A new series of case studies from the Center for Health Care Strategies reports on the result of a Commonwealth Fund–supported project exploring the business case for quality improvement in Medicaid. While three health care organizations were able to improve care for Medicaid beneficiaries with high-risk childhood asthma, they did not achieve a financial return on their investment. The savings accrued from improved quality did not exceed the interventions' costs. A policy brief and evaluation provide lessons for policymakers to consider amid growing pressure to demonstrate rapid savings from quality improvement initiatives.