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 Intro

00:51 Signs a health system is ready for value-based care

03:14 One operating model for fee-for-service and value

05:55 The value-based care scorecard

07:54 Post-acute spend and ED utilization

10:51 What Navvis does differently

12:38 The case for mandatory CMMI models

15:08 What CMMI should expand next

17:23 Why buying AI isn't transformation

20:03 Health system skepticism on AI ROI

22:46 Culture before compensation

25:59 Where founders should build

28:14 Avoiding pilot purgatory

30:38 Business literacy for physicians

33:13 The high-performing health system of the future

34:52 Rapid fire

GUEST

Tim Elliott, CEO of Navvis: https://www.navvis.com/

Time Elliot LinkedIn: https://www.linkedin.com/in/tim-elliott-b246aa151

HOST

Sathvik Bilakanti: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/

SPONSOR

Interconnext 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 #VentureCapital

Spotify

Health 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 A

CONNECT WITH NAVIN NAGIAH

LinkedIn: https://www.linkedin.com/in/navin-nagiah-8ab16

LEARN MORE ABOUT DAFFODIL HEALTH

Website: https://daffodilhealth.com

LinkedIn: https://www.linkedin.com/company/daffodilhealth

LEARN MORE ABOUT MAVERICK VENTURES

Website: https://www.maverickventures.com

LinkedIn: https://www.linkedin.com/company/maverick-ventures-sf

CONNECT WITH PRATEESH

LinkedIn: https://www.linkedin.com/in/prateesh-maheshwari/?isSelfProfile=false

HOSTED BY VIK BILAKANTI

LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/?isSelfProfile=true

FOLLOW CARE SHIFT

Website: https://careshift.vc

LinkedIn: 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.

Timestamps

00:00 Intro
00:53 Welcome Seth Sternberg
00:59 From IBM and Meebo to home care
02:56 Why pick a hard market the second time around
04:43 Treating care pros as customers
06:03 Why Honor started as an agency, not a tech layer
09:30 Buying Home Instead and the M&A AI trend
11:00 Stories vs. data after an acquisition
13:21 What the Honor Care Network taught them
14:39 Winning over franchisees: the 10/80/10 rule
16:48 State-by-state regulation
18:33 From vendor to franchisor
21:46 What AI startups in home care get wrong
27:36 Advice for a 23-year-old founder in care
29:06 The case for a caregiving visa
34:14 Raising caregiver pay through stability
35:33 What a caregiving visa should look like
38:11 Robotics, devices, and human care
42:04 Why Honor isn't going public
44:03 Home care in 2040
45:56 Would he start in home care today?
47:12 Where AI helps founders and where it hurts
49:25 Rapid fire
52:19 Outro

More about Seth & Honor

Seth Sternberg

• LinkedIn: https://www.linkedin.com/in/sethjs/
• X: https://x.com/sethjs

Honor

• Website: https://www.honorcare.com
• LinkedIn: https://www.linkedin.com/company/joinhonor

More about Vik & Care Shift

LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/?isSelfProfile=true

X: 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 Intro

02:25 Building conviction when others pass

07:01 The moats that still matter in 2026

09:59 Selling healthcare data to AI labs

13:48 Can Epic replicate your startup?

17:37 Starting Looking Glass Capital

24:08 Earning LP trust as a solo GP

30:12 Why health, climate, and economic drivers

41:01 Oversized rounds and bloated financial models

46:22 The biggest fundraising mistake founders make

49:07 Rapid fire

Looking Glass Capital: https://lookingglass.vc

Adam on LinkedIn: https://www.linkedin.com/in/besvinick

Care 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 Consulting
LinkedIn: https://www.linkedin.com/in/mahmudsamad/
Interconnext Consulting: https://interconnextconsulting.com
Interconnext on LinkedIn: https://www.linkedin.com/company/interconnext-consulting/

More on Vik & Care Shift

LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/

Care Shift on LinkedIn: https://www.linkedin.com/company/care-shift/?viewAsMember=true

Care Shift Website: https://careshift.vc/

If you wait for the claim, you've already lost. Ed Liebowitz, President and General Manager of Well-being at Personify Health, breaks down pre-encounter engagement, what CFOs want from wellness vendors, the Virgin Pulse and HealthComp merger, GLP-1 strategy for employers, and where AI is actually moving the needle in employer health.

