TOIIW — The Oncology Institute, Inc.

Summary of The Oncology Institute's Q1 2026 Earnings Call

1. Key Financial Results and Metrics

• Total Revenue: $147.4 million, up 41.2% year-over-year (from $104.4 million).
• Patient Services Revenue: $59.1 million, representing 40.1% of total revenue, an 11.3% increase year-over-year.
  • Capitated Revenue: Grew 54% year-over-year to $26.9 million.
  • Fee-for-Service Revenue: Decreased approximately 10% year-over-year to $32.2 million.
• Specialty Pharmacy Revenue: $87.5 million, up 77.6% year-over-year, driven by a 103% increase in prescription fills.
• Gross Profit: $23.3 million, with a gross margin of 15.8%, slightly down from 16.5% year-over-year.
• Adjusted EBITDA: Loss of $2.4 million, an improvement from a loss of $5.1 million in Q1 2025.
• Cash Position: $30.3 million in cash and cash equivalents, down from $33.6 million at year-end 2025.
• Operating Cash Flow: Negative $2.3 million, improved from negative $5 million in Q1 2025.

2. Strategic Updates and Business Highlights

• Expansion in Florida: Achieved profitability in Florida, with plans to cover 25 counties and approximately 200,000 Medicare Advantage lives by Q3 2026.
• Pharmacy Growth: Record performance in Specialty Pharmacy, with significant operational improvements and a focus on reducing leakage to outside pharmacies.
• AI Initiatives: Continued progress on AI integration for operational efficiencies, targeting $2 million in operating expense savings for 2026.
• Provider Portal Launch: Set to launch in Q3 2026, aimed at enhancing provider engagement and adherence to clinical pathways.

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: Reiterated at $630 million to $650 million.
• Gross Profit Guidance: Expected between $97 million to $107 million.
• Adjusted EBITDA Guidance: Forecasted to range from $0 to positive $9 million.
• Free Cash Flow Guidance: Updated to a positive range of $5 million to $15 million, improved from previous estimates of a loss to positive $5 million.
• Q2 2026 Adjusted EBITDA: Anticipated to be between a loss of $1 million to positive $1 million.

4. Bad News, Challenges, or Points of Concern

• Fee-for-Service Decline: Fee-for-service revenue decreased by approximately 10%, indicating potential pricing pressures and operational challenges in that segment.
• Operating Losses: Despite improvements, the company still reported an adjusted EBITDA loss, highlighting ongoing financial pressures during the seasonally challenging first quarter.
• Cash Decrease: A reduction in cash reserves from the previous quarter raises concerns about liquidity as the company scales.

5. Notable Q&A Insights

• Delegated Risk Arrangements: The company confirmed it will cover the entire Florida market by Q3, with a medical loss ratio (MLR) performing slightly better than the targeted 85%.
• Competitive Positioning: The CEO noted differences in care delivery models as a potential reason for TOI's better MLR performance compared to competitors like Evolent Health.
• Specialty Pharmacy Capabilities: The company clarified that its Specialty Pharmacy focuses exclusively on oncology medications, which may limit broader market opportunities.
• Future AI Use Cases: There are expectations for further AI integration beyond current initiatives, particularly in care navigation, which could enhance operational efficiencies.

This summary encapsulates the key points from The Oncology Institute's Q1 2026 earnings call, highlighting both the positive momentum and challenges faced by the company.