Care Shift

Tim Elliott, CEO of Navvis, helps health systems and physician enterprises move from fee-for-service to value-based care. We get into why value-based care is an operating model change, not a reimbursement issue, why mandatory CMMI models like TEAM and CJR-X are good for the industry, why AI is an enabler and not a strategy, and where founders should be building next.This episode is sponsored by Interconnext Consulting. Founded by Mahmud Samad, former VP of Accounting and Revenue Cycle Management at MDLIVE, Interconnext gives startups and growth-stage companies hands-on fractional CFO, strategy, and operations support to reach their next stage of growth. Want to learn more? Go to https://interconnextconsulting.com/connect/ and tell them Care Shift sent you.00:00 Intro00:51 Signs a health system is ready for value-based care03:14 One operating model for fee-for-service and value05:55 The value-based care scorecard07:54 Post-acute spend and ED utilization10:51 What Navvis does differently12:38 The case for mandatory CMMI models15:08 What CMMI should expand next17:23 Why buying AI isn't transformation20:03 Health system skepticism on AI ROI22:46 Culture before compensation25:59 Where founders should build28:14 Avoiding pilot purgatory30:38 Business literacy for physicians33:13 The high-performing health system of the future34:52 Rapid fireGUESTTim Elliott, CEO of Navvis: https://www.navvis.com/Time Elliot LinkedIn: https://www.linkedin.com/in/tim-elliott-b246aa151HOSTSathvik Bilakanti: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/SPONSORInterconnext Consulting: https://interconnextconsulting.com/Connect with Interconnext: https://interconnextconsulting.com/connect/Mahmud Samad, Founder: https://www.linkedin.com/in/mahmudsamad/

Health plans spend millions every year paying middlemen a cut of "savings" on out-of-network claims, savings calculated from a rack rate nobody ever expects to be paid. Daffodil Health is automating that process end to end and cutting out-of-network repricing costs by about 80%.In this episode of Care Shift, Navin Nagiah (Co-Founder and CEO, Daffodil Health) and Prateesh Maheshwari (Managing Director, Maverick Ventures) break down how out-of-network claims really get paid, who ends up bearing the middleman fee, and why Daffodil walked away from the percent-of-savings model even though it means giving up 50 to 60% of potential revenue. Navin draws on his years at MultiPlan to explain why incumbents can't make this shift themselves, and Prateesh shares what he learned running finance at Oscar Health and why Maverick backed Daffodil at seed and again at Series A. We also cover the No Surprises Act, where AI fits in claims pricing, and who ultimately captures the value.CHAPTERS00:00 Welcome Navin and Prateesh00:06 What Daffodil Health does02:42 Following a $30K out-of-network claim03:52 Who really pays the middleman fee05:52 Out-of-network costs at Oscar Health07:34 What is a rental network?09:16 How middleman fees squeeze health plan margins11:07 The $10M margin opportunity for mid-sized plans12:13 Why cost containment startups never broke out15:29 Choosing trust over short-term revenue16:48 Why MultiPlan can't build this in-house19:53 How incumbents fight back22:01 The problem with percent-of-savings pricing24:03 Pricing shifts and backing spinout founders27:25 Maverick's seed diligence29:39 Giving up revenue by design31:23 Will percent of savings die?33:29 Landing the first design partners38:35 Vendor selection lessons from Oscar40:15 Regulation, press, and the No Surprises Act43:32 How the No Surprises Act works45:57 Where AI fits and where humans stay in the loop50:37 Making pricing decisions auditable52:55 What stays defensible in 3 to 5 years54:55 What Maverick looked for at Series A56:46 Why Navin chose Maverick58:17 Health plans in 3 to 5 years1:01:55 Who captures the value1:03:55 Best advice they didn't takeLISTEN TO CARE SHIFTSpotify: https://open.spotify.com/show/6JghxsuNbQ7hWIHuLjaoJzApple Podcasts: https://podcasts.apple.com/podcast/id1858302821#CareShift #HealthTech #HealthInsurance #OutOfNetwork #NoSurprisesAct #AIinHealthcare #VentureCapitalSpotifyHealth plans pay middlemen millions to "save" money on out-of-network claims, but those savings are calculated from a bill nobody expects to be paid. Navin Nagiah, Co-Founder and CEO of Daffodil Health, and Prateesh Maheshwari, Managing Director at Maverick Ventures, explain how Daffodil is automating out-of-network repricing and cutting those costs by about 80%.We cover:- How an out-of-network claim actually gets paid, and who bears the fee- Why Daffodil rejected the percent-of-savings model- Why incumbents like MultiPlan struggle to change- Lessons from Oscar Health on vendor costs and margins- The No Surprises Act and independent dispute resolution- Where AI helps in claims pricing and where humans stay in the loop- What Maverick looked for at seed and Series ACONNECT WITH NAVIN NAGIAHLinkedIn: https://www.linkedin.com/in/navin-nagiah-8ab16LEARN MORE ABOUT DAFFODIL HEALTHWebsite: https://daffodilhealth.comLinkedIn: https://www.linkedin.com/company/daffodilhealthLEARN MORE ABOUT MAVERICK VENTURESWebsite: https://www.maverickventures.comLinkedIn: https://www.linkedin.com/company/maverick-ventures-sfCONNECT WITH PRATEESHLinkedIn: https://www.linkedin.com/in/prateesh-maheshwari/?isSelfProfile=falseHOSTED BY VIK BILAKANTILinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/?isSelfProfile=trueFOLLOW CARE SHIFTWebsite: https://careshift.vcLinkedIn: https://www.linkedin.com/company/care-shift/

