There are a number of strategic reasons for establishing a clinically integrated network (CIN), but there is only one that offers a path to sustainability. That reason is to provide a competitive vehicle for contracts with payers and employers that would otherwise be unavailable because of legal constraints. Indeed, CINs that have no contracts and covered lives can’t generate a return with which to invest and incentivize continued participation and are ultimately doomed to failure. Some health systems start with their own employee health benefit plan as the initial focus, and that’s fine as a beginning. But CINs that go no further will have difficulty sustaining clinician interest. So, it’s crucial that health systems recognize that if they don’t set their sights on creating a commercially viable entity, they shouldn’t take the CIN trip.