There have been many periods of change in health and human services ushered in by some external environmental factors: The creation of Medicare and Medicaid. New pharmaceutical agents. Medicaid home- and community-based services waivers. State block grants. Managed care. Olmstead. Medicare Part D. The Patient Protection & Affordable Care Act. Parity. Each period of change has caused some disruption to the field. There have been the expected winners and losers. But I think the current period of change – the move to value-based reimbursement – is having and will have the most far-reaching effects on the field. The environmental . . .