For accounts with lots of campaigns and ad groups, use labels and consistent naming conventions to give yourself easy ways to summarize the account at a high level. Also become comfortable with Google Ads Editor for bulk editing.
Do those things and the workload isn’t really that much more than it would be with more consolidated campaigns. At the end of the day even if you cut it in half to 100 campaigns, that’s still one-hundred-freaking-campaigns. It’s going to take more than just consolidating match types to really make that manageable.
With Labels, set them up with a prefix that helps group similar campaigns or ad groups. For example: “LOCATION: New York,” “LOCATION: Florida,” etc.; “DEPARTMENT: Tennis Shoes,” “DEPARTMENT: Dress Shoes,” etc. Then when you go in to check on the account, you can just go to the Labels report, sort alphabetically, and get a quick summary of how the account is performing in key dimensions so you can decide where to drill down and focus your time.
Consistent naming conventions similarly can be used along with a few Excel skills to summarize data. For example, an ad group naming convention could look like: “[Topic] KW Root – Modifier.” Then when you pull any report with the ad group column, you can use Text to Columns in Excel to break the ad group name into 3 separate columns, and then create a Pivot Table to view the data any way you want.