1. DaVita for cancer care.

2. Fresenius Medical Care for cancer treatment.

• Medical Oncology Services
  • Physician Services: Direct medical consultations, diagnosis, and treatment planning provided by oncology specialists.
  • In-House Infusion and Dispensary: On-site administration of chemotherapy and other intravenous therapies, along with dispensing of prescribed oncology medications.
  • Outpatient Stem Cell Transplants and Transfusions Programs: Specialized services for performing stem cell transplants and blood transfusions in an outpatient setting.
  • Palliative Care Programs: Care focused on providing relief from the symptoms and stress of a serious illness for patients and their families.
• Clinical Research Services
  • Clinical Trial Services: Management and execution of clinical trials for researching and developing new cancer treatments.
• Patient Support Services
  • Patient Support: Comprehensive assistance and resources provided to patients throughout their cancer treatment journey.

Starling Oncology (symbol: TOI), which operates as The Oncology Institute, Inc., primarily sells its medical oncology services directly to individuals (patients) in the United States. Based on its service offerings, its major customer categories include:

• Cancer Patients Seeking Comprehensive Medical Oncology Care: This category includes individuals who require physician consultations, in-house infusion therapies, dispensary services for medications, and general patient support throughout their cancer treatment journey.
• Cancer Patients Participating in Clinical Trials: The company offers and manages clinical trial services, catering to patients who are eligible and choose to enroll in investigational treatments.
• Cancer Patients Requiring Specialized Treatments and Support: This includes individuals needing advanced services such as outpatient stem cell transplants, transfusions programs, and palliative care for symptom management and quality of life improvement.

Daniel Virnich, M.D., MBA, FACHE, Chief Executive Officer

Dr. Daniel Virnich joined The Oncology Institute in 2020 and became CEO in 2023. Prior to his role at TOI, Dr. Virnich served as President of DaVita Medical Group, Florida, where he managed a full-risk medical group and IPA with over 1,400 teammates and clinicians accountable for more than 92,000 Medicare Advantage members. He was also Senior Vice President of Operations for Healthcare Partners in Southern California and Chief Medical Officer for Team Health's Acute Care services division.

Rob Carter, Chief Financial Officer

Rob Carter was promoted to Chief Financial Officer of The Oncology Institute, effective October 14, 2024. He joined TOI in 2021 as Vice President of Finance and was promoted to Senior Vice President in 2023, overseeing corporate finance, financial planning and analysis (FP&A), treasury, and investor relations. Mr. Carter brings over a decade of finance leadership experience in the healthcare sector. His previous roles include Head of FP&A at Hoag Health System and various financial leadership positions at Kaiser Permanente, SCAN Health Plan, and McKesson.

Jeffrey Langsam, Chief Clinical Officer

Jordan McInerney, Chief Development Officer

Kristin England, Chief Administrative Officer

The Oncology Institute, Inc. (symbol: TOI) faces several key risks to its business operations and financial stability:

1. Financial Health and Liquidity: The company's financial position is a dominant concern, characterized by less than a year of cash runway based on its current free cash flow trend and negative equity. The Oncology Institute is deeply unprofitable and consistently burning through significant cash, leading to strained liquidity where current liabilities exceed current assets. This precarious financial state necessitates raising capital or incurring further debt, which could dilute existing shareholders or heighten balance sheet risks.
2. Cybersecurity Incidents and Data Breaches: The Oncology Institute has recently disclosed a cybersecurity incident involving a third-party software service provider, which resulted in unauthorized access to certain information systems, including those containing patient data. Such breaches pose substantial legal, reputational, and financial risks, potentially leading to regulatory inquiries, litigation, and significant remediation costs. These incidents can also severely impact the company's relationships with patients, employees, and governmental regulators.
3. Regulatory and Reimbursement Pressures: The company operates within a highly regulated healthcare environment, making it vulnerable to changes in healthcare policy and regulatory frameworks. Specifically, the business is exposed to drug pricing pressures and shifts in reimbursement rules, particularly concerning Medicare reimbursement for oncology services. The Specialty Pharmacy segment, a major revenue contributor, faces ongoing reimbursement challenges, including the lagged reflection of annual drug pricing increases in reimbursement rates.

The addressable markets for Starling Oncology (formerly The Oncology Institute, Inc.) are primarily within the expansive U.S. oncology sector and the global oncology clinical trials market.

