One of the tenets of health care reform is to provide incentives to raise quality, improve outcomes and lower costs.

That idea is what’s behind about $3.3 billion in federal incentives dangled in front of public hospitals in California as part of the Medicaid waiver deal completed late last year. A new policy brief from the California Association of Public Hospitals details some of those changes.

The deal in the waiver agreement — the Delivery System Reform Incentive Program — is a pay-for-performance initiative for 21 public hospitals in California. That change in performance is measured by meeting a myriad of different milestones.

So public hospital systems across California are busy implementing anywhere from 12 to 19 major projects simultaneously, according to CAPH.

For example, many public hospitals are trying to revamp their patient systems so that rates of mammogram screening are improved — something that’s a measure of improved quality, care coordination and better outcomes.

According to CAPH, about four-fifths of California’s public hospitals are expanding their medical home model as a quality-improvement step, and about two-thirds of them are revamping their tracking method for diagnosing and treating chronic conditions.

A summary of CAPH’s policy brief is here. The full brief is here.