This edition explores the dynamics of optimal coordinated care, in relation to governmental policies/actions and MCO operational activities.  There are several combinations of ways that optimal care coordination programs are not yet being achieved. The construct described may be useful in identifying how a given program can be modified to better yield an optimal setting for facilitating access to needed care, ensuring that the services rendered are as cost-effective as possible, and helping covered populations maintain and improve their health status over the course of their daily lives.  The years ahead create exciting opportunities to widen and strengthen partnerships between state and federal governments and the MCO industry in the Medicaid and Medicare arena.