I hand quilt and love it. I draw on the top with special colour quilt pencils and the lines will wash out. I have a few specialised rulers that help me draw the pattern as well as stencils I have bought or created myself.
Then I put the layers together and baste.
I use coloured quilting thread which you can by from your LQS or on the internet and if I have chosen a plain pale colour for the backing, I can use toning colours for the fabrics in the top. That can create lovely patterns on the reverse of the quilt.
I have also used Japanese quilting which creates fantastic patterns on the plain reverse of the quilt, so you get two quilts for the price of one.