The workers’ compensation industry faces a persistent challenge that impacts every stakeholder in the care continuum: data silos. When ancillary care, case management, and bill review systems operate independently, critical information can become isolated or opaque, preventing adjusters, providers, and care teams from making fully informed decisions. This fragmentation not only increases costs but also delays recovery times for injured workers who deserve coordinated, efficient care.

“When products or services exist in individual silos, they each maintain separate datasets regarding outcomes, cost management, and other key metrics,” said CJ Cypcar, Vice President of Network Solutions & Product Integration at CorVel. “If you cannot normalize and integrate this data, you miss seeing the total impacts across the claim continuum.”

The Hidden Costs of Fragmented Data

CJ Cypcar, Vice President of Network Solutions & Product Integration, CorVel

The impact of siloed systems extends far beyond simple inefficiencies. Without integrated data, organizations struggle to identify patterns that could dramatically improve claim outcomes. Claims adjusters, who need comprehensive information to make effective interventions, find themselves working with incomplete pictures of each case.

“In bill review, you might observe reasonable provider network utilization and wonder how to improve it,” Cypcar explained. “What you might not see is that your use of triage is lower, which is crucial for channeling care into those networks and management systems.”

This fragmentation creates a domino effect throughout the claims process. Adjusters cannot identify when claims with specific characteristics typically encounter challenges in ancillary services. They miss opportunities to proactively schedule referrals or recognize when alternative treatment paths might yield better results. For instance, integrated data might reveal that for certain injury types and patient demographics, proceeding directly to surgery rather than physical therapy produces superior outcomes.

The traditional approach forces each department to work with its own dataset, following isolated processes that may conflict with or duplicate efforts in other areas. This not only wastes resources but also creates delays that directly impact injured workers’ recovery timelines.

Transforming Communication Through Integration

The shift toward integrated analytics represents more than a technological upgrade—it can transform how the entire workers’ compensation ecosystem communicates and collaborates. Organizations implementing these systems are witnessing measurable improvements in both operational efficiency and patient outcomes.

“We’re seeing decreased litigation rates and better return to work outcomes,” Cypcar said. “The quicker an injured worker returns to work, the better it is not only for them, but also reduces the overall claim cost in terms of medical expenses and indemnity benefits.”

This integration creates what Cypcar describes as “three-point integration,” connecting payers, providers, and injured workers around a shared goal: returning the injured worker to their pre-injury condition as quickly and completely as possible. With better integration between payers and providers, adjusters can access referral information much more quickly. They have improved analytics at their fingertips to make more informed decisions on approving those referrals, which means treatment occurs faster than before.

“These integration points, processes, and efficiencies are critical,” Cypcar noted. “Without them, you won’t see that quick turnaround time.”

The industry has been gradually shifting toward integrated analytics, but the real game-changer has been the move to real-time data processing. Rather than relying on datasets that might be months old, organizations can now work with current information that reflects the immediate state of each claim.

“Advancements in technology, AI, and natural language processing have enabled us to work with these data models in real time,” Cypcar explained. “This allows us to provide more strategic interventions and data points that aren’t outdated based on historical datasets.”

The tangible benefits of this approach are already evident in key areas. “We’ve seen significant progress, especially when it comes to provider utilization and pharmacy utilization,” Cypcar said. “The more our interventions allow us to bring services back in network, the more we experience reduced costs and quality care in those areas.”

The Future of Technology in Claims Management

Looking ahead, artificial intelligence and advanced analytics promise to accelerate the transformation of claims management. However, the pace of change presents both opportunities and challenges for the industry.

“Technology is changing much more rapidly than anything we’ve seen in the past fifteen to twenty years,” Cypcar observed. “What we predict today could be completely different in just three to five months.”

AI’s most significant contribution may be its ability to serve as an intelligent assistant, pulling insights from vast amounts of data in real time. Traditionally, claim information might be spread across five or six different screens, including notes and records. AI can now instantly retrieve specific information when requested, eliminating hours spent reviewing documents and enabling faster, more informed decision-making.

“AI also effectively analyzes unstructured data,” Cypcar explained. “Now with AI technology, we can convert unstructured notes, records, and documents into usable data for our models and insights.”

However, Cypcar emphasizes that human oversight remains crucial. “AI won’t replace jobs or take over claims decisions; it functions as an assistant or tool,” she said. “Users must be able to identify anomalies or instances where information doesn’t appear accurate.”

This requires significant investment in workforce education. Professionals need training not just in using AI tools, but in critically evaluating their outputs. “When AI pulls something that doesn’t look quite right, I ask for its source,” Cypcar shared from personal experience. “This type of education and critical engagement is what we all need to invest in for appropriate AI utilization at the right time.”

The industry is also seeing shifts toward value-based care models that emphasize prevention and early intervention. “When you think about value-based care models; prevention, prediction, and treating the whole injured worker or patient, versus only symptoms or transactional in-and-out care, that’s where we’ll see more integrations across those silos,” Cypcar said.

As a technology and analytics provider specializing in workers’ compensation solutions, CorVel has developed integrated approaches that address these industry challenges. By normalizing data from multiple sources and providing real-time analytics, the company helps organizations identify optimal intervention points and resource allocation strategies.

“Once normalized and functioning in near real-time, the data helps identify potential gaps or areas for improvement,” Cypcar explained. “Organizations can then make informed decisions for their strategic roadmaps, such as enhancing triage approaches, improving utilization rates, or launching initiatives like pharmacy card distribution.”

The ultimate goal extends beyond individual organizational benefits. “This is all a collaboration amongst multiple parties within one system, and our goal is to help injured workers return to work and achieve the best outcomes,” Cypcar emphasized. ” Integrated analytics help us bridge gaps across these spaces to continue improving those outcomes.”

As the workers’ compensation industry continues to evolve, the organizations that successfully implement integrated analytics will be best positioned to navigate regulatory changes, manage costs, and most importantly, deliver superior care to injured workers. The technology exists today to break down the silos that have long plagued the industry—the challenge now is implementation and adoption at scale. &