While this case study uses an example of a home health team, it is meant to describe a system in which clinicians and healthcare organizations specialize and develop expertise by performing a large volume of specific services, procedures for given medical conditions or diagnoses. We introduce the concept of “consumer as a direct employer” of healthcare services. In this model, nurses may work as independent contractors, or as a member of a team contracting out as a unit, as in our example of the Rhine Home Health Team. Nrses also may work as employees to healthcare organizations as they do today.