Seth Sternberg co-founded Meebo (acquired by Google), then started Honor to change how society cares for older adults. Today Honor owns Home Instead and runs the largest home care network in the Western Hemisphere.In this episode of Care Shift, Seth explains why he launched a home care agency before building any technology, what the Home Instead acquisition taught him about "M&A AI," and why most AI tools being sold to home care agencies are built in a vacuum. We also get into the caregiver shortage, his case for a time-limited caregiving visa, why he has zero desire to take Honor public, and his warning to founders: use AI to move faster, but never outsource your judgment.Timestamps00:00 Intro00:53 Welcome Seth Sternberg00:59 From IBM and Meebo to home care02:56 Why pick a hard market the second time around04:43 Treating care pros as customers06:03 Why Honor started as an agency, not a tech layer09:30 Buying Home Instead and the M&A AI trend11:00 Stories vs. data after an acquisition13:21 What the Honor Care Network taught them14:39 Winning over franchisees: the 10/80/10 rule16:48 State-by-state regulation18:33 From vendor to franchisor21:46 What AI startups in home care get wrong27:36 Advice for a 23-year-old founder in care29:06 The case for a caregiving visa34:14 Raising caregiver pay through stability35:33 What a caregiving visa should look like38:11 Robotics, devices, and human care42:04 Why Honor isn't going public44:03 Home care in 204045:56 Would he start in home care today?47:12 Where AI helps founders and where it hurts49:25 Rapid fire52:19 OutroMore about Seth & HonorSeth SternbergLinkedIn: https://www.linkedin.com/in/sethjs/X: https://x.com/sethjsHonorWebsite: https://www.honorcare.comLinkedIn: https://www.linkedin.com/company/joinhonorMore about Vik & Care ShiftLinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/?isSelfProfile=trueX: https://x.com/vikbilakanti1

Adam Besvinick, founder and managing partner of Looking Glass Capital, joins Care Shift to talk about being the first yes at pre-seed, and why raising too much, too early is a mistake.Looking Glass is a solo GP pre-seed fund investing across health, climate, and economic drivers. Before starting the firm in 2019, Adam invested from pre-seed through Series C at Deep Fork Capital and Anchorage Capital Group, backing companies like Transfix, BigID, One Concern, and Carrot.In this episode, we cover the moats that still matter in the AI era, the risks of selling healthcare data to frontier labs, whether Epic is really a threat to healthcare startups, how Adam built a solo GP fund starting right before COVID, and why capital constraints often produce better companies.00:00 Intro02:25 Building conviction when others pass07:01 The moats that still matter in 202609:59 Selling healthcare data to AI labs13:48 Can Epic replicate your startup?17:37 Starting Looking Glass Capital24:08 Earning LP trust as a solo GP30:12 Why health, climate, and economic drivers41:01 Oversized rounds and bloated financial models46:22 The biggest fundraising mistake founders make49:07 Rapid fireLooking Glass Capital: https://lookingglass.vcAdam on LinkedIn: https://www.linkedin.com/in/besvinickCare Shift newsletter: https://careshift.substack.com/Vik's LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/

Mahmud Samad has spent 20 years scaling companies across Johnson & Johnson, Burger King through its Bain Capital and TPG years, Wellpath, and MDLIVE. Today he is Founder and Principal of Interconnext Consulting, working with founders, boards, and private equity teams as a strategic CFO and operator.We cover why healthcare startups stall after their first three pilots, what a repeatable process actually means, and why he calls domain expertise the most overrated thing in business. Mahmud also explains the difference between growth and scale, what he looks at first on a P&L, who to hire before your Series A, when a company should not raise VC money, and what franchising can teach healthcare about removing friction for patients.A conversation for early-stage founders, operators, and anyone trying to build something that holds up past the first few customers.Connect with Mahmud & Learn More About Interconnext ConsultingLinkedIn: https://www.linkedin.com/in/mahmudsamad/Interconnext Consulting: https://interconnextconsulting.comInterconnext on LinkedIn: https://www.linkedin.com/company/interconnext-consulting/More on Vik & Care ShiftLinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/Care Shift on LinkedIn: https://www.linkedin.com/company/care-shift/?viewAsMember=trueCare Shift Website: https://careshift.vc/