Global competition and productivity enhancing technology have proven powerful inducements for reducing costs and increasing value for customers in many industries and Quality Improvement has been an effective tool in this evolution. Meanwhile healthcare has remained somewhat immune from market forces, fearing commoditization of this intensely personalized discipline if industrial strength management tools were applied. However, bankruptcies and consolidation indicate the rapid evolution of the healthcare marketplace, while employer and consumer dissatisfaction with soaring prices suggest the industry may be ripe for change. As part of its response, the industry has seen broad adoption and subsequent maturation of Quality Improvement programs over the past decade, and this research examines the effectiveness of Quality Improvement as a cost management tool in healthcare. A population of federal and state healthcare quality award winners sponsored by the Bureau of Commerce and the Malcolm Baldrige Quality Foundation were identified and paired with similar non-award winning hospitals, to determine if institutions operating with mature Quality Improvement implementations are able to operate at a lower cost. In addition, cost data for the quality award winners were examined over time to determine if cost per discharge at those institutions declined as quality programs spread through their organizations.