Episode 3: An Independent Voice

Dr. Wendy Molaska is Board Certified Family Medicine physician, fellow of the American Academy of Family Physicians and founder of Dedicated Family Care, a direct primary care clinic in Madison, Wis. Dr. Molaska graduated from the University of Wisconsin Madison School of Medicine and Public Health and completed her residency through the University of Minnesota at North Memorial Hospital and Broadway Clinic. She served with the National Health Service Corps providing full spectrum family medicine in rural Colorado before returning to Wisconsin. She has more than 20 years experience providing “womb to tomb” family medicine in both urban and rural settings, as well as completing medical missions in multiple countries around the world. Disillusioned with our current health care system and increasing administrative and insurance burdens, Dr. Molaska founded Dedicated Family Care to eliminate been barriers placed between the doctor, patient and the care they deserve. Learn more: https://www.familydpc.com/

Curt Kubiak: Welcome to our next podcast of NOVO Live, I’m glad to be presenting to you again with influencers within the health care community that are trying to change things for the better, making things more accessible, more affordable and higher quality within the health care spectrum. And so I’m very pleased to have today’s guest join me from the physician community, which we haven’t heard from yet. And it’s definitely changing, in my opinion, for the better. Certainly not fast enough, but we’re making changes. And so I’d like to introduce you to Dr. Wendy Molaska, who joins me from the Madison area. And, Dr. Molaska, I want to welcome you to the show today. And thank you for joining me.

Dr. Wendy Molaska: Thank you for having me.

Curt Kubiak: So I’m very excited to have our guests get to know you a little bit and understand your journey. When I first got introduced to you, and learned what you were doing, and the reasons why you were doing them, I was fascinated. And again, I think it does embody this, you know, NOVO Health strategy that we’ve held for years, which is we need better access to higher quality physicians at a lower price point. And so can you talk to me a little bit about your journey into primary care and where you are today and how it is that you know, you came to find some of those values and what you’re doing, but I think your story is, is equally important. So if you could just give us an introduction and take us on your journey.

Dr. Wendy Molaska: Sure, be happy to. So my name is Dr. Wendy Molaska, and I am a family practice physician currently in the Madison, Wisconsin area. My journey is that I’ve always wanted to be a doctor. And I think a lot of that stems from the fact that I’ve also been a patient a lot during my lifetime. And so I have kind of both the patient and doctor perspective of our health care system. After doing my medical school in Madison, Wisconsin, I did residency in inner-city Minneapolis, and then worked for the National Health Service Corps at a federally qualified health care center out in rural Colorado. And I did, I provided what I call womb-to-tomb medicine. So I delivered babies and dealt with everything in between all the way up to hospice. So I really had a varied practice there. I eventually moved back to Wisconsin, which is where I’m from originally joined another rural practice, and then eventually met my spouse. And because it was easier for me to find a job than for him, we moved to the Madison area where he had his job. And I joined a larger group in the Madison area. Because of my experiences, again as a patient, and then because of frustrations that I had trying to address the needs of my own patients as a physician, I started looking at direct primary care a couple of years ago. And then an opportunity arose for me to pivot my practice from doing a lot of Obstetrics, and prenatal care to doing more hospice, which was also one of my passions. So I spent some time doing hospice. But again, as an employed physician, I just kept realizing there were more and more problems with dealing with things like coding and billing and scheduling that just did not benefit the patients or myself. And so I felt like I was burning out. In a practice that was something that I wanted to do and what I love to do. I would hear complaints from my patients that Hey, Doc, you know, in my primary care clinic, it you know, takes me three months to get into see you. You know, if I call in with something acute I can never get into see you I have to see whoever is available, which is not great patient care, because I know these patients. I’ve taken care of them for years and therefore I know their stories better than whoever just happens to be on call that day. And then from my own perspective as a patient, insurance changes over the years being covered under either my employer or my husband’s employer and dealing with deductibles and coinsurance and my own medical problems, the costs were just they’re so hard to try and figure out as a physician who understands coding and billing, and being able to fight insurance companies on things that they know are wrong. I have no idea how the lay person tries to do that. So all of these things kind of added up. And so when I started hearing about direct primary care a couple years ago, at first it was just kind of a, you know, that’s interesting, but as I learned more and more about it, I was like, yeah, that’s what I need to do. Basically, it lets me focus on my patient. I don’t have to worry about insurance and coding and billing. I get to spend more time with my patients, really getting to know them and address their issues. And then the cost savings that I’ve come across from doing wholesale meds and labs and radiology has just been astounding to me. And part of that I feel like is as an employed physician, we’ve just never had to know the costs of a lot of the different tests and stuff that we’re ordering. We’re kind of in the dark, in terms of what things actually cost. And even the costs that are presented to us because of different insurances, or different contracts or whatever are so varied between patients, it would be impossible to stay on top of each of those. So direct primary care by just kind of getting rid of all the insurance and the middlemen and so forth, has really been a game changer for me. And I think for my patients.

