Thirty years ago, the health and human service delivery system looked very different for consumers with chronic conditions and complex support needs. A Medicaid beneficiary with a serious mental illness, with an intellectual/developmental disability (I/DD), or with a physical or other cognitive disability would most likely be receiving treatment in an inpatient or residential facility; but the health and human service market has experiences several waves of change that have created a new system focused on lowering costs, improving quality, and creating a better system of care for complex consumers. There have been what I like to think . . .