00:00 Intro

01:30 Why Ed left finance for digital health

03:05 Lessons from Everyday Health, HealthReveal, and BD

05:06 Is corporate wellness just a perk?

06:51 The ROI metrics CFOs care about now

08:29 How engagement starts: HRAs and predictive risk

09:38 Employers vs. health plans: different paths to ROI

10:49 The white space for founders in employer health

12:27 Why waiting for claims data means you've already lost

14:33 Reaching beyond healthy members: the MSK pilot

17:42 How to avoid bias in personalization

19:40 Earning trust with member health data

20:55 Personal wellness plans

23:52 The Virgin Pulse and HealthComp merger

25:16 How owning the TPA changes wellbeing

26:37 Lessons from post-merger integration

28:32 What evidence closes the deal with CFOs

30:12 Network contracting and Surest

31:49 How benefits consultants evaluate vendors

33:08 GLP-1s and employer budgets

36:27 Building product as a patient

38:15 What's changing in longitudinal care

39:20 The conditions driving employer spend

40:49 Where AI is moving KPIs today

42:18 AI governance and member trust

43:21 Why Personify vs. ChatGPT and Anthropic

45:25 AI agents and benefits navigation

46:13 Who wins employer health consolidation

47:39 The North Star metric for the category

48:07 Rapid fire

More about Ed Liebowitz & Personify Health

Ed Liebowitz's LinkedIn: https://www.linkedin.com/in/edliebowitz/

Personify Health LinkedIn: https://www.linkedin.com/company/personify-health/

Personify Health Website: https://personifyhealth.com/

More about Vik & Care Shift

Vik's LinkedIn: www.linkedin.com/in/sathvik-bilakanti-8b5344169

Care Shift LinkedIn: https://www.linkedin.com/company/110446420/admin/dashboard/

Care Shift Website: https://careshift.vc/

JPMorgan Chase reviews about 400 healthcare companies a year and invests in three.

Dan Mendelson, CEO of Morgan Health, explains what gets a company into that group.

We cover the $330M deployed off JPMorgan's balance sheet, why a company that only

cuts cost gets a pass, and the misconception Dan corrects with nearly every founder:

Morgan Health's check does not come with a contract from JPMorgan's benefits team.

Dan also gets into $27,000 family premiums, small employers dropping coverage, ICHRA,

the coding practices driving six figure claims, and where AI is genuinely working.

Dan founded and sold Avalere Health and ran health policy at OMB under the Clinton

administration.

(00:24) The mission and the $330M mandate

(01:48) Why founders pick Morgan Health

(03:35) The myth: funding is not a JPMorgan contract

(05:29) 400 companies, 3 investments, what earns a yes

(06:40) Savings only count if quality goes up

(08:19) $27K premiums and why the market hasn't broken

(09:36) Employers dropping coverage, ICHRA, narrow networks

(12:17) Affordability, access, and social determinants

(13:50) Why Medicare Advantage is ahead of commercial

(15:39) The fee for service trap

(17:23) The Lantern thesis and surgical spend

(18:16) Cancer as a top cost driver

(19:39) Six figure claims and coding

(22:35) Where AI is actually working

(25:44) What ICHRA needs to go mainstream

(27:16) Lessons from OMB, CHIP, and Avalere

(28:40) Rapid fire

More about Morgan Health & Dan MendelsonMorgan Health

Website: https://www.morganhealth.com/

About Dan Mendelson: https://en.wikipedia.org/wiki/Dan_Mendelson

Dan Mendelson's LinkedIn: https://www.linkedin.com/in/dnmendelson/

Morgan Health LinkedIn: https://www.linkedin.com/company/jpmorganchase/home/

About Vik & Care Shift

Vik's LinkedIn: www.linkedin.com/in/sathvik-bilakanti-8b5344169

Care Shift Website:https://careshift.vc/

Care Shift LinkedIn: https://www.linkedin.com/company/care-shift/posts/?viewAsMember=true

Luis Voloch, CEO of Jimini Health and co-founder of Immune.ai, joins Care Shift to talk about why he traded oncology AI for behavioral health, and why he believes clinicians, not chatbots, are the key to doing AI in mental health right.

