Delivery System Reform Incentive Payment (DSRIP) demonstrations provide federal funding to hospitals and other health care providers to transform the delivery system and thereby improve quality of care and patient outcomes, reduce the cost of care, and prepare providers for value-based payment. This study examined the early impact of these demonstrations in California, New Jersey, and Texas on three outcome measures that reflect care transformation: (1) emergency department (ED) visits; (2) follow-up after an ED visit for patients with ambulatory-care sensitive conditions; and (3) hemoglobin A1c testing for patients with diabetes. Findings are inconsistent across both states and measures. For ED visits, DSRIP was associated with a smaller decrease relative to the comparison group in California and New Jersey; however, in Texas, DSRIP was associated with an increasing trend in the post-period. For follow-up after an ED visit, there was no relative change across all three states. Finally, for diabetes testing, there was a relatively smaller decrease for the demonstration group relative to the comparison group in California, an increase for the demonstration group contrasting with a decrease in the comparison group in New Jersey, and mixed effects in Texas. The evaluation examined changes in the initial years of these DSRIP demonstrations, when DSRIP activities were primarily focused on infrastructure development and capacity building. As the evaluation continues, impacts may be detectable in later years when demonstrations move beyond the initial implementation phase.