TOI — The Oncology Institute, Inc.

Summary of The Oncology Institute (TOI) Q1 2026 Earnings Call

1. Key Financial Results and Metrics

• Total Revenue: $147.4 million, up 41.2% year-over-year (YoY).
• Patient Services Revenue: $59.1 million, representing 40.1% of total revenue, with capitated revenue growing 54% YoY to $26.9 million.
• Specialty Pharmacy Revenue: $87.5 million, up 77.6% YoY, driven by a 103% increase in prescription fills.
• Gross Profit: $23.3 million, up from $17.2 million YoY; overall gross margin at 15.8%.
• Adjusted EBITDA: Loss of $2.4 million, an improvement from a loss of $5.1 million YoY.
• Free Cash Flow Projections: Updated to a positive range of $5 million to $15 million for the year.

2. Strategic Updates and Business Highlights

• Continued expansion of value-based contracts and growth in ancillary services, particularly in the pharmacy sector.
• Achieved profitability in the Florida market, with plans to expand to 200,000 Medicare Advantage lives across 25 counties by Q3 2026.
• Launch of a proprietary provider portal aimed at enhancing provider engagement and adherence to clinical pathways.
• Successful implementation of AI initiatives aimed at operational efficiencies, with expected savings of $2 million in 2026.
• Appointment of Minh Merchant as Chief Legal Officer to oversee legal and compliance matters as the company scales.

3. Forward Guidance and Outlook

• Reaffirmed full-year 2026 revenue guidance of $630 million to $650 million and adjusted EBITDA guidance of $0 to positive $9 million.
• Anticipated adjusted EBITDA for Q2 2026 to range from a loss of $1 million to positive $1 million, reflecting seasonal improvements.
• Continued focus on operational execution, scaling the delegated capitation model, and deepening payer partnerships.

4. Bad News, Challenges, or Points of Concern

• Operating Losses: Despite improvements, the company reported an adjusted EBITDA loss, which is typical for Q1 due to seasonal headwinds.
• Gross Margin Decline: Overall gross margin decreased to 15.8% from 16.5% YoY, attributed to a nonrecurring rebate from the previous year and a shift towards lower-margin delegated contracts.
• Fee-for-Service Revenue Decline: Fee-for-service revenue decreased by approximately 10% YoY, despite increasing visit volumes, indicating potential pricing pressures and conservative reserve management.

5. Notable Q&A Insights

• Delegated Risk Arrangements: TOI will achieve network adequacy across 25 counties in Florida by Q3, with medical loss ratios (MLR) performing slightly better than the target of 85%.
• Part D Risk: The company only bears risk on Part B, with Part D providing additional economic benefits through their specialty pharmacy.
• Provider Education: The attachment rates for pharmacy services have exceeded expectations, driven by improved workflows and provider education.
• AI Integration: While current forecasts do not include additional AI efficiencies beyond the $2 million for 2026, there is significant potential for future savings as AI capabilities expand.

This summary encapsulates TOI's strong start to 2026, marked by robust revenue growth and strategic advancements, while also addressing challenges related to profitability and margin pressures.