The country then made changes to strengthen the quality and availability of outpatient primary-care services (including payments to encourage physicians to provide e-mail access, off-hours consultation, and nursemanagers for complex care).
Insurer Aetna began using nurse-care managers to help manage both Medicare and commercially insured patients with terminal illness in 2004, using telephone consultations with patients, doctors and families to, among other things, ensure advance directives are in place and complied with.
If dementia is confirmed, the center's nurse practitioners, social workers and care managers work closely with family caregivers and primary-care physicians to customize care plans, reviewing medications to reduce the use of drugs that can be harmful to older brains.