This chapter is a case study of a payment reform in New York State by Medicaid. The payment was organized as a Delivery System Reform Incentive Payment (DSRIP) programme with the ultimate goal of reducing avoidable hospital care by 25 per cent, while making sure that no more providers would require financial state-aid to survive. The programme aimed to incentivize providers to coordinate care, increase transparency of services and payments based on outcome. The programme runs from 2015 until 2020. The first results look promising, but it is too early to draw definite conclusions. Although the programme is still unfolding, some lessons can already be drawn: rewarding voluntary participation ensures motivated participants, the programme must be flexible and the programme should maintain pace.