This study examines Critical Access Hospitals’ (CAHs) performance across financial and quality benchmarks to identify characteristics associated with strong performance in both domains. Using 2022–2024 data from Medicare cost reports, the Flex Program’s Medicare Beneficiary Quality Improvement Project, and national CAH surveys, 914 CAHs were categorized into four performance quadrants based on whether they met 0–2 (low) or 3–5 (high) benchmarks for financial and quality measures. Seventy-seven CAHs (8%) achieved high performance on both financial and quality metrics. These hospitals were more likely to be located in Medicaid expansion states, have higher swing-bed and lower acute average daily census, lower net patient revenue but a higher share of outpatient revenue, and a dedicated quality improvement leader who integrated quality goals into the hospital’s strategic plan. They also tended to offer specialty services such as ENT, gastroenterology, oncology, pulmonology, and cardiac rehabilitation, and were less likely to offer intensive care or hospice services. Findings suggest that organizational focus on quality leadership and strategic integration of quality initiatives, as well as certain service configurations and state policy environments, may support CAHs’ dual success in financial sustainability and care quality—key goals for participation in value-based care models.