We cover the ChatGPT suicidal ideation numbers that shaped Jimini's thesis, why Sage was built as an extension of the clinician rather than a replacement, and how that choice became the company's biggest moat. Luis also breaks down selling AI into large health systems, pricing a product with no existing benchmarks, and how Medicaid and underserved populations fit into Jimini's long-term roadmap.

We also get into the radiology analogy for why AI might make clinicians more in-demand rather than less, what happened to the wave of mental health chatbots that disappeared over the last two years, and where Luis sees behavioral health heading over the next 6 to 12 months.

Timestamps:
0:00 Intro
0:15 Why Luis pivoted from oncology AI to behavioral health
1:16 Why language is both the therapy and the diagnosis in mental health
2:19 Responding to the "it's all vibes" critique
3:28 What happens to patients between therapy sessions
4:26 How clinicians and patients are responding to Sage
5:30 Differentiating from Spring Health, Headspace, and other players
7:14 The ChatGPT suicidal ideation numbers
8:51 What Sage is and how Jimini sells it
9:30 The administrative burden problem
10:19 Why clinicians are the moat, not the cost center
11:11 What happens when AI in behavioral health goes wrong
12:04 Where FDA regulation stands
13:23 Going from CTO at Immune.ai to CEO at Jimini
14:28 Teaching at Stanford and common AI health founder mistakes
16:02 Technologist vs. clinician as founder
17:41 Moving upmarket to large behavioral health organizations
18:46 Pricing AI with no existing benchmarks
20:34 The FDA's Tempo and ACCESS programs
22:26 Where AI has (and hasn't) moved the needle
23:23 How Jiminy uses AI internally to build faster
25:02 Retention and outcomes data
26:35 Building a team from Immune.ai, Cedar, and Palantir
28:46 Where behavioral health is headed in 6-12 months
30:45 Does AI take clinicians' jobs? The radiology analogy
32:15 Common misconceptions about behavioral health
33:14 The two-tiered access problem in behavioral health
34:09 Consolidation risk and Jimini's defensibility
35:35 Medicaid, underserved patients, and reimbursement
37:13 What happened to the wave of mental health chatbots
38:28 Will one company dominate behavioral health AI?

More on Jimini Health & Luis Voloch

Luis's LinkedIn: https://www.linkedin.com/in/luisvoloch/

Jimini Health Website: https://jiminihealth.com/

Jimini Health LinkedIn: https://www.linkedin.com/company/jiminihealth/

More about Vik & Care Shift

Vik's LinkedIn:https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/

Vik on X: https://x.com/vikbilakanti1

Care Shift LinkedIn:https://www.linkedin.com/company/110446420/admin/dashboard/

Care Shift Website: https://careshift.vc/

Chris Molaro left the Army after leading a platoon in combat to build NeuroFlow, a behavioral health infrastructure company now working with the VA, national health plans, and health systems across the country. We talk about the 60% of people with a mental health diagnosis who never get treated, how AI helps flag suicide risk before it's too late, and the eighteen months NeuroFlow spent stuck behind a legal barrier before finding a way through. Chris also shares the story of a father NeuroFlow's system helped get into an appointment within 24 hours after he'd been told he'd have to wait over a month.

