CEO/Co-Founder, @NitraFinance. Exec Chair / Founder @FiscalNote. Chairman and Co-Founder, @GetAmberEV, Jericho Security. Princeton and Harvard.
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Welcoming America’s newest public company @FiscalNote (NYSE: $NOTE) to the @NYSE by ringing the Opening Bell!
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Tim Hwang retweeted
Lord give me the confidence of a person that has never built anything writing advice posts on how to build a startup
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Tim Hwang retweeted
Why is it ‘cancelled’ in the U.K. but ‘canceled’ in the U.S.?
Because we gave them that L in 1776.
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Nitra is an N of 1 company on track to become the next decacorn in healthcare. There was never a company like it, and probably will never be a company like it.
VCs struggle to define what we are because we’re not focused on investor pattern matching, but on solving real problems for customers. Here’s how we cracked the code:
We started with a simple mission - save doctors time and money - building an all-in-one financial management platform for doctors:
(1) We built a regulated vertical fintech company from scratch (credit cards, accounts payable, point of sale, etc.) bundled with the best AI accounting, expense management, and vendor controls specific to healthcare finance. All of it free to doctors.
This business has grown 13x in 18 months and will cross $100M in annualized revenue this year. The US commercial banking market did $800 Billion in revenue last year, with $200 Billion+ (25% of US GDP) in healthcare.
(2) We used that expense data to build a fully fledged B2B online pharmacy and medical/surgical equipment marketplace with agentic workflows for purchasing, procurement, and inventory management.
This business has grown from nothing into an 8-figure business since launching last fall. The top 5 specialty pharma distributors did $1 trillion in revenue last year.
(3) We identified the most challenging workflows in healthcare and began automating them one by one with AI agents. We started in voice scheduling and eligibility, the most commoditized segment, and partnered with customers to deliver the lowest cost, highest quality solution by bundling our full offering.
Now we’re moving aggressively into prior auth, specialty RCM, and more, with emergent services previously unheard of. If a patient is scheduled for an infusion next Thursday, our system verifies insurance eligibility, predicts drug demand, purchases inventory, arranges financing, and ensures the drug is available before the appointment without staff intervention.
Because we operate the financial and procurement systems of a practice, our AI agents have access to context unavailable to point solutions and we’re bundling it with other areas making us the lowest cost provider.
(4) We’re partnering with life sciences companies to bring new drugs to market faster, eliminating buy and bill financing obstacles and accelerating market access through our procurement engine. As AI-driven biologics and therapies hit the market, we’re making it easier than ever for life sciences companies to get life-saving drugs to providers and patients.
Nitra is onboarding 3-5 practices per day across the full platform and is on a run of a lifetime. The numbers show it. Every day I talk to doctors who are amazed at how fast we’re moving.
So what does it all mean?
Our mission: save doctors time and money.
Our vision: maximize the time doctors spend with patients and make everything else work effortlessly.
The outcome: we’re going to build the biggest VC-backed healthtech company of our generation.
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BS.
Attention was born in Montréal
PyTorch in NYC.
AlphaGo in London
AlphaFold in London
ESMFold in NYC
Llama 1 in Paris.
Llama 2 in Paris+NYC+SV
DeepSeek in Hangzhou
Plus:
DINO in Paris
JEPA in Montréal+Paris+NYC
SV is 3 mos ahead on topics SV is singularly obsessed with.
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Tim Hwang retweeted
On Tuesday, Nitra, an AI-powered healthcare financial and operational platform, announced a $50 million Series B round, bringing its total capital raised to $205 million. bit.ly/4s3Lwjz
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Today we’re announcing that @NitraFinance has raised a combined $187 million in financing as we build the AI-native operating system for healthcare practices.
We're also announcing that Dr. Richard Park, founder of CityMD and healthcare legend, will be joining Nitra’s Board.
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Doctors are not just service providers. They are the backbone of every community, yet many are forced to act as part-time CFOs, insurance specialists, and procurement officers just to run their practices. They deserve software that works as hard as they do.
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If you’re a physician who wants to modernize your practice or want to help us build the future of healthcare we’d love to hear from you.
