Medical Loss Ratios climbing to 90%, 95%, and higher. Major health plans reporting quarterly losses in the hundreds of millions. CMS reimbursement policies have executives scrambling. Employers done with double-digit cost increases and openly exploring alternatives.

Something has to change. Now.

As 4L CEO Clay Wilemon observed at a recent payment integrity conference — when a session moderator asked the audience how many of their health plans ran on a claims platform more than 25 years old, almost everyone in the room raised their hands.

That’s the problem.

“Systems must change in a big way for health plans to change their fiscal trajectory.” — Clay Wilemon, CEO, 4L Data Intelligence

In their opening keynote at the Millennium Alliance Transformational CFO Healthcare Payers Assembly, Clay and Christina Hedge, VP at Booz Allen Hamilton, presented five guiding principles for meaningful fiscal performance improvement — ones that don’t require massive capital commitments, but do require abandoning incremental thinking for good.

Read the whitepaper. The Power of Now starts here.

Want to learn more? Email Fast@4LData.com.

Key findings

• Medical loss ratios at health plans are climbing to 90%, 95% and higher, and major plans are reporting quarterly losses in the hundreds of millions of dollars.
• Most plans still run claims platforms more than 25 years old. When a payment integrity conference session asked, almost everyone in the room raised their hands.
• Legacy systems and processes are siloed, labor-intensive and latent, so CFOs’ improvement levers are siloed too. Incremental fixes will not change a plan’s fiscal trajectory.
• The paper sets out five principles for fiscal performance improvement: Fast, Capital, Bad, Cloud and Evil.

Why are health plan medical loss ratios rising?

Health plans face systemic financial pressure: medical loss ratios of 90% or more, shifting CMS reimbursement and compliance policies, and employers who are done with double-digit annual cost increases. The paper argues the root cause is structural. Plans run on decades-old, siloed claims systems that cannot support systemic performance change.

What are the five principles for health plan financial performance improvement?

1. Fast. Advanced technology, especially artificial intelligence platforms like patented Integr8 AI™, must be able to be deployed and generate financial returns fast and with clear certainty of those returns for the organization.
2. Capital. Big improvements should not require big capital commitments.
3. Bad. You can’t catch enough ‘bad’ things to achieve financial success; you must accomplish good things and detect operational threats 24/7/365 before they impact performance.
4. Cloud. You can’t fix dynamic problems with old, latent systems. The cloud is secure, fast, and flexible in the right environment.
5. Evil. Silos are evil, and you need technology to connect what should be connected so that everything being done to deliver the plan design you want and the member outcomes you need is working together in a synchronous, transparent environment.

How does 4L help health plans improve financial performance?

4L applies the continuous operational threat detection described in its Integr8 AI patent across three solution suites that run as one system or as building blocks: 4L Health Plan Intelligence; 4L Integrated Provider & Payment Integrity; and 4L Pharmacy Compliance, Pricing & Management. With Booz Allen, 4L brings AI, analytics, automation and intelligence-grade cybersecurity to commercial health plans, TPAs and self-insured employers.

Source: “Health Plans Need Help. Now. Incrementalism Is the Enemy.” by Clay Wilemon, CEO, 4L Data (March 2026). Download the full white paper above.