Despite strong evidence about deficiencies in quality and safety, and abundant rhetoric about moving from volume‐based to value‐based care, to date, little systematic research has examined whether and how health systems are reengineering the way health care is organized and delivered. We adopt the term care delivery redesign (CDR) to capture the variety of tools and organizational change processes used by health systems to pursue the Triple Aim. We answer the following research questions.Are health systems motivated to engage in CDR? What factors are driving these efforts?What CDR strategies and activities are health systems using?Key informant interviews with 162 executives in 24 health systems as part of the Agency for Healthcare Research and Quality’s Comparative Health System Performance Initiative. Interviews were audio‐recorded and transcribed, and global codes were applied using the Dedoose qualitative software based on a systematic codebook developed by the study team. Study investigators and analysts reviewed transcripts and coded text to arrive at study findings using a team‐based qualitative analytic approach.Purposive sample of health systems in four states (California, Minnesota, Washington, and Wisconsin). Health systems in each state were selected to provide variation across a number of dimensions including size, profit status, geography served, and financial condition.We report seven motivating factors reported by health systems for engaging in CDR, including intrinsic factors (organizational priorities; organizational culture; fiscal health) and extrinsic factors (public policy and price and quality transparency, alternative payment models, community and population needs, current scientific guidelines). We also present and discuss five categories of CDR activities health systems are pursuing (consistency and efficiency of care; care coordination and management; consumer‐centric care; patient in environment; and evidence, data, analytics, and technology). We provide specific examples of each area and use case examples to qualitatively illustrate the variation across systems in both motivating factors and CDR activities).The breadth and depth of CDR activities in our health system sample varied. Systems with executives who reported having strong intrinsic motivation for their efforts appear to be on a more well‐defined path than systems with executives who report strong extrinsic motivation. Health systems are engaging in a wide range of activities, with some systems focusing only on small‐scale or incremental changes and others focusing on a broad range of activities that fit within a larger vision of CDR. The variation that exists on CDR activities may be useful for developing a systematic measurement approach for CDR activity in a broader sample of health systems.Currently, researchers are not able to validly and reliably measure CDR activities, preventing quantification of the impact these activities have on the Triple Aim outcomes.Agency for Healthcare Research and Quality.