Curt Kubiak: It’s very interesting, right. So I would say the consistent theme of the podcast we’ve done so far is this confusing nature of health care. Where if you think about how we’re consumers in every other industry, that it’s very straightforward. I can see my options, I understand what the quality differences are, I can understand the price points and I can make an informed decision. But as you’re describing, in health care, not only is it not easy for us as patients, but even for physicians, it’s a challenge.

Dr. Wendy Molaska: Oh, my gosh, yeah. And it’s crazy, too, because the thing that would really frustrate me the most is that based on whatever the insurance contract is each year, a lot of these things are going to change every year. So I get a patient stabilized on one medication, and then come January of the next year, the insurance contracts change. And so the insurance is now saying this medication is no longer covered, you have to try something else. And so even though the patient’s been doing well, and this previously was a covered medication, all of a sudden, I have to completely change their plan of care. And that makes absolutely no sense.

Curt Kubiak: There’s a lot within the health care space, right? That just is is not straightforward. And so to try to simplify that, I think is something admirable. I’m interested, not only are there again employers and third party administrators and network providers that are interested in trying to make it simple, but it’s great to hear from the physician’s perspective that you to recognize that it’s too complex, and that you think that you can make a difference, trying to simplify your practice. And so you’ve introduced this term direct primary care, can you just tell our audience what that means? What does it mean to have a direct primary care practice?

Dr. Wendy Molaska: So direct primary care is kind of a growing model across the United States to really kind of, again, focus on that patient centered care. So instead of the traditional fee-for-service model, where you’re using insurance, and you have copays and deductibles and premiums, in the true direct primary care model, it’s based more on a membership model. So you pay one membership fee per month, for generally all of your primary care needs. Depending on the actual clinic itself, the direct primary care clinic, membership fees are either just set at one level, some of them are based on age, some of them are based on family sizes, different things like that. But the idea is basically This frees me up to provide the best type of care that my patient needs at the time that they need it. So if they need a telehealth visit quick during their lunch hour at work, I can easily do that, versus having them come into the office, which means taking time off of work, and then driving here and waiting in a waiting room and then eventually seeing me and sometimes you just don’t need to do that. There’s times when you do need to come into the clinic. And so yeah, on Saturday, when you cut your finger, you just give me a call and I’ll meet you at the office and we can stitch that up. But basically, it lets me focus on what my patients need at that time period. And then the amazing thing for me has been working with the vendors for laboratory, medications and radiology and actually finding out the costs of a lot of these things and then being able to pass on that wholesale cost to my patients, which several have actually said, “you know, hey, this is actually cheaper than when I use my insurance.”

Curt Kubiak: Interesting, right. So I’ve worked with other physicians that have said, “you know, I’ve spent countless hours on process improvements on continuum of care improvements, and never really seen those efforts, benefit my patient directly in terms of better care or lower cost.” But you, in a short time, practicing this direct primary care methodology, you’re already seeing that with the patients that you’re managing.

Dr. Wendy Molaska: Yeah, and it’s just been, it’s been fun for me. And, it’s also been eye-opening and then my patients have really been engaged as well. There’s one who is a, you know, very high-level high-functioning person who got frustrated with her insurance and her primary care provider always saying, “Oh, well, you just need to see a specialist for this, that and the other thing.” And so she came in and sat down with me. And we talked through all of the different conditions. And one of them was that well, maybe she had pre-diabetes or was worried about her blood sugars. So I was able to get her a continuous glucose monitor with a, you know, free coupon card. So she wore this for 14 days and was able to see exactly what her blood sugars were doing over 14 days. And she was unable to say, “Oh, my gosh, when I eat this and don’t exercise or do this, this is how it affects my blood sugars” and this has been super eye-opening for her and has now allowed her to have a better input into her own choices.

