Org Efficiency Case Study : Integrated Care Operations.

Structural Simplification Delivers $24M in Savings Without Sacrificing Value

The Backdrop

An Integrated Care Operations Company faced a structural inflection point. Years of organizational accretion produced management duplication, blurred decision rights, and spans of control that consumed execution capacity. The Client served blue-chip customers with high switching risk. Cost reduction was non-negotiable. Structural disruption without precision would erode the client relationships anchoring the revenue base. FulcrumQ was engaged to reduce cost and strengthen value delivery simultaneously.

The Challenge

Execute $24M in cost reduction while preserving all critical client-facing capabilities
Eliminate structural drag across four workstreams without triggering capability loss in the highest-value roles
Identify an additional $30M in productivity improvements over the following 36 months

The Approach

FulcrumQ structured a four-week co-created engagement across four workstreams: Benefit Programs, Operations Excellence and Affordability Services. CXO intake sessions established the value agenda and produced multiple structural design principles that governed every decision. FulcrumQ examined spans of control, management layers, decision-right distribution, and headcount alignment to value-creating work. A weekly SteerCo cadence maintained alignment as savings plans were co-created with workstream leaders. The engagement concluded with a cross-workstream workshop where structural decisions were pressure-tested against client-relationship risk and interdependencies were resolved before execution.

Management Layer Reduction

The Senior Manager layer was the primary structural drag point. FulcrumQ eliminated this layer and rationalized Manager roles to a 1:22 span of control. This single move shortened the decision chain to front-line execution and accounted for the majority of savings, with fully loaded costs declining from approximately $52.7M to a $43.5M target.

Role Architecture Redesign

A simpler role hierarchy with overlapping accountability was redesigned into three authority levels: Account Management owning contracting, Managers owning program and people accountability, and Coordinators managing task execution. This eliminated work duplication and sharpened decision authority precisely at the client-facing level where revenue risk was highest.

Critical Role Protection

Ten Senior Management roles were identified for deliberate retention despite the broader layer elimination. These roles held direct relationships with the Top weighted customers, the highest-margin and highest-switching-risk accounts in the portfolio. Protecting them prevented operational savings from converting into client-relationship risk on the revenue side.

Structural Design Guardrails

Seven design principles were codified before any structural decision was made, governing all four workstreams simultaneously. They covered management duplication, productivity targets, resource pooling, role-talent alignment, strategic focus, resource sharing, and critical role preservation. This ensured structural coherence and prevented the value leakage common to ad hoc reductions.

The Client executed $24M in cost reduction with all Top weighted client relationships preserved through deliberate role retention. Fully loaded costs in the core workstream declined from approximately $50M to a $40M target. The structural redesign positioned the Client to realize an additional $30-40M in productivity improvements over the following 36 months. Cost reduction and value protection were achieved at the same moment.

Org efficiency done with discipline is not a cost exercise. It is a value protection and value creation exercise executed simultaneously.

Client Perspectives Shaping Us

“The change point for us was that we went through a pivotal moment where we needed a rebuild. We were in a moment of radical transformation when we reached out to FulcrumQ. ”

“What was useful for me was the timing of it was perfect. We were in a big pivot point and restructuring point. ”

“Their superpower is amazing people with a lot of experience and business acumen that can debate the CEO about where their value hotspots are. ”

“ They’re critical partners at moments of inflection. They will challenge our assumptions; they never just tell us what we want to hear. ”

“ They help us make real, tangible change much quicker because they carry the strategy all the way through to mobilization. They don’t stop at the value, work and roles. They answer “what do we do about it”. ”

“ They synthesize the core strategies that drive value and then find the exact JTBD and people in the Organization that can make them happen ”

“ We found that what FulcrumQ does is pretty unique; applying tools in an HR context (at a very high level in the C-Suite) through leveraging human capital to drive value creation and accomplish strategic goals. ”

“ They have the ability to smell where the problems are and they have credibility (the people that they bring to the table speak with great authority and great insight), but they do it in a way that creates trust. ”

“ CEO Works doesn’t provide the answers, they walk you through a process of reflection. CEO Works is more like therapy than consulting. It’s implicit that you as a business leader understands your business and can collaborate with them throughout. ”

“ They can sit in a room of very senior leaders, without being awestruck or nervous, and they can have conversations at that level. They can say to the CEO: ‘this is what you're trying to accomplish, do you have the right people to do this?’. They can work in the board room. This is where they live. Very few firms can do that. ”

“ Ultimately, they find the leverage points that will get your strategy moving. The metaphor which sticks is “You have a bear that won’t move, you have to poke it in different places to find the right way to make it move.” ”

“ Their work is highly collaborative. Even if we present them with a pivot, they come back and tell us what the pivot really is and what we need to do about it. Every time we thought the pivot was this, they helped us realize it was that. ”

“ Today, the headwinds are much bigger, the challenges are much harder, and there are more existential questions. Business models are being totally wiped out. Most organizations are asking ‘Am I aligned?’ And ‘How can I be?’ ”

“ They are great provokers. ”

“ They’re less about ‘you have a problem, let’s solve it’. They are about ‘you’re currently looking for or trying to create value in the wrong places'. It’s about reinventing. ”

“ FulcrumQ acts as catalysts, shaking up the company and catalyzing the action within the organization. ”

“ Whether for a business, leader, or team, they deeply understand the pivot. And move with pace. And leave you better than when they arrived. They are pivot maximizers. ”

Power The Pivot

Engage with Fulcrumq