Josh Miller, CEO & Co-Founder of Gradient Health: 40 People, $40 Million, and the Data Behind Medical AI
Josh Miller, CEO and co-founder of Gradient Health, joins me to share how a Durham-area startup became the go-to source of medical data for AI developers around the world.
Josh traces the path from his first company, FarmShots, a satellite imaging startup acquired by Syngenta, to Gradient, which began as an attempt to build cancer-detection AI and turned into something bigger once the team saw how hard it was to get the data. The conversation covers why de-identifying medical data is so much harder than removing a name, how foundation models changed the value of labeled data, and why expert-curated datasets are becoming the next frontier.
Gradient's numbers are remarkable: roughly 40 million dollars in revenue this year with about 40 people, on only about 9 million dollars raised. Josh credits a culture that is willing to talk openly about what isn't working, along with AI-native engineering that has made his best engineers dramatically more productive. He also talks about go-to-market when customers are racing a 20 million dollar training run, his company's moat, and a personal reminder for founders to take care of themselves on the long road.
Timestamps
00:00 Welcome to NC Tweener Talks
00:25 Thanks to our sponsors
01:35 Scot's intro: portfolio wins you can't talk about
02:30 Why Tweener invested in Gradient Health
04:55 Welcome Josh Miller
05:55 FarmShots: satellite imagery for farms
07:45 A lever through time
08:30 The Syngenta exit and Duke roots
09:25 Never again… then startup #2
10:40 Founding Gradient before ChatGPT
11:30 From building cancer AI to supplying the data
13:30 De-identification and the 87% problem
14:30 Paying hospitals back
15:20 Weak labels vs. strong labels
16:55 First contract and the revenue curve
19:20 Fundraising: $9M raised in total
20:35 Getting pulled by the market
21:55 Atlas 2 and multimodal data
23:00 Picks and shovels vs. building the model
23:55 40 people, $1M per head
25:30 Post-training and expert-curated data
27:35 Culture: talking about problems
28:55 AI-native engineering and the 100x engineer
30:15 Go-to-market in the AI data space
32:10 Gradient's competitive moat
33:10 Founder lesson: take care of yourself
34:15 Wrap and credits
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Where to Find Josh Miller:
LinkedIn: https://www.linkedin.com/in/joshmichaelmiller/
Gradient Health: https://gradienthealth.io/
Where to Find Scot Wingo:
LinkedIn: https://www.linkedin.com/in/thescotwingo/
Tweener Times: https://www.tweenertimes.com/
X: https://x.com/scotwingo
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This episode of Triangle Tweener Talks is hosted by Scot Wingo, presented and produced by NC Tweener Fund, with creative assets and design support from Walk West.
We couldn’t share posts like this without our amazing sponsors:
Platinum:
NC IDEA: https://ncidea.org
Gold Sponsors:
- Balentine: https://www.balentine.com/triangle-entrepreneurs
- EisnerAmpner: https://www.eisneramper.com
- Robinson Bradshaw: https://www.robinsonbradshaw.com
Silver Sponsors:
- Automated Consulting Group: https://automated.co
- Bank of America: https://business.bofa.com/en-us/content/technology-industry-group.html
Josh traces the path from his first company, FarmShots, a satellite imaging startup acquired by Syngenta, to Gradient, which began as an attempt to build cancer-detection AI and turned into something bigger once the team saw how hard it was to get the data. The conversation covers why de-identifying medical data is so much harder than removing a name, how foundation models changed the value of labeled data, and why expert-curated datasets are becoming the next frontier.
Gradient's numbers are remarkable: roughly 40 million dollars in revenue this year with about 40 people, on only about 9 million dollars raised. Josh credits a culture that is willing to talk openly about what isn't working, along with AI-native engineering that has made his best engineers dramatically more productive. He also talks about go-to-market when customers are racing a 20 million dollar training run, his company's moat, and a personal reminder for founders to take care of themselves on the long road.
Timestamps
00:00 Welcome to NC Tweener Talks
00:25 Thanks to our sponsors
01:35 Scot's intro: portfolio wins you can't talk about
02:30 Why Tweener invested in Gradient Health
04:55 Welcome Josh Miller
05:55 FarmShots: satellite imagery for farms
07:45 A lever through time
08:30 The Syngenta exit and Duke roots
09:25 Never again… then startup #2
10:40 Founding Gradient before ChatGPT
11:30 From building cancer AI to supplying the data
13:30 De-identification and the 87% problem
14:30 Paying hospitals back
15:20 Weak labels vs. strong labels
16:55 First contract and the revenue curve
19:20 Fundraising: $9M raised in total
20:35 Getting pulled by the market
21:55 Atlas 2 and multimodal data
23:00 Picks and shovels vs. building the model
23:55 40 people, $1M per head
25:30 Post-training and expert-curated data
27:35 Culture: talking about problems
28:55 AI-native engineering and the 100x engineer
30:15 Go-to-market in the AI data space
32:10 Gradient's competitive moat
33:10 Founder lesson: take care of yourself
34:15 Wrap and credits
---
Where to Find Josh Miller:
LinkedIn: https://www.linkedin.com/in/joshmichaelmiller/
Gradient Health: https://gradienthealth.io/
Where to Find Scot Wingo:
LinkedIn: https://www.linkedin.com/in/thescotwingo/
Tweener Times: https://www.tweenertimes.com/
X: https://x.com/scotwingo
---
This episode of Triangle Tweener Talks is hosted by Scot Wingo, presented and produced by NC Tweener Fund, with creative assets and design support from Walk West.
We couldn’t share posts like this without our amazing sponsors:
Platinum:
NC IDEA: https://ncidea.org
Gold Sponsors:
- Balentine: https://www.balentine.com/triangle-entrepreneurs
- EisnerAmpner: https://www.eisneramper.com
- Robinson Bradshaw: https://www.robinsonbradshaw.com
Silver Sponsors:
- Automated Consulting Group: https://automated.co
- Bank of America: https://business.bofa.com/en-us/content/technology-industry-group.html
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Triangle Tweener Talks is sponsored by:
Triangle Tweener Talks is sponsored by:
- Atomic Object: https://atomicobject.com/