Curt Kubiak: What a wonderful educational opportunity, a way to actually use data to manage somebody’s health where, where you’re kind of sharing the experience with them. It feels to me like it’s almost co-managed, right? That they’re understanding the information, and they’re coming to the same conclusion that you are that I really do need to change, you know, my habits in order to keep myself in check with regard to this diabetes situation.

Dr. Wendy Molaska: Yeah, and part of what I always enjoy doing. I’m probably one of the few doctors that even when I was with the big systems, and we had the EMRs that had kind of the my chart, one of the things I always like to do was try and hold my patients accountable. And so try and make changes in lifestyle type things. And with direct primary care, it’s just so much easier, I can say, Okay, well, our goal for this week, as we’re talking is that you know, you haven’t been exercising at all. So we’re going to start with, you know, five minutes of walking three days a week, and I’m checking in at the end of the week. And so I shoot them a text and check in and so many patients just find that, you know, having somebody hold them accountable, and especially their doctor, and getting that text from their doctor, they’re like, “yeah, I’m definitely getting out and walking.”  How exciting. It’s a totally different experience than what we would expect from a traditional primary care engagement. So I think that what you’re doing is very interesting, I, myself as a patient, find what you’re doing very, very attractive, because again, I think all of us have the best intentions. But to have somebody there supporting us and following through gives us that infrastructure that support system, I think that we need an Act to actually make the changes happen. Right, which is, which is not always easy. So talk to me a little bit about this, the way that we that you get paid, then you’re getting paid directly by the patient. So really, without insurance, they pay you directly and then you provide the service directly. So you’re kind of taking out a couple of layers of the health system and and offering your services directly to these consumers. What happens if they have health insurance? How does that work for them in terms of using your services and their health insurance service? So there’s, there’s a bunch of different ways. And so I’m always very straightforward and saying that direct primary care is not insurance. So you should still have some kind of form of insurance for those catastrophic needs. So some people will pair direct primary care with a high deductible insurance plan and a health savings account so that if they end up needing, you know, their gallbladder taken out, they have that to fall back on. Other people, this one example I gave just a little bit ago with the diabetes, she actually has insurance. But she’s like, you know, for the cost of my cell phone bill, it’s actually less than my cell phone bill each month to pay for your membership fee, I’d rather have you as my primary care provider. And then when we compared what her, you know, lab costs were through her insurance versus what I can offer, she’s a lot of times taken, you know, my labs versus going through her insurance. So there are a couple of different ways of doing that. There’s also the possibility some people have health savings or not savings account, health cost sharing accounts. So there are companies that basically cost share, and that will be their kind of backup for primary care. I can do about 90% of your needs. But yeah, if you need that, you know, joint replacement, you need your gallbladder taken out, you need to see a specialist, you’re going to need health insurance at some point in time. The interesting thing is that I do have access to about 130 specialists via like a computer console service, which is free to my patients. So if I just have a question for, you know, dermatology, hey, this rash looks really weird to me, I have no idea what it is I can take a picture, send it to my specialist, that doesn’t cost my patient anything and it might save them, you know, months or weeks to try and get in to see a dermatologist, as well. So there are a couple different options there.

Curt Kubiak: A very exciting development, right. Something that even I wasn’t aware of before meeting you, right, that these kind of these virtual consultations were available with specialists so that as I’m using my direct primary care services, you’ve also got the backing of specialists that have you know, depth of knowledge and various things. I can imagine, you know, a variety of different specialties covered. Maybe you can talk about that a little bit. But that’s great to know they’re there that they can also assist you in managing a patient’s care. So what types of specialties are you working with?

Dr. Wendy Molaska: Recently, I had a patient that I did a virtual consult for ear, nose and throat. But she actually needed to be seen then for a biopsy. So she got referred then to a live specialist, but because of that previous computer console, or econsult, they were able to get her in much more quickly with the specialists, and I think she would have been able to get it done normally. Dermatology is very common, rheumatology, cardiology, I think those are my big ones that I’ve been using so far.

