Today’s healthcare system is undergoing radical shifts in care delivery and payment models, transforming the very nature of the care continuum. The imperative to decrease cost, improve quality, and measure and report on outcomes is prompting stakeholders to focus on value-based care through coordinated, patient-centric, and data-driven care delivery. Providers recognize that complex interactions between the varying physical, mental, and behavioral needs of a patient contribute to overall health—and are increasingly seeking to incorporate community and social service entities into the care continuum. Advanced case management technology can help social service organizations collect, integrate, and manage data to deliver high-quality, value-based care to underserved populations while also improving operational efficiency and report for compliance and outcomes. This paper describes the experience of two such organizations, Region 6 Behavioral Healthcare and the AIDS Foundation of Chicago as they implement health information technology to serve their patient populations.