After a transaction, finance gets a playbook and commercial gets a person

Nov 4

In the first year after a healthcare company changes hands, its finance function usually changes twice. It gets a new CFO, and it gets a new way of running finance. The commercial function usually changes once, if at all. It gets a new person.

That difference shapes the value creation plan more than it gets credit for. The growth line and the cost line were underwritten in the same model, with the same confidence, but only one of them arrives with a standard.

Why finance arrives with a standard

The CFO is the most frequently replaced role after a buyout. Among PE-backed healthcare services companies, WittKieffer reports that 84 percent replace the CFO, on average 11 months after the transaction. Russell Reynolds Associates found the same pattern in Europe, where 60 percent of the portfolio companies in its sample had replaced the CFO after acquisition.

The new CFO doesn’t start from a blank page. The sponsor has run finance across many companies, and it brings the same expectations to every one: a faster monthly close, a 13-week cash forecast, KPI reporting, lender and covenant reporting, and a board package in the sponsor’s format. A good CFO adapts it to the business. Nobody asks them to invent it.

That’s the right call, and it isn’t optional. Lenders and limited partners need finance to work the same way everywhere, and a playbook that transfers is how a sponsor gets there quickly. Finance has a standard because someone outside the company requires one.

What commercial gets instead

Commercial gets a person. When growth needs to change after a transaction, the sponsor’s reflex is talent: a new revenue leader, a new head of sales, sometimes a new CMO. Raines International’s 2025 private equity report, a survey of 109 PE partners, found that partners now rank the revenue leader third among the roles they worry about replacing, behind only the CFO and the CEO.

What the person rarely gets is a standard. In the pattern we see across healthtech and pharmacy, finance, IT and data get standardized across a portfolio, and the commercial system is left to each company. Often the founder or longtime CEO who carried the most important relationships has just moved into a new role or out of the company. The new leader inherits a number, a clock and a commercial motion nobody wrote down.

So growth after a transaction depends on how good that one person is. Sometimes they’re excellent, and the plan holds. Sometimes the leader who fit the old model can’t see what the new mandate takes, and replacing them is the right move. Either way, the result rests on an individual rather than a system. That’s growth by heroics, and it doesn’t scale past the person producing it.

It also carries the plan. In Bain’s analysis of technology buyouts since 2010, revenue growth produced more than half of the value created, and margin improvement produced 4 percent. The line with no standard is the line the returns depend on.

Why a faster hire doesn’t close the gap

Hiring the revenue leader sooner helps. It doesn’t change what they walk into. A CFO hired in month three runs the sponsor’s playbook. A revenue leader hired in month three spends much of the first year working out how the company wins, which customers matter now, which motions to keep and which acquired names to fold.

Then the seat turns over. Across 14,000 executives tracked by Pave, the average CRO and VP of Sales lasts about 1.8 to two years, and Live Data Technologies found about half of new CROs leave within two years. Without a standard, the next leader starts the same work over.

Platforms built through acquisition feel this most. In McKinsey’s survey of 200 M&A executives, most fell short of their revenue goals, by an average of 23 percent, and revenue gains took about five years to capture against two for cost savings. Cost work arrives with an owner, a template and a date. Growth work arrives with a hire.

What a commercial standard would contain

No single commercial model fits every company, and it doesn’t need to. A finance playbook doesn’t standardize the business. It standardizes the close, the cadence and the controls. A commercial standard would do the same: a fixed set of decisions every portfolio company makes on purpose, in order, with owners.

How the company wins today, written down: where new accounts come from, who holds each relationship, and what depends on one person.

The position and story for the next stage of growth, rebuilt or optimized for the new plan and tested with customers.

A growth model for winning, expanding and keeping accounts, with the numbers leadership runs on.

A rule for every acquired name: whether it stays or folds, and why.

A map of who decides now, whether that’s referral sources, payers, employers and health systems, or the clinical, IT and finance leaders who buy software.

A named owner for every commercial seat and every handoff between teams.

Proof of results captured as it happens, kept by the company rather than by the people who produced it.

What stays custom is everything inside those decisions: the position itself, the segments, the channels, the pricing and the sales motion. An infusion platform and a revenue cycle software company would fill in the same framework with completely different answers.

Who owns the standard across a portfolio

Some funds now bring commercial expertise to their portfolios. Heidrick & Struggles’ 2024 survey of 251 U.S. private equity operating professionals found more of them specialize in sales and marketing than in finance, and some healthcare funds have added operating partners focused on commercial excellence.

Expertise isn’t the same as a standard. What I rarely see is a fixed set of commercial decisions every portfolio company has to make, reviewed in the board package the way the finance section is. Lenders make sure finance gets one. Nobody makes sure commercial does, so commercial help tends to arrive as advice and projects rather than a requirement.

Without a standard, each portfolio CEO is left to build one alone, on the plan’s clock, while running the business. Some do it well. The fund then has a different commercial system in every company and no way to carry what worked in one into the next.

What a CEO can ask for in the first 100 days

A CEO doesn’t have to wait for the fund to build this. In the first 100 days, ask the sponsor what its commercial standard is. If there isn’t one, write it: the seven decisions above, each with an owner and a date. Then put it in the board package next to the finance section, so it gets reviewed with the same discipline.

The growth line and the cost line sit in the same model. Only one of them came with a playbook.

Dr. Roxie Mooney is founder and CEO of Legacy DNA. Legacy DNA builds the commercial systems that let mid-market PE-backed and independently owned healthtech and pharmacy companies grow, scale, and exit at a premium.

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