The Federally Qualified Health Center Urban Health Network is a coalition of 10 federally qualified health centers (FQHCs) in the Minneapolis–St. Paul area that pursued an accountable care organization (ACO) through a Medicaid demonstration project with Minnesota. Under the ACO model, the coalition has assumed responsibility for the total cost and quality of care delivered for an assigned patient population. This case study explores: the state context under which the ACO contract emerged; origins of the coalition; the members’ motivations to participate; strategies and processes established to work toward cost and quality benchmarks; challenges faced in pursuing accountable care; and the organizational strengths that facilitated the health centers’ shift from competition to collaboration. The keys to the coalition’s success include a committed leadership team focused around a singular purpose; the partnership with its administrative services partner; and the diversity of programs, services, and experiences among the 10 FQHCs.