Appreciate @FortuneMagazine & @CatGioino for the story: fortune.com/2026/03/10/tim-h…
Learn more about the Nitra story: nitra.com/resources/founder-…
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According to @ARKInvest’s research, the most profound application of #AI will be in health care. Deregulation is accelerating this transformation in healthcare. Check out Tempus’s results, reported today.
The FDA just made one of the most significant shifts in its evidentiary standards in decades—and it feels like a lot of people have slept on the news!
The FDA will now default to ONE pivotal trial for drug approval, not two.
The science of evaluating whether a drug works has advanced enormously. Today, development programs build evidence across multiple dimensions—mechanism of action, biomarker effects, intermediate endpoints—that collectively tell a more complete story. That body of confirmatory evidence, from mechanistic data to real-world evidence, can replace a second pivotal trial.
We have historically seen more regulatory flexibility in rare diseases and oncology where need is acute. But the biggest impact we expect to see with the shift from two to one pivotal trial is likely to be in common conditions like cardiovascular and respiratory where the two pivotal trial dogma has been more entrenched. Potentially up to $350M in savings per program and years off timelines.
And this might just be the start—could continuous trial designs that collapse the rigid phase structure be the next paradigm shift in clinical development?
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Thank you to the amazing team at NVIDIA for the fruitful conversations and inspirational look at the future of generative AI. Particularly struck by the willingness to lift up the entire ecosystem and make sure that this amazing technology reaches every corner of the planet.
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The first sentence of this morning’s New York Times coverage of crypto reads: “Few people own cryptocurrencies,” followed by a detailed critique of deregulation under the new administration (nytimes.com/2025/02/10/brief…). This characterization is both misleading and dismissive of the growing participation in digital asset ownership and innovation. Estimates suggest that somewhere between 25% and 33% of Americans actively own cryptocurrencies—far from a “few.”
Just another example of biased narratives that often overlook the transformative potential of fintech innovation, particularly in areas like blockchain technology and digital assets. The crypto ecosystem continues to be a hub for technological advancements that can redefine global financial infrastructure. Instead of minimizing its impact, we should engage in balanced discussions that recognize both the opportunities and challenges in this rapidly evolving space.
It’s clear that blockchain has far-reaching applications beyond just digital currencies—applications that could fundamentally improve financial systems while promoting transparency and efficiency. For those of us exploring responsible and sustainable ways to apply these technologies, such reporting does little to advance meaningful discourse.
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Whether DeepSeek/Chinese companies violated export controls or they produced novel innovations (both can be simultaneously true), it was always inevitable that the costs of LLMs were going to be driven down exponentially through relentless competition and innovation. Not really worth debating how it happened but what it means. This was always going to be the case whether it was just American companies competing amongst themselves or globally.
The simple reality is that competition drives down cost. The real game starts now as the costs of implementing AI continue to get driven down and the ability to implement and extend novel use cases continue to multiply. While OpenAI, DeepSeek, etc get all the mainstream press there are thousands of companies who are working to implement these models into their own use cases and workflows from medicine to law to customer support.
If you are one of those companies (particularly startups), your costs will continue to go down and implementing novel AI use cases will continue to become more accessible. The real value of AI was never in the LLMs but in the applications they were going to serve.
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Tim Hwang retweeted
One of the best things the U.S. can do is make high-skill immigration easier. @levie is right.
It is awful that the wait time for a green card can be over a decade, and that after waiting years someone can still be forced to leave simply because they lost a job. Fixing this is both an economic and a moral issue.
A rigorous economic analysis (by Pierre Azoulay and collaborators) shows that immigrants create more jobs than they take. So to create jobs for Americans, lets let more immigrants in!
High skilled immigration has been central to America leading the world in tech.
The biggest misunderstand about high skill immigration stems from people thinking that the market opportunities in tech, and tech-adjacent fields, are zero sum. This essentially imagines innovation is finite and we’re all fighting over the same job or opportunity pool.
This may be true of a few very legacy, slow growth industries, but it’s categorically not true for any important industry in the past 50 years or the next 100. Biotech, AI, advanced manufacturing, software, EVs, new energy sources, and dozens of other fields of the future are our high growth industries. And there’s no inherently fixed volume of companies or talent that the market needs.
