This synthesis examines current performance-based management practices that are applied by state departments of transportation (DOTs) in highway maintenance and operations (M&O). Past studies have focused on the elements that make up a performance-based M&O approach, such as condition ratings, levels of service, performance measures, and threshold values. This study focuses on how state DOTs actually use performance-based measures to manage their highway programs. Information used in this study was acquired through a review of the literature, a survey of state DOTs, and follow-up interviews with four state DOTs to develop case examples of highway M&O performance management.