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Objective. To understand how health care providers and social services providers coordinate their work in communities that achieve relatively low health care utilization and costs for older adults. Study Setting. Sixteen Hospital Service Areas (HSAs) in the United States. Study Design. We conducted a qualitative study of HSAs with performance in the top or bottom quartiles nationally across three key outcomes: ambulatory care sensitive hospitalizations, all-cause risk-standardized readmission rates, and average reimbursements per Medicare beneficiary. We selected 10 higher performing HSAs and six lower performing HSAs for inclusion in the study. Data Collection. To understand patterns of collaboration in each community, we conducted site visits and in-depth interviews with a total of 245 representatives of health care organizations, social service agencies, and local government bodies. Principal Findings. Organizations in higher performing communities regularly worked together to identify challenges faced by older adults in their areas and responded through collective action--in some cases, through relatively unstructured coalitions, and in other cases, through more hierarchical configurations. Further, hospitals in higher performing communities routinely matched patients with needed social services. Conclusions. The collaborative approaches used by higher performing communities, if spread, may be able to improve outcomes elsewhere. Key Words. Social determinants of health, coordination, older adults, Social determinants of health are critical for older adults with complex health needs, often described by policy makers as high-need, high-cost patients, a group estimated to constitute 5 percent of [...]