For its core offerings of medical oncology services, in-house infusion and dispensary, outpatient stem cell transplants and transfusions programs, and patient support, Starling Oncology operates within the broader **U.S. Oncology Market**. This market demonstrates significant size and growth:

• The U.S. oncology market was valued at approximately USD 72.79 billion in 2024 and is projected to reach around USD 211.78 billion by 2034, expanding at a compound annual growth rate (CAGR) of 11.75% between 2025 and 2034.
• Another estimate places the U.S. oncology market at USD 85.64 billion in 2024, expected to grow to USD 93.54 billion in 2025, and reach USD 189.55 billion by 2033, with a CAGR of 9.23% from 2025 to 2033.
• Further data indicates the U.S. oncology market was valued at USD 145.52 billion in 2024 and is projected to reach approximately USD 416.93 billion by 2034, growing at a CAGR of 11.1% over the period 2025 to 2034.

For its clinical trial services, Starling Oncology addresses a segment of the **Global Oncology Clinical Trials Market**:

• The global oncology clinical trial market was valued at US$ 13.64 billion in 2024, is anticipated to grow to US$ 14.36 billion in 2025, and is projected to reach nearly US$ 22.85 billion by 2034, exhibiting a CAGR of 5.30% throughout the forecast period.

Starling Oncology (NASDAQ: TOI), known as The Oncology Institute, Inc., is expected to drive future revenue growth over the next 2-3 years through several key initiatives:

1. Expansion of Value-Based Care Contracts: The Oncology Institute is a pioneer in value-based community oncology care, with an ongoing commitment to expanding these contracts across markets. This approach prioritizes patient outcomes and cost efficiency, aligning with evolving healthcare reimbursement trends. The company has seen success with its value-based contracts, notably achieving profitability ahead of plan in Florida and preparing to cover approximately 200,000 Medicare Advantage members across 25 counties. This continued expansion of delegated contracts, especially in regions like Florida, is a significant driver of top-line growth.

2. Growth in Specialty Pharmacy Services: The company's Specialty Pharmacy segment has demonstrated substantial growth and is a key contributor to revenue. In Q1 2026, Specialty Pharmacy revenue surged by 77.6% year-over-year, fueled by a 103% increase in prescription fills. Analysts have also highlighted the company's strong pharmacy revenue growth. The Oncology Institute anticipates that dispensary revenue could eventually comprise approximately 50% of its total revenue, indicating a strategic focus on this segment.

3. Expansion of Clinical Trial Services and Research Partnerships: The Oncology Institute is actively expanding its clinical trial offerings through strategic partnerships, such as the enterprise-wide collaboration with Helios Clinical Research. This initiative aims to enhance patient access to cutting-edge cancer trials and integrate clinical research into community oncology settings. The company's clinical research division, TOI Clinical Research, manages over 160 clinical trials and is committed to expanding access at more sites, improving health equity by offering these treatments in diverse communities. This expansion provides patients with more treatment options and contributes to the company's revenue streams.

4. Geographic Expansion and New Clinic Openings: The Oncology Institute continues to grow its physical footprint and patient reach. Operating over 100 clinics and affiliate locations across five states (California, Nevada, Arizona, Oregon, and Florida), the company emphasizes providing convenient access and expert care in community settings. This ongoing organic growth, driven by an aging population and the shift from hospital to community-based care, is a fundamental component of its revenue growth strategy.

5. Strategic Partnerships and MSO Platform Development: The appointment of a Chief Development Officer to spearhead growth initiatives, including cultivating new partnerships with payors and establishing Management Services Organization (MSO) platforms, signals another avenue for revenue growth. This strategy involves MSO partnerships with independent practices to deliver value-based oncology care nationwide, further expanding the company's network and patient base.

Share Repurchases

• The company's Board approved a share repurchase program on August 28, 2023, authorizing the purchase of up to 2 million shares of common stock.
• Under a previous repurchase program, The Oncology Institute repurchased 1,593,128 shares of its common stock for approximately $894,000.
• The company reported no spending on share buybacks in Q4 2024.

Share Issuance

• In November 2021, The Oncology Institute, Inc. became a publicly traded company through a business combination, which was accounted for as a reverse recapitalization where Old TOI effectively issued stock for the net assets of DFP.
• Following the November 2021 business combination, up to 12,500,000 additional "Earnout Shares" were to be issued if certain stock price performance targets were met within two or three years.

Inbound Investments

• In July 2026, The Oncology Institute completed a strategic refinancing with OrbiMed, which involved repaying the outstanding $86 million Deerfield Convertible Note, thereby strengthening its balance sheet and improving liquidity.

Outbound Investments

• The company acquired certain non-clinical assets of Covina Cancer Care Medical Center Inc. d/b/a Southland Radiation Oncology Network for $4.3 million in cash.
• The Oncology Institute also acquired assets from Dr. Perkins for $8.92 million in cash, along with a contingent consideration of $2 million.

Capital Expenditures

• The Oncology Institute invested $1.0 million in capital expenditures during the first quarter of 2026.
• For the fiscal year 2025, the company's capital spending totaled $3.2 million.
• Capital expenditures are primarily focused on funding long-term assets and infrastructure to support its oncology care operations and clinic expansion.