Commentators have often celebrated care coordination as an encompassing solution capable of reducing costs and increasing quality in US healthcare. It is unclear, however, under which conditions organizations implement high-quality work practices that are essential for achieving improved outcomes in the context of care coordination programs. My paper examines two institutional factors that improve the quality of work practices: occupational community, and regulatory intensity. I argue that the interaction of both factors produces higher quality than either would in isolation. I also demonstrate how in the absence of both factors, a prioritization of cost-effectiveness reduces the quality of work practices. To make my argument I draw on 80 semi-structured interviews, 80 documents, and 15 hours of observation in my study of three care management agencies that focus on serving low-income chronic disease patients in one of the most resource-poor communities in New York State.