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Employed medical groups and their health systems face increasing financial pressure owing to declining reimbursement rates, rising labour costs and rising inflation. Traditional financial reporting, with its focus on bottom-line net income, is not particularly insightful as a gauge of medical group operational performance and does not naturally point to the operational steps necessary to improve financial performance. The 5 Levers Framework is a data-driven, activity-based model developed by Trinity Health that supplements traditional bottom-line metrics with a more operationally driven measure: net investment per relative value unit (RVU), benchmarked against national standards. The framework is grounded in the CMS (Centers for Medicare & Medicaid Services) RBRVS (Resource-Based Relative Value Scale) and evaluates medical group performance across five operational domains: Physician/Provider Portfolio Management, Provider Productivity, Revenue Optimisation, Practice Expense (PE) Optimisation and Provider Compensation Alignment. Each lever is tied to actionable operational metrics. Performance is tracked via real-time dashboards and benchmarked using AMGA (American Medical Group Association) survey data. Application of the framework across 15 regional medical groups led to a US$166m year-over-year financial improvement, an 8-point increase in operating margin percentage and a 7.5 per cent increase in work relative value units (wRVUs). These results demonstrate the framework’s effectiveness in aligning operational drivers with financial outcomes. The 5 Levers Framework offers a replicable, scalable model to more effectively and accurately assess and improve medical group financial performance. It enables health systems to move beyond simplistic financial accounting and towards strategic, data-informed decision making grounded in clinical activity and system value. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.