Tesla being started or not started in America is the difference between 100,000’s of jobs here - and leading in EVs globally - and not. Apple being started here is the difference between potentially millions of jobs being here - and leading consumer electronics globally - and not. You could go through this list all day long.
Tech is not zero sum. More startups, pursuing more ideas, ultimately create more innovation and ultimately more jobs and prosperity. And that means you need the right talent to both work at these companies, and start the next ones. High skilled immigration has directly made America dominant technically and thus economically, and create far more jobs in America for others than are supposedly displaced.
Even briefly imagining the alternative scenario, it’s obvious how disastrous this would be. The demand from tech companies for this top talent will remain, yet America won’t benefit directly from their hiring. That talent will go to another company that competes with the US and makes our dominance harder to maintain. You’re just increasing the odds you have more competition in the future.
And even in the “best case” scenario (for our competitiveness) where a larger company like Google hires the same people internationally that would have otherwise moved here, when that person leaves Google to start their next company, it will be in their country of origin, not America.
This is how you lose the tech war within one or two generations. There’s simply no good game theory in anything that reduces our talent access.
Yes, we absolutely have and need to continue to educate and train incredible talent that grows up in the US, but equally having access to the world’s smartest talent has always been a huge advantage for America.
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FiscalNote $NOTE holders - some thoughts as we get towards the end of the year. It's been an incredible year for the company in 2024 (more below):
- We clocked five straight quarters of AEBITDA, with the highest ever/record AEBITDA profit in company history in the last Q
- We dropped ~$105m of cash onto the balance sheet this year by selling two non-core products that represented ~11.5% of our GAAP revenues (one company we bought for $10m of cash in 2021 and made a 9.5x cash-on-cash return for shareholders)
- We sold those two none-core companies for ~7x ARR and another ~5x ARR (should give you a sense of what we're seeing in the private markets on valuations even though we're trading at 1.5-3x right now)
- We used a big chunk of cash to slash half our senior debt
- We launched multiple new AI Co-Pilots in the market (piped.video/watch?v=oFAKdwsg…) for long term growth
- Brought in a new head of product from Casetext (which sold to Thomson Reuters for $650m)
- Launched new partnerships with Prorata.ai, building on our partnerships with OpenAi, Microsoft, and Google in the GenAI space
- Expanded our customer relationships with the White House, dozens of federal departments and agencies, Supreme Court, etc. as well as major companies in the F500
- Launched a bunch of new services to help customers navigate the new Trump Administration including data and analysis on all the new players, legislation, and regulations in everything from oil and gas to crypto
Despite this, my strong opinion (which I've said publicly in earnings) is that the company is completely undervalued on a fundamental basis. We have a clear AI leadership position in our sector. We generate nine figures in compounding recurring revenue ARR from thousands of customers with retention rates in the mid to high 90s. We drive consistent, 80%+ high adjusted gross margins. We have an operational foundation that drives extremely high operating leverage. We are profitable on an Adjusted EBITDA basis.
The markets may not have realized it yet, but we'll just continue to execute and deliver until they do.
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I (and anyone on my team) am always happy to be available to answer any questions about the company, what we've accomplished this year, and what we're looking forward to in the new year and beyond.
If anyone has any questions they can email ir@fiscalnote.com (which is actually manned by real people!) or me tim@fiscalnote.com directly and will address the questions.
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Tim Hwang retweeted
Democrat Andy Kim will be the next senator from New Jersey, CNN projects. He will win the seat left behind by Democratic former Sen. Bob Menendez, who resigned this summer. Kim will be the first Korean American elected to the US Senate. cnn.it/40Bl5qC
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Tim Hwang retweeted
The NYSE welcomes @FiscalNote in celebration of its 10th anniversary of founding and 1 year of $NOTE #FiscalTakesNOTE #FN10 nitter.net/i/broadcasts/1YpKkglQQ…
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Great work by the @FiscalNote ($NOTE) team this quarter: in addition to posting 21% growth in Q2 2023, we increased Q3 Profitability guidance with the expectation to be profitable on an Adjusted EBITDA basis next quarter in Q3 2023, a quarter earlier than expected!
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For more information check out: investors.fiscalnote.com/new…
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