All episodes

Why Most Health Systems Fail at Value-Based Care | Tim Elliott, CEO of Navvis

Why do so many health systems struggle with value-based care? Tim Elliott, CEO of Navvis, has spent years helping health systems and physician enterprises make the shift from fee-for-service, and his answer is simple: it's an operating model change, not a reimbursement issue. In this episode of Care Shift, we cover the signals that a health system is actually ready for value-based care, why Tim supports mandatory CMMI models like TEAM and CJR-X, why buying an AI tool isn't transformation, how SSM Health led with physician culture before touching compensation, and where the biggest openings are for founders building in value-based care. 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. They've worked with everyone from early-stage founders to Fortune 500 companies across healthcare, SaaS, franchising, and more. Want to learn more? Go to https://interconnextconsulting.com/connect/ and tell them Care Shift sent you. Chapters 00:00 Intro 00:51 The first signal a health system is ready for value-based care 03:14 Fee-for-service vs. value-based care: one operating model, not two 05:55 The scorecard: metrics that prove value-based care ROI 07:54 Peeling the onion on total cost of care: post-acute spend and ED utilization 10:51 What Navvis delivers that consultants and tech platforms can't 12:38 Why Tim supports mandatory CMMI models like TEAM 15:08 The models CMS and CMMI should expand next 17:23 Change management: why buying AI isn't transformation 20:03 Why health system execs are skeptical about AI ROI 22:46 Culture before compensation: engaging physicians at SSM Health 25:59 Where founders should be building in value-based care 28:14 How to avoid pilot purgatory 30:38 Building business literacy for physicians 33:13 What high-performing health systems will look like 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/ LISTEN Spotify: https://open.spotify.com/show/6JghxsuNbQ7hWIHuLjaoJz

Navin Nagiah and Prateesh Maheshwari on Cutting Out-of-Network Costs by 80%

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. CHAPTERS 00:00 Welcome Navin and Prateesh 00:06 What Daffodil Health does 02:42 Following a $30K out-of-network claim 03:52 Who really pays the middleman fee 05:52 Out-of-network costs at Oscar Health 07:34 What is a rental network? 09:16 How middleman fees squeeze health plan margins 11:07 The $10M margin opportunity for mid-sized plans 12:13 Why cost containment startups never broke out 15:29 Choosing trust over short-term revenue 16:48 Why MultiPlan can't build this in-house 19:53 How incumbents fight back 22:01 The problem with percent-of-savings pricing 24:03 Pricing shifts and backing spinout founders 27:25 Maverick's seed diligence 29:39 Giving up revenue by design 31:23 Will percent of savings die? 33:29 Landing the first design partners 38:35 Vendor selection lessons from Oscar 40:15 Regulation, press, and the No Surprises Act 43:32 How the No Surprises Act works 45:57 Where AI fits and where humans stay in the loop 50:37 Making pricing decisions auditable 52:55 What stays defensible in 3 to 5 years 54:55 What Maverick looked for at Series A 56:46 Why Navin chose Maverick 58:17 Health plans in 3 to 5 years 1:01:55 Who captures the value 1:03:55 Best advice they didn't take 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/

Honor CEO Seth Sternberg on Buying Home Instead and Building the Biggest Home Care Network

Seth Sternberg co-founded Meebo (acquired by Google), then started Honor in 2014 to change how society cares for older adults. After acquiring Home Instead in 2021, Honor now runs the largest home care network in the Western Hemisphere and is backed by Andreessen Horowitz, Thrive Capital, and Baillie Gifford. In this episode of Care Shift, Seth explains why Honor opened its own home care agency before building any technology, what the Home Instead acquisition taught him about buying old-world businesses and injecting AI, and why most AI tools being sold to home care agencies are built in a vacuum. We also get into America's coming caregiver shortage, his case for a time-limited caregiving visa, and his warning to founders: use AI to move faster, but never outsource your judgment. CHAPTERS 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 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 CONNECT WITH SETH STERNBERG LinkedIn: https://www.linkedin.com/in/sethjs/ X: https://x.com/sethjs LEARN MORE ABOUT HONOR Website: https://www.honorcare.com LinkedIn: https://www.linkedin.com/company/joinhonor Vik & Care Shift Socials LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/?isSelfProfile=true X: https://x.com/vikbilakanti1 Care Shift Website: https://careshift.vc/ LISTEN TO CARE SHIFT Spotify: https://open.spotify.com/show/6JghxsuNbQ7hWIHuLjaoJz Apple Podcasts: https://podcasts.apple.com/podcast/id1858302821 #CareShift #HomeCare #SeniorCare #HealthTech #AIinHealthcare #Startups

Adam Besvinick of Looking Glass Capital: Why Raising Too Much, Too Early Is a Mistake

Adam Besvinick has backed companies like Transfix, BigID, One Concern, and Carrot. In this episode of Care Shift, he breaks down why raising too much, too early can kill a startup, and what a healthy pre-seed round actually looks like. Adam is the founder and managing partner of Looking Glass Capital, a solo GP pre-seed fund built around one idea: be the first yes. Looking Glass invests across health, climate, and economic drivers. Before launching the firm in 2019, Adam invested from pre-seed through Series C at Deep Fork Capital and Anchorage Capital Group. We get into: - Why founders with deep industry networks have one of the last real edges in the AI era - The risk of building a business around selling healthcare data to frontier labs - Whether Epic can replicate what healthcare startups are building - How Adam raised Fund I as a solo GP, right before COVID - How ChatGPT split his portfolio in two - Why a two-person company reaching ~$2.5M ARR is proof that constraints win - The most common fundraising mistake first-time founders make Timestamps 00:00 Intro 00:58 Why be the first check 02:25 Building conviction when others pass 04:30 Picking winners in crowded markets 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 Leaving Anchorage to start Looking Glass 21:28 Lessons from raising Fund I 24:08 Earning LP trust as a solo GP 30:12 Why health, climate, and economic drivers 33:56 What Adam looks for in healthcare founders 36:39 How ChatGPT changed his portfolio 41:01 Oversized rounds and bloated financial models 43:36 How multi-stage firms reshaped seed 46:22 The biggest fundraising mistake founders make 49:07 Rapid fire Connect with Adam Looking Glass Capital: https://lookingglass.vc LinkedIn: https://www.linkedin.com/in/besvinick Connect with Care Shift Newsletter: https://careshift.substack.com/ LinkedIn: https://www.linkedin.com/in/sathvik-bilakanti-8b5344169/ #venturecapital #healthcare #startups #fundraising #preseed

From Burger King to MDLIVE: The Playbook for Scaling Healthcare

GLP-1s Broke Employer Budgets. Here's What Comes Next With Ed Liebowitz of Personify Health