Optimising medical group performance: The 5 Levers Framework for operational and financial improvement
Abstract
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/.
The full article is available to subscribers to the journal.
Author's Biography
Dr Mark A. LePage, MD, MBA, is a seasoned healthcare executive with a distinguished career spanning clinical practice, medical group management and healthcare system leadership. Dr LePage is Senior Vice President of Medical Groups and Ambulatory Strategy at Trinity Health, overseeing 15 medical groups, 7,500 providers and US$2.1bn revenue. In 2025, he expanded his portfolio to include Clinical Integration and Population Health, managing over US$2.3bn in medical expenditures and US$600m in premium revenue in risk-based arrangements. Prior to his current role, Dr LePage was CEO of IHA (Integrated Health Associates), a large multispecialty medical group that is part of Trinity Health Michigan, where he led strategic expansions, improved payer contracts and developed innovative financial models. His leadership resulted in significant growth in attributed patients and provider count, and a doubling of operating margin. Earlier roles include Chief Medical Officer at Marshfield Clinic and Security Health Plan, where he pioneered data-driven staffing models, cost-reduction initiatives and value-based care strategies. His clinical foundation as an interventional radiologist in both civilian and military settings informs his pragmatic approach to healthcare transformation. Dr LePage holds an MD from the University of Michigan, along with an MBA and MS in Finance from Indiana University. He has served on multiple boards, including Saint Alphonsus Health System and the American Medical Group Association Public Policy Committee, and is a frequent speaker on healthcare strategy and performance optimisation.
Michael Prisby is Vice President, Strategic Financial Planning and Operations at Trinity Health. He oversees strategic financial planning, including capital and long-range financial planning, and finance operations for Trinity Heath’s Community Division, which includes medical groups, ambulatory surgery centres, outpatient imaging and population health management. Prior to joining Trinity Health, Prisby led business development at PerfectServe, a venture capital–backed healthcare technology firm. During his tenure there, PerfectServe experienced significant market growth, resulting in a total of 8,000+ physician clients and new hospitals in multiple US markets. Prior to this role, Prisby spent nearly 10 years as a management consultant at Deloitte and Ernst & Young in Cleveland, Cincinnati and Denver, specialising in financial planning, feasibility studies, M&A and performance improvement in the healthcare industry. Prisby began his career in the Financial Management Development Program at AT&T’s headquarters in Parsippany, New Jersey. He earned a BS in business administration from the University of Dayton and an MBA from the Carlson School of Management at the University of Minnesota.
Fusen Li, MCIS, is Director of Business Intelligence — Medical Groups at Trinity Health and a strategic data and analytics leader with over 20 years of experience across health care, higher education, banking and retail. At Trinity Health, Fusen built analytics capabilities from the ground up, supporting Medical Group leadership at all levels with actionable data and insights. Fusen led the development of an enterprise data warehouse; created and maintained scorecards and dashboards across finance, operations, quality, clinical workflows and patient experience and collaborated with executive leaders to drive improvements in patient access, operational effectiveness and financial well-being. Fusen also worked with benchmark organisations for data submission and analysis. Previously, as Senior Director of Business Intelligence at IHA (Integrated Health Associates), Fusen developed analytics strategy, built a high-performing team and implemented self-service BI (Business Intelligence) solutions using Microsoft SQL Server tools and Power BI. Fusen managed machine learning projects, integrated data from multiple systems and collaborated on claims data warehouse and ACO (Accountable Care Organization) analytics. Earlier, at Michigan Medicine, Fusen directed data foundations and managed teams responsible for health system data warehousing, Epic Cogito and the Medical School Business Data Warehouse as well as led the Michigan Medicine Data Warehouse Strategy Committee. Fusen holds an MS in computer and information science from Cleveland State University, has completed advanced leadership programmes at the University of Michigan and AAMC GIR Leadership Institute and is a Lean Six Sigma Green Belt.
Amy Tschopp serves as the Manager of Business Intelligence at Trinity Health Medical Groups, where she leads strategic analytics initiatives that support finance, operations and clinical performance. She brings deep expertise in SQL database management, dashboard development and data-driven reporting to deliver insights that help leadership make informed decisions and improve outcomes. Her work spans the development of drillable key performance indicator (KPI) dashboards, clinical quality scorecards and large-scale data integrations. Amy is highly skilled in Tableau and is known for mentoring colleagues in data visualisation and reporting best practices. With a collaborative mindset and a clear communication style, Amy partners across teams to build user-friendly analytics solutions that drive strategic alignment and operational excellence. She is recognised for her empathy, problem-solving abilities and commitment to advancing health equity through data.
Citation
Lepage, Mark A., Prisby, Michael, Li, Fusen and Tschopp, Amy (2026, March 1). Optimising medical group performance: The 5 Levers Framework for operational and financial improvement. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 10, Issue 3. https://doi.org/10.69554/IOCH4591.
Publications LLP