Unless you are living under a really big rock, you know that the world around us is changing in a dramatic fashion. Every day brings a new challenge. And though it seems that all of this change is sudden and overwhelming, some scholars predicted a global transformation decades ago. Even as early as 1994, Vaclav Haval, President of the Czech Republic, said as he was accepting the Philadelphia Liberty Medal at Independence Hall:

€There are good reasons for suggesting the modern age has ended. Many things indicate that we are going through a transitional period, when it seems that something is on the way out and something else is painfully being born. It is as if something were crumbling, decaying and exhausting itself, whiles something else, still indistinct, was arising from the rubble.€

Reflecting on his words today makes us wonder if we are actually observers of the chaos that he predicted. Applying his perspective even further to €our world of supports for people with disabilities,€ and according to The Fiscal Survey of States, a report jointly released by the National Governors Association and the National Association of State Budget Officers, states will continue to face significant fiscal challenges, with Medicaid continuing to outpace overall general fund expenditures. Add to that the lightening-paced marathon that we are experiencing in North Carolina to convert to multiple managed care systems with closed network initiatives -- hello!

Overall, it seems like a fairly gloomy picture for providers and the consumers they support. You may ask: Aren't you a provider? Why are you painting such a bleak picture? Don't you understand that we must survive another day to support the most vulnerable people in our society? Aren't you aware that to speak of dwindling resources is almost sacrosanct? The answer to these questions is €maybe,€ but that would only be true if you are willing to adopt the mindset of scarcity and limitations. And alas, I am not.

I do, however, accept the notion that change is inevitable and that change in this instance must be all encompassing. I believe that, as Haval suggested, we are going through a painful transition period. I also believe that if done correctly, change through inter-connectivity can bring abundance and will determine the true currency of supporting people with disabilities to realize their full potential and aspirations. When the world around us becomes fully connected and effectively self-aware, it will drive efficiencies like never before.€ (Renee Pietrangelo, CEO, ANCOR Association)

How do we reach this state of Nirvana? There will be plenty to go around if we learn to recognize that we are all connected. We thrive through the nourishment of the same eco-system, and to continue to exist and prosper in this world of declining resources we must learn to better co-exist and draw upon each other's knowledge, experience, and expertise. The soil that nourishes me contains your roots, as well as my roots that nourish you. We must keep expectations reasonable, learn to trust, and create new ways of accomplishing outcomes. Hippie-talk, you say? Please consider these seven principles for a world of abundance and connection.

1. Free our system from restrictive pathologies, unresolved €sink-holes,€ and historical baggage. We need a true delivery system model that includes structural and programmatic freedom from old constraints with new financial incentives designed to attain high performing Medicaid systems. The new and improved delivery system would promote considerable flexibility to achieve real person-centered outcomes and not just properly framed goals that pass audit muster. The €15 minute increment€ requirement would be eliminated so that valuable therapeutic time, better spent working with consumers and families, would not be sacrificed. The Affordable Care Act provides new options that allow for some of this necessary flexibility.

2. Modernize now! Incorporate new technologies that are critical to service delivery transformation and capable of producing cost analysis, performance, quality, consumer, and program data to improve quality and efficiency. We need new standards, modern architectures, and more specific guidance for the building of state systems with federal investments. We need Local Management Entities (LMEs) to forge ahead as Managed Care Organizations (MCOs) only after they demonstrate that they possess the business acumen to get the job done and after assurances that billing systems are fully €beta-tested,€ ready-to-roll-out, with 100 percent accuracy. After all, there are vulnerable people at stake.

3. Expect good stewardship to be at the center of all we do. New models for accountability should accompany new flexibilities. A strong quality measurement infrastructure is essential for transition to a more outcomes-based accountability model. We need MCOs and providers, working together with consumer input, to create statewide performance measures specific to the service being delivered. Providers cannot accommodate multiple versions of performance standards that are redundant, expensive, inefficient, and irrelevant. Trust and respect must be the cornerstone of all we do. New service models and payment methodologies must be explored, but rates must be actuarially sound for MCOs, and fair and reasonable for providers in order for access issues to be adequately addressed. Recognize that MCOs and providers have overhead and administrative costs and both must run stable businesses for the system to work.

4. Collaborate and build new kinds of partnerships in order for this new world order to take full advantage of the resources and talents that we all bring. Egos and unhealthy competition must take a step back to give way to the needs of the greater good. We need to look for expertise outside of our own realm that can enrich the consumer's experience and satisfaction. Broad system transformation is only achievable by partnership of all stakeholders: the legislature, state, MCO, in our state Community Care of North Carolina (CCNC), provider associations, providers, advocacy groups, and consumers. Almost always, in the long run, dissonance makes for a better end product. We must stop holding stakeholder meetings where decisions are made well before the discussion with the group begins and for the purpose of simply checking off a federal requirement. Stakeholders must come prepared to discuss matters related to system improvement and not the growth of their own interests, and discussions must be couched in terms of reasonable expectations that accommodate the current reality. Natural supports must also be cultivated to take on additional responsibility. Sorry, families -- it's true.

5. Encourage openness within all organizations to possible solutions for current and even previous problems. Sometimes brilliant ideas come from unexpected sources. In the new world, the flow of ideas and creativity will be welcome and commonplace. We cannot expect change to evolve into new levels if serious, unresolved problems or threats are still looming within the present state. Where are the land mines hidden? Sensible solutions focus on first things first, concentrating on issues appropriate to their current level of existence. We must demonstrate that the system is being properly managed.

6. Engage insightful people into the on-going dialogue for system improvement. By insightful, I mean people who have an understanding of (1) what went wrong with the previous system and why, as well as (2) what resources are now available for handling problems better. Very important to remember is to begin the journey by first asking the question: What are we changing from and what are we changing to? Failing to have an answer means we are not ready to engage in the process of change. Further, until people have a rationale for understanding €why the prior system was embraced initially and why it was eventually undermined, lasting change into t