Chapters:
00:00 Intro
00:30 Lessons from West Point and leading soldiers in combat
03:21 Why NeuroFlow built infrastructure instead of another therapy app
05:52 Finding the patients who fall through the gaps
07:58 Winning trust with the first provider groups
11:45 How NeuroFlow flags suicide risk with AI and LLMs
17:50 The 18-month legal barrier, and how response services solved it
20:10 Selling into the VA, national payers, and health systems
22:58 What a Blue Cross study revealed about cost and outcomes
30:25 Build versus buy: the VA, Quartet, and Owl Health acquisitions
40:48 The morning NeuroFlow's algorithm helped save a father's life
43:03 The next five to ten years for NeuroFlow
47:24 Rapid fire

About 8 to 9% of NeuroFlow's team are military veterans, and several of the company's investors are too.

More about NeuroFlow & Chris Molaro

NeuroFlow Website: https://www.neuroflow.com/

NeuroFlow's LinkedIn: https://www.linkedin.com/in/chrismolaro/

Chris Molaro's LinkedIn: linkedin.com/in/chrismolaro/

More about Vik & Care Shift

Vik's LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/

Care Shift LinkedIn: https://www.linkedin.com/company/care-shift/?viewAsMember=trueCare Shift Website: https://careshift.vc/

Care Shift on Spotify: https://open.spotify.com/show/6JghxsuNbQ7hWIHuLjaoJz?si=9b761459412846ddCare Shift on

Apple Podcasts: https://podcasts.apple.com/us/podcast/care-shift/id1858302821

John Zutter took over as CEO of Lantern in December 2016 — right after the company lost 50% of its clients in six months. Today, Lantern is one of the largest specialty care platforms in the country, serving 12 million people across 500+ facilities, with a surgical complication rate under 1% (vs. a national average of 8-15%).

In this episode, we go deep on how Lantern rebuilt trust with employers, why the "fly patients to a name-brand hospital" model failed, the five-part heuristic Lantern uses to decide which conditions to tackle next, why they chose to open-source their savings methodology, and where AI actually moves the needle in specialty care versus where it doesn't.

John spent his early career in investment banking and growth equity before joining Lantern in 2016 with no healthcare background — and turned around a business now backed by a $30M round led by Morgan Health (JPMorgan Chase) and Echo Health Ventures.

In this episode:

• Why Lantern lost half its clients before John took over — and what was actually broken
• The "Centers of Excellence" model that looked good on paper but failed in practice
• How Lantern scaled a two-sided provider network market by market
• The real reason their complication rate is under 1%
• How Lantern decides which new categories to enter (surgery → cancer → infusions)
• Why they open-sourced their savings and bundling methodology — and why competitors haven't followed
• What CEOs, CFOs, and benefits leaders each actually want from a healthcare vendor
• Where AI will — and won't — change specialty care
• His non-consensus take on GLP-1s

Timestamps:
00:00 – Intro
01:11 – Coming into healthcare with no healthcare background
03:59 – Taking over Lantern after losing half its clients
05:58 – Why the "Centers of Excellence" model failed
08:06 – Scaling a two-sided provider network
12:11 – Advice for early-stage founders on network-based models
14:54 – How Lantern gets complication rates under 1%
17:07 – Addressing the "cherry-picking healthy patients" critique
20:12 – Why cancer, surgery, and infusions eat 50%+ of health spend
23:12 – Expanding from surgery into cancer care
26:22 – Partnerships vs. building in-house (Access Hope, Hinge Health)
28:20 – Expanding into infusion therapy
30:18 – When platform consolidation helps buyers — and when it doesn't
35:25 – Why Lantern open-sourced its savings methodology
39:45 – Where AI fits into the next 5 years of specialty care
44:55 – Shifting from procedural to therapeutic care (GLP-1s, cell/gene therapy)
46:38 – Working with health plans vs. employers directly
49:12 – A non-consensus bet on GLP-1s
50:09 – Rapid fire

More about John Zutter & Lantern

John's LinkedIn: https://www.linkedin.com/in/john-zutter-687000a/

Lantern's LinkedIn: https://www.linkedin.com/company/lantern-specialty-care/

Lantern's Website: https://lanterncare.com/

More about Vik & Care Shift

Vik's LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/

Care Shift LinkedIn: https://www.linkedin.com/company/care-shift/?viewAsMember=true

Care Shift Website: https://careshift.vc/