Curt Kubiak: Yeah, that’s excellent. So from a normal health perspective, representing a large number of specialists, we’ve talked and I’m very excited about having, you know, access to your services as primary care, because you’re kind of the quarterback right of all of these patients’ health and health care needs. Tell me a little bit about how does something like the NOVO Health group, you know, potentially support something like direct primary care? What value would that possibly bring?

Dr. Wendy Molaska: Well, I think that’s where, you know, I get to turn the tables on you and say, this is where I was excited to get to meet you and learn about NOVO Health, is that there are times when people need to see specialists in person, and especially for procedures, you know, knee replacements, hip replacements, gallbladder surgery, any of these types of things. You need to actually see the specialist and have the procedure done. So working with NOVo Health and being able to find out Yeah, which of these providers provide really good care with few complications? And then what the true cost of that is, so that my patients are able to see that upfront and know where the best care is, and then where the best prices are. That’s huge.

Curt Kubiak: As we think about kind of how things are progressing. And this is all relatively new, in my experience, right? So direct primary care as a concept has been around for, if I were to just guess maybe it’s been longer, but maybe a half a dozen years that I’ve been aware of it, but really making some significant strides in the last two to three years. Is that fair to say?

Dr. Wendy Molaska: In the Madison area alone, there was a, or there is still, a direct primary care that was here before I think the term even direct primary care was available. So they’ve been here for about a dozen years. But this was even before the term, direct primary care was there. And so now over the last, since 2019, there are now three of us, nope, four of us, that are doing direct primary care in the Madison area. But the growth across the country and throughout Wisconsin has just been phenomenal, especially in these last couple of years. I think more and more patients are just fed up with both not having good access to their primary care providers, the hidden costs, the copays, the deductibles, the coinsurances. So I think more and more patients are becoming frustrated and trying to find other options as well.

Curt Kubiak: Yeah, so maybe this is coming, you know, into its own, you know, fruition here as a result of both the demand market at market demand shift. Because we as consumers want things to be different. And then we’ve got providers on the provider side, also wanting to simplify things. And so most recently, I think the level of frustration, maybe has got to a point where we want to do something about it. And again, we’re talking about, you know, three and four in this, the Madison market, but across the state, it’s dozens. And so, you know, talk to me a little bit about how you how you see this, you know, proliferating as we go forward, and I do want to give our audience just a little bit of a backdrop. I did share with you some information from a group called the Association of Independent Doctors, suggesting that more physicians are becoming employed today than ever before. So they talk about 70% of physicians now being employed. And since January of 2019, the date that you brought up, 13% more employed physicians, you know, that today than there were back then. How do you see this potentially changing that dynamic? And is there a possibility that we see more independent primary care physicians or independent specialists?

Dr. Wendy Molaska: I think we do. I think the tipping point becomes when there are enough of us who have already established our DPC program, direct Primary Care Program, or independent specialist practice, where we are able to start taking on other physicians or hiring other providers within our groups. Starting a direct primary care practice as a physician who has no business background is pretty daunting and intimidating and all of the little boxes and you know, malpractice insurance and business insurance and a business plan and vendor relationships and biz dev and setting up a website is just overwhelming, I think, for the typical physician. And so there’s something to be said for employed positions, because hey, you have your malpractice paid for and you have a 401k. And you don’t have to worry about ordering lab supplies, and all of this stuff is already there for you. So the idea is that supposedly, you’re just getting to practice medicine. And then what you find out is that actually, what you’re doing is practicing medicine and dealing with insurance and paperwork, and all this other stuff that wasn’t part of the deal. So I think as more of us have these practices, and then are able to also hire other physicians, I think that will help to grow it because some of the physicians that I talked to, and this is just within, you know, my own circle of friends, and you know, my own primary care provider, they’re burned out in the system, but they don’t want to take the chance on trying to start a whole business. So if that position was open, and I was like, Oh, yeah, my practice has grown so much that I need to bring on an extra provider, I think I could get the providers to hire.

