Healthcare organizations (HCO) have historically invested in health information exchange (HIE) technology expecting that access to a patient’s longitudinal record can help clinicians deliver better care. But there has always been a financial motive. In light of the continued move to value-based reimbursement (VBR), HCOs are raising their expectations about the role an HIE can play in the financial health of the enterprise. In the not-too-distant future, HIE objectives will be far more complex than they are currently. An HCO’s success will depend on effective and efficient care processes in venues that the HCO does not control but nevertheless must understand and influence. HCOs need new capabilities, including better visibility into the clinical processes of other HCOs, if they are to manage their risk and optimize care processes no matter where their patients seek care across the continuum. HCOs will require a new level of distributed intelligence to extract value from clinically integrated networks. Beyond driving referrals and accessing a patient’s record, HCOs will need to ensure that all clinicians with whom they share risk have access to tools and are receiving the information they need to meet contract-based clinical quality and financial metrics.