Analogy 1: DaVita for cancer treatment and clinical trials.

Analogy 2: A network of specialized cancer clinics, similar to a localized 'Mayo Clinic' or 'MD Anderson' focused on outpatient care and research.

• Medical Oncology Physician Services: Provides expert consultation, diagnosis, and personalized treatment planning by oncology specialists.
• Infusion & Dispensary Services: Offers in-house administration of chemotherapy, immunotherapy, and other treatments, alongside medication dispensing.
• Clinical Trial Services: Manages and facilitates patient participation in clinical trials to advance new cancer therapies.
• Outpatient Stem Cell Transplant & Transfusion Programs: Delivers specialized outpatient procedures, including stem cell transplants and transfusions, for cancer patients.
• Patient Support & Palliative Care: Provides comprehensive programs focused on enhancing patient quality of life, managing symptoms, and offering support throughout their cancer journey.

The Oncology Institute, Inc. (TOI) primarily provides medical oncology services directly to individuals (patients). Therefore, its major customers can be categorized as follows:

1. Patients: These are the individuals who receive medical oncology services, including physician services, in-house infusions, dispensaries, outpatient stem cell transplants, and patient support programs for their cancer treatment.
2. Health Insurance Providers (Payors): While patients are the direct recipients of services, a significant portion of TOI's revenue comes from various health insurance companies (commercial plans, Medicare, Medicaid) that cover the costs of these medical services on behalf of their insured members.
3. Pharmaceutical and Biotechnology Companies: The Oncology Institute offers and manages clinical trial services. In this capacity, pharmaceutical and biotechnology companies developing new cancer treatments or drugs are customers, as they contract with TOI to conduct and manage clinical trials.

Daniel Virnich, Chief Executive Officer

Daniel Virnich, M.D., MBA, FACHE, was appointed Chief Executive Officer and Executive Director of The Oncology Institute in June 2023. Prior to joining The Oncology Institute in 2020, Dr. Virnich served as the President of DaVita Medical Group, Florida, where he managed a full-risk medical group and Independent Physician Association (IPA) accountable for over 92,000 Medicare Advantage members. He also previously held the role of Senior Vice President of Operations for Healthcare Partners in Southern California.

Robert Carter, Chief Financial Officer

Robert Carter became the Chief Financial Officer of The Oncology Institute in October 2024, having joined the company in 2021 as Vice President of Finance and later promoted to Senior Vice President in 2023. Mr. Carter brings over a decade of finance leadership experience within the healthcare sector. Before his tenure at The Oncology Institute, he was the Head of Financial Planning & Analysis (FP&A) at Hoag Health System, a multi-specialty physician group practice and management services organization (MSO). His background also includes various financial leadership positions at Kaiser Permanente, SCAN Health Plan, and McKesson US Pharma, where he gained expertise in pharmaceutical finance, Medicare Advantage, Medi-Cal, and physician group practices.

Jeremy Castle, Chief Operations Officer

Jeremy Castle, MBA