This resource describes a study of 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.

• The study examined 10 higher-performing Hospital Service Areas (HSAs) and six lower-performing HSAs.
• 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.
• Hospitals in higher-performing communities also routinely matched patients with needed social services.
• The collaborative approaches used by higher-performing communities, if spread, may be able to improve outcomes elsewhere.