't simply whether health systems possessed contract, purchase order, or invoice data. The challenge was bringing those data together at sufficient scale to identify meaningful discrepancies and patterns without requiring employees to manually review transactions one at a time.

But AI, technology, and intelligent orchestration are changing that equation.

Modern analytics and automation can compare large volumes of transactional information against contract intelligence, identify exceptions across datasets, and surface patterns that would be difficult to detect through manual review alone. Instead of depending primarily on spot checks or discovering issues after an invoice has been paid, teams can analyze transactions more systematically and prioritize those that warrant investigation.

That creates a progression in operational maturity where every stage creates a different kind of value: Detect the discrepancy → understand the cause → correct the issue → identify the pattern → prevent recurrence

Rather than discovering a pricing discrepancy months after payment, health systems can work toward identifying exceptions earlier in the procure-to-pay lifecycle, creating an environment in which more discrepancies can be addressed and prevented before they become financial leakage.

What if price assurance becomes continuous?

Consider what the operations gap could look like five years from now.

Instead of relying primarily on retrospective audits, spot checks, and employees manually tracking discrepancies, health systems could connect contract and transaction intelligence across the procure-to-pay lifecycle.

The role of supply chain and accounts payable professionals would evolve.

Less effort would be needed to search for discrepancies and assemble evidence after payment. Instead, the focus could be directed toward managing exceptions, resolving root causes, working with suppliers, and strengthening the processes that prevent errors from recurring.

And the definition of high-performing procure-to-pay would evolve with it. Leaders would look at how accurately negotiated terms translate into paid transactions, how quickly exceptions are identified and resolved, and whether recurring sources of leakage are declining over time.

That’s the opportunity in closing the operations gap: making accurate execution as disciplined as the negotiation that created the value in the first place.

Closing the operations gap

P2P Price Assurance connects contract and transaction intelligence to identify price discrepancies, support resolution, and help prevent recurring leakage across procure-to-pay workflows.

The capability is designed to help supply chain teams identify where existing contracts could be leveraged, where new sourcing opportunities exist, and which opportunities warrant attention first, turning fragmented spend into a more actionable pipeline.

Learn how P2P Price Assurance can help protect negotiated value from contract through payment.

Executive action guide

Five questions leadership teams should ask about the contracting gap:

  1. How accurately does the price we negotiate flow through purchase order, invoice, and payment? A contract creates potential value, but execution determines whether that value survives.
  2. Where do price, invoice, and contract exceptions occur most frequently in our organization? Looking for patterns can help distinguish isolated errors from systemic sources of leakage.
  3. How much workforce capacity is devoted to identifying, investigating, and resolving exceptions manually? Manual effort is part of the cost of the operations gap, even when financial discrepancies are ultimately recovered.
  4. Are we fixing individual transactions, or addressing the underlying causes that allow discrepancies to recur? Recovery protects value retrospectively. Root-cause resolution creates a path toward prevention.
  5. Who owns the financial outcome from negotiated price through payment? Clear accountability across supply chain, finance, and accounts payable can help ensure that transaction processing and savings realization are managed as connected outcomes.

Author

Smiling professional man in business suit

Bill Selles

Senior Vice President/GM, Spend Management Services

Bill Selles, Senior Vice President/GM Spend Management Services at Vizient, is focused on transformation efforts across the Spend Management Business Unit. He has responsibility for optimizing operational performance and overseeing programs, services and operational functions that support the delivery of category-based solutions across the continuum of care. Selles joined Vizient with a wealth of experience in supply chain leadership across...