California has 12 county hospital systems and five University of California public hospitals that deliver the majority of inpatient and a significant amount of outpatient care to Medicaid patients in the state. In this seminar, Nadereh Pourat, the Center’s director of research, discussed findings from a comprehensive evaluation of a major effort to promote innovation and improve care at these hospitals: the Delivery System Reform Incentive Payment (DSRIP) program. California was the first out of several states nationally to implement DSRIP, making these findings significant to the broader national experiment in health system reform. Pourat, who was the lead evaluator of the five-year California DSRIP program, describes newly assessed measures of progress, what interventions were the most successful, and whether a “pay for performance” incentive system worked.