Curt Kubiak: What’s interesting is that we, in my experience, you know, dealing with health care change. In my vernacular, I talk about the two percenters. And so there are about 2% of the population that are really the risk takers that are the innovators that want to be at the tip of the spear. And then there’s, you know, a group of say, 13, to 15% of the close followers, that they’d really love to do it. But they’re really not up for as you described it, right, all of the risk and all of the work. So as you become more established with your 2% work, and you get to an infrastructure that is stable, that next 13 to 15% of those physicians out there that find what you’re doing appealing, it does become a little bit easier for them to get on board and join something that pre exists as opposed to having to create it from scratch, like you did.

Dr. Wendy Molaska: I think that’s Yeah, totally correct way of putting it.

Curt Kubiak: I’m excited for the way that this is starting to gain some traction and where things are starting to move. So from, from your perspective, you’ve talked a little bit about what you’ve done so far, individually. You’ve talked a little bit about how maybe going forward, you might actually be employing other primary care physicians and growing a group. Ideally, if you were to kind of project this out for three or five years, how would you like to see health care working, so that it’s working on behalf of the physicians and the patients?

Dr. Wendy Molaska: Oh, my gosh, I would love to build my own little Empire. And again, the main goal here is to focus on the patient. Another one of my backgrounds, I’m really a huge proponent of social justice. And so I want to see, you know, potentially my clinic or direct primary care, being able to offer multiple different, you know, either levels of membership or subsidized membership for patients, having multiple providers to be able to provide care, having a more functioning clinic, where I’m able to work with people like NOVO Health and other groups to be able to say, okay, yep, when you need specialist care, we’re gonna send you here, they’re gonna take great care of you, it’s also gonna cost this much. Or we have a social worker on staff at that point, maybe to try and help figure out you know, how to get this specialist care covered or other needs covered. So I think it would be more of an all inclusive system where you have your primary care, which is really kind of the bedrock, of course, I’m biased, but then have all of the specialist support the social work, support, the nursing therapies, all the other stuff as part of this as well.

Curt Kubiak: What an excellent vision and picture that you’re painting, right for the way that things could be. And it does take someone to, to, you know, visualize it before we can create it, right? So somewhere, it’s kind of start there. So I’m excited to see how this could take place and how, you know, we could be working together, right to change, you know, the course of health care over the next, you know, three to five years, and looking forward to working with groups, you know, like, well, individuals, like you, groups, you know, like the Madison market and finding out how it is we can positively influence things. I listen to you talk, you almost sound mission-driven, right, this is more than just a career for you that this is, you know, some something that’s even larger does this, does this feel mission-driven?

Dr. Wendy Molaska: I think so in a lot of ways. And I think part of that goes back to, you know, again, me being both the patient and the doctor. And so, one of my missions that I’d said to myself when I was first starting direct primary care was you know, I’m radically changing health care one patient at a time. And that’s pretty much true, you know, each patient gets all of this individual attention. And so, you know, even, you know, random little things, all of a sudden, I have the time to really focus on that patient. You know, look up different treatments or you know, other interventions or whatever it is. But part of it just comes from my own experience as a patient too. I mean, like I said, you know, with insurance, the the amounts I’ve been charged for labs and radiology are at least a 10x multiplier on what I’m able to get for my patients. And now just being aware of that. Our health care system is unfortunately broken in the United States. And we have terrible outcomes at huge costs. So something needs to change.

Curt Kubiak: So let me get this right. Again, for our viewers, I think these numbers are important for them to understand. So when you’re talking about ordering labs, diagnostics, and you’re not talking about cost savings that you’re offering your patients 10 to 15 to 20%, you’re talking about 10x. Right, so so literally 10% of what they might be charged through a standard health insurance health system model? Am I understanding that correct?

Dr. Wendy Molaska: Yeah, so I can give you two examples that are right on the top of my head, always. So a CBC a complete blood count I had done with employer sponsored insurance, So I’m on my husband’s insurance at the time, So $80 for the CBC and $33 for the phlebotomy fee, the actual draw fee, so $113, for that. For my patients through Quest Labs, $3.25.

Curt Kubiak: Astounding.

Dr. Wendy Molaska: Radiology, breast MRI, because of price transparency, I was really pleased to hear ahead of time that, you know, hey, your cost is going to be $6,700. And with your insurance because of deductibles and copays and coinsurance, it’s going to come out to about $2,100. With a group that I’m working with, that’s an independent radiologist that uses the same type of MRI magnet, the same strength, the same contrast $650.

