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/