Clinically Integrated Networks (CINs) are an evolving model to support rural hospitals that wish to remain independent rather than merge with or be acquired by health systems and larger hospitals. Interest in CINs is growing rapidly with at least four CINs currently operating in rural areas and additional CINs under development. This project will conduct case studies of CINs to understand how they work with Critical Access Hospitals (CAHs) and identify potential opportunities for State Flex Programs to encourage CAH engagement with CINs.