Curt Kubiak: These are really remarkable cost savings, right? And what you’re telling me is that the quality isn’t different. No, it is the same, and you’re paying significantly less. And so we’ve talked, again, on a number of occasions about the fact that the cost in health care doesn’t necessarily reflect the quality. In other words, if you pay more for something, that doesn’t necessarily mean you’re getting a better service. Right?

Dr. Wendy Molaska: Yep, that’s pretty much exactly right.

Curt Kubiak: And it’s hard, it’s hard for us to comprehend, right? Because in everything else that we buy, it’s exactly the opposite. So we’re trying to bend the curve in health care and trying to take those same practices that you’d find in other industries, and make those manifest themselves in our industry. And so I think you’re talking about, you know, healthy competition, healthy transparency, you know, then really let the market decide what you know, the cost of things should be. But there really ought to be that ability for us to shop and to make informed decisions, and to be active involved actively and involved with our health care with our primary care doctor. Does that sound similar to what you would advocate for?

Dr. Wendy Molaska: Yeah, absolutely. And just taking out the confusion of it, because yeah, if you have one insurance, you’re gonna be charged one amount for this. If you have a different insurance, you’re charged a different amount for the same test or lab or anything. Yeah, more transparency, more understanding.

Curt Kubiak: So you know, again, I think, you know, we’re up against, you know, some some daunting, established, you know, forces in the marketplace. And so I don’t think the changes that we’re looking for ultimately are going to be one or two years away, but they they’re probably more like, you know, 10, 15 years away. So it’s a long game, you know, that we’re after. When I talk to folks about the reason why I’m involved in this, I’m really involved in this for the next generation, I’m involved in this for my kids who are entering the workforce, who are going to have to pay, for the bills that we’ve racked up on behalf of them. And you know, all of these folks that are looking to enter the workforce. That’s my motivation. Can you talk to me a little bit about what motivates you and how soon you’re looking to make these changes? And are you in this for the long haul?

Dr. Wendy Molaska: Yeah, definitely in it for the long haul. But I think you’re right, I think we’re so entrenched in the United States and feeling like we have to have insurance and insurance is the best way to go. But health insurance was never meant to be like we’re using it. So health insurance should be more like your car insurance, right. So to keep your car running, you need to pay for gas, you need a new battery once in a while, some new tires, maybe some windshield wiper fluid, an oil change, all of that comes out of your own pocket. When you have your major collision or you need a new tranny all of a sudden, then that’s when you’re using your car insurance and using that deductible and paying that. Health insurance was supposed to be the same way but then multiple horses and for-profits got involved, and we started using it for preventative care and primary care. And it kind of snowballed into what it is today. So I think that there is, like you said, the opportunity to change all of this. And I think there are a lot of innovators in the space. And I think actually, if you want to look for a silver lining in the pandemic, I feel like the pandemic has pushed more of this into the spotlight. And so I think there’s the potential for good change. But like you said, I think it’s going to take years.

Curt Kubiak: Well, I am super happy to have had you on the show today, Dr. Molaska and in for you to be able to share your story and and to educate our audience about an alternative health care delivery model that’s really taking shape here in Wisconsin, right. So not something that’s happening, you know, on one of the coasts or at Rochester or Cleveland, but happening here, you know, in Madison, Wisconsin and throughout the state, and you’re bringing it to life. And I want to thank you for you know, the work that you’re doing, but also for being on our podcast and sharing your story with us today.

Dr. Wendy Molaska: Thank you so much. So happy to be able to partner with you and NOVO Health and continue to try and change the health care for our kids going forward.

Curt Kubiak: So if people are interested in your story and want to want more information, what’s the best way for them to get in touch with you?

Dr. Wendy Molaska: My website is at www.familydpc.com. The name of my clinic is Dedicated Family Care. So if you Google “Dedicated Family Care,” and Madison, Wisconsin, you should be able to find me there as well.

Curt Kubiak: That sounds wonderful. I’m hoping a lot of people check you out. And for all of our listeners, you can also find us via our website, our social media and of course, on our podcasts (All linked below), and so looking forward to talking to you and until then, let’s keep the conversation going.