This episode is a part of our new “People You Should Know” series, where we spotlight industry professionals shaping the future of life sciences, healthcare, and physicians’ compensation. In today’s episode, we talk about what it takes to lead transformation without losing your people in the process.
Meet Dr. John Piatkowski
a physician executive who has led from just about every seat: pediatrician, medical group leader, hospital CEO, Deputy Chief Clinical Officer at Medica, and now a promising consultant.
He’s helped lead value-based care for over 750,000 members, overseeing $3.5 billion in spend, and guided large health system integrations—all while maintaining a clear sense of mission, humor, and humanity.
In this episode, he shares insights on:
- How he brings people together across some of healthcare’s trickiest intersections: payer and provider.
- How sometimes the best strategy is just sitting across the table and rebuilding trust.
- The keys to making value-based care programs and models work at scale.
- What’s changed in physician compensation and what still needs to change.
- What needs changing in physician engagement and compensation design.
- The evolution of population health.
- And so much more.
You can watch/listen to the video here
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Snippets from the podcast
Your background isn’t typical. You went from MIT aerospace engineering to pediatrics to health plan executive and now consultant. Tell us about your journey—and what thread ties this all together?
“I started with a major in aerospace, then took a twist in junior year when I did a thesis on the effects of space on the human body. By senior year, all of my electives were pre-med school prerequisites to qualify for med school.
During med school, I did two years of pediatric spine research. As an engineer, I was going to be an orthopedic surgeon. I enjoyed the surgery, but I loved the dynamic of the problems of healthcare before, during, and after the surgery—not just the surgery itself. That focus on the whole spectrum and operations of healthcare has continued for me all the way.
So I really describe myself as an engineer who practices medicine. Then came pediatric training, chief residency—always asking, “How do we improve things?” Into practice, then quickly into leadership: first at a multi-specialty clinic in Woodbury, Minnesota, then leading a small health system’s medical group and hospitals in Virginia. Then as a Chief Physician Executive and SVP in North Carolina.
Most recently, at Medica, I’ve had the privilege—with my team—to partner with over two dozen health systems in the greater Midwest, solely focused on improving outcomes and experience for patients and members.
How do the health system and payer work together? Sometimes successfully, sometimes not. But it’s always the same question: How do you do a rapid, rigorous evaluation of the problem? How do you create actionable, measurable steps to improve? And then how do you repeat that cycle?
Whether you call it a PDSA or use any other tool, it’s about actionable steps to the teams and individuals involved—and doing it collaboratively.”
I’m a fifth-generation engineer—the first physician in the family. And I think my journey, if I look back, really goes all the way back to the dining room table when I was a kid. We were encouraged to analyze, challenge, and improve the status quo. That’s continued for me all the way through.
Dr. John Piatkowski
You helped grow value-based care programs across commercial, Medicaid, and Medicare Advantage lines. What are the keys to making these models work at scale?
“The first step is how do you create trust and transparency so all the parties feel fully heard and engaged. There are going to be differences—but how are they being heard?“
So I served as a liaison(going all the way back to my pediatric spine research) between engineers and physicians, often between physicians and administrators, or even patients and physicians. Often they are using the same words but with completely different meanings—which is a huge problem. So it’s not just about whether we said the same thing; it’s about whether we meant the same thing. How do you create a forum to get to that?
Dr. John Piatkowski
“Then you quickly move to: Can you supply clear data and analytics toward actionable insights? Data isn’t the problem. Everyone has loads of it, overwhelming amounts. That’s not the issue. The value of a consultant—internal or external—is how you condense and scope that data down to actionable items that the team can control and effectively manage.
Then you have to work with the client directly. What is their situation and limitations: is it manpower, is it the infrastructure? Generally, people are in the situation they’re in for complex reasons. You have to understand that. A generic solution won’t work.
You need to understand what’s best and the limitations, then match those to actionable, measurable items. Measurable for two reasons: one, to show progress; and two, to build trust and confidence. That investment leads to the next success. It’s a snowball. Now you’ve worked together and generated success, so the barriers to the next initiative are smaller—not zero, but smaller. And the pace of improvement increases.”
You’ve led employed groups, designed comp models, and navigated politics around retention. What’s changed in physician compensation? And what still needs to change?
“I’ve been involved in clinician leadership and compensation work in multiple states over multiple decades—kind of showing my age here a little.”
The common theme is: there is no magic pot of money or revenue. You have to look at the situation honestly and work from there. But there have been massive changes—and there will continue to be. Ambulatory care, primary care, hospitalist medicine, specialists… Where’s the pendulum swinging? Are we still under-leveraging ASCs in the Midwest? Absolutely. My time on the East Coast a decade ago—we’re still not where they were then.
Dr. John Piatkowski
“You have to align with your current revenue streams. There’s no magic money. And then you have to “bend at the edges,” designing the future you want: quality, experience—but volume still matters, especially for the near foreseeable future.
All of it matters. All of it needs to be recognized—and used in moderation. There’s not one unique way to do this.
You also have to respect group traditions, the mix of specialists, hospital and ambulatory environments. Then you need to create clear governance model for them, and the correct data in.
We’ve had great partners our there. SullivanCotter and others are great at supplying data and benchmarking. But then how do you turn that into a model that works and is trusted by your administration, finance and clinical teams?
So I think that’s the intersection of having the key stakeholders in the room, understanding the problem, using common language and really the fun part for me is we have a you know history of we’ve shown success across multiple geographies, multiple health systems, design, multiple types of health systems, community, academic, independent clinics.
And we’ve seen the opposite too—even here in the Twin Cities. In the past decade, we’ve seen systems make big comp changes that were disconnected from where revenue came in. Then they had to quickly fix those models. That caused distrust, dissatisfaction, and increased turnover—which is incredibly expensive.”
Let’s talk about what keeps you motivated. Whether it’s leading a startup for aphasia patients, rebuilding rural hospitals, or serving on nonprofit boards—what keeps Dr. John going?
We’re all participants in healthcare, whether we like it or not. Ourselves and our loved ones. And as experts in the field, we know the system needs changing. We can see it—everyone is struggling. There aren’t clear winners. Everyone’s working hard. So why not be part of the change? Why not engage?
Dr. John Piatkowski
“That was especially true when I worked in rural health. Coming from the Twin Cities and moving to the mountains of Virginia with Carilion, I saw firsthand the challenges with rural poverty and rural healthcare. It’s more hidden than urban issues, but just as real. There are difficulties in delivering cutting-edge. So, how do you leverage telehealth and virtual care? But the grace and thanks you receive from people in those communities—when they see you’re trying to help—it’s unbelievable.
Other motivations come from personal experiences. My father battled primary aphasia, which took his voice over the last decade of his life. You’ve seen Bruce Willis’s story—unfortunately, they shared that condition. My father was one of the most literate people I knew. And aphasia took that from him. He passed in 2023. So I’m dedicated to working on tools for people with aphasia.
My oldest sister passed two decades ago from cancer. Supporting nonprofits like Gilda was a natural fit for me.
Healthcare is a crucial part of all our lives. It’s something we depend on—and something we should be proud to help deliver to the community. Communities with strong, affordable, efficient healthcare do better. We know that around the world. We know that around the country.
And it kind of goes back to that dining room table—enjoyment of working the problem, whether it’s small or large. Being part of a team and leadership group that wakes up each day, tries to make things better, and rolls up its sleeves to do it again. That’s what drives me.”