Many large medtech companies are carrying something that never appears on the balance sheet: operational debt.

For some, decades of acquisition-led growth have added complexity. With each deal, systems multiply, processes diverge, and teams keep working in parallel. For others, it’s the legacy of a decentralized operating model, where each business built its own ways of working. Either way, most find themselves with fragmented enterprise resource planning (ERP) systems, inconsistent processes, and regional structures that resist standardization.

Yet growth through M&A remains a strategic imperative for most large medtechs. And the complexity is compounding without a scalable operating model to absorb it.

Enterprise shared services offer medtech companies an opportunity to untangle compounding complexity. Unlike functional shared services—which optimize within a single function but leave the connective tissue between them unaddressed—a mature, cross-functional, enterprise-wide model creates shared ownership of processes that cut across finance, HR, IT, and beyond.

That integration is where the real value lies. It frees up capacity and capital for innovation, enables faster and lower-cost acquisition integration, boosts customer loyalty, accelerates AI adoption, and broadens access to specialized talent. Given that growth is the primary driver of medtech valuations, companies that embrace a fully empowered enterprise shared services model will quickly outpace those that don't.

The cost case for enterprise shared services is real too. Our analysis of the 19 largest pure play public medtech companies reveals that, on average, gross margins have contracted by 149 basis points since 2019. Continuous cuts to R&D investment and commercial execution can put growth at risk, leaving general and administrative (G&A) as the primary hunting ground.

But framing shared services as a cost play is a fast way to underdeliver on it. The more powerful argument is capacity. When operational enablers—finance, HR, IT, and elements of supply chain—are centralized, handled by a purpose-built organization, and running effectively, the rest of the business can focus on what generates growth. Commercial teams sell. R&D innovates. Business development pursues the next deal. Cost savings tend to follow but aren’t the main purpose.

Why medtechs should revisit their enterprise shared services strategy now 

Compared with other industries, medtech has been slower to build fully mature enterprise shared services models. There are legitimate reasons: customer intimacy makes some work difficult to standardize; decentralized business models and strong business unit autonomy have long defined the sector; and the relentless pressure to pursue revenue growth outweighed any urgency around simplifying the back office.

That context is changing as four forces converge:

1. Enterprise shared services are uniquely positioned to capture the AI opportunity.

Scaling AI is an executive mandate. AI agents and tokens could represent 20% to 30% of operating expenses for AI pioneers by 2028–2029, vs. just 1% to 2% today. Yet only 15% to 25% of finance organizations have scaled AI into full production. The limiting factor isn't the technology. It's the absence of the process and data foundations that AI requires to perform.

Standardized workflows reduce model complexity. Consolidated data improves accuracy. Concentrated volume increases the return on automation. Centralization isn't a detour from AI value; it's the shortest path to it.

The most forward-leaning enterprise shared services organizations are already making this shift, evolving from transaction factories to AI deployment platforms. They’re owning process redesign and AI-enabled execution across functions, including areas once considered too specialized to centralize, such as regulatory documentation, quality management, and clinical operations.

2. M&A execution is a competitive advantage.

In a sector where inorganic growth is a strategic imperative, the ability to integrate quickly and effectively is invaluable.

Companies with mature enterprise shared services organizations are in a better position to move fast. They can integrate acquired businesses into common platforms, scale standardized processes more easily, and capture synergies sooner. Over time, that creates something even more valuable: a repeatable integration approach that powers an efficient, effective M&A engine.

3. Customer expectations have shifted.

The Amazon effect has reshaped expectations in every industry, including medtech. In a world where consumers can get real-time tracking on their paper towel restock order, buyers want more visibility into their $5,000 medical device order. Yet hospitals still receive three separate bills from three different representatives across brands owned by the same parent company. These sorts of common, fragmented customer experiences are where operational debt becomes visible. When customers feel that friction, it’s a competitive vulnerability.

Companies that build customer-centric solutions and operations into their shared services can gain a significant first-mover advantage. Those with leading shared services organizations have seen as much as a 30% improvement in their Net Promoter Score^SM, a key measure of customer loyalty.

4. Selling, general, and administrative pressure is real.

When we asked medtech commercial leaders to rank their top challenges, managing pricing pressure to preserve or expand margins landed in the top five, with 10% citing it as their No. 1 concern.

Operating income expansion remains an expectation, and the math only works if costs come down somewhere. Since G&A sits furthest from the growth engine, it’s where many leadership teams are looking first. But in a sector defined by decentralized business models, G&A costs are often fragmented across business units and inconsistently tracked—making them hard to reduce without a common structure to govern them.

Enterprise shared services are one of the clearest mechanisms to establish that structure. Bain research shows that mature shared services organizations have consistently reduced costs by 20% to 40%.

These four forces are reshaping the role of enterprise shared services. For years, leading companies have been pushing beyond traditional G&A functions into knowledge-based, high-value services once considered too specialized or customer-facing to centralize. Within medtech, some companies have included clinical and regulatory activities such as clinical trial design, regulatory submissions, and post-market surveillance into their shared services models. Quality is another frontier: validation activities, quality system management processes such as corrective and protective action (CAPA) and root cause analysis, and supplier quality audit and performance monitoring. R&D functions such as prototype development, product analytics, and usability engineering are yet another opportunity. As AI tools increase productivity and capability for knowledge workers, this trend will only grow.

How leading medtechs are rethinking the journey

Enterprise shared services can address several high-stakes ambitions: near-term cost savings without disrupting growth, genuine ROI from AI, and a scalable platform for M&A integration. One medtech facing margin pressure and a fragmented back office, including outsourced finance and accounting functions, demonstrates the benefits of shared services beyond cost. By establishing centralized shared services ownership of process execution, it not only achieved $15 million to $25 million in gross savings but also increased key customers’ satisfaction by 12% and cut average back-office cycle times by 10% to 15%.

The transition to an enterprise shared services model works best when leadership teams explicitly define why they are adopting it and what success looks like. Leaders can start by asking themselves four key questions:

1. Where is our operating complexity actively holding back growth, and how aggressively are we willing to simplify?
2. How much faster could we integrate acquisitions, serve customers, and scale AI if our core processes were truly standardized?
3. Are we treating enterprise shared services as a cost-cutting tool or as a strategic platform to unlock growth, speed, and competitive advantage?
4. What will it cost us—in performance, valuation, and talent—if we wait two more years to act?

The only wrong move in shared services is not having a clear strategy. The further competitors progress in simplifying processes, standing up shared capabilities, and embedding AI into workflows, the harder it will be to close the gap. The question for medtech executives is no longer whether to build a more scalable operating model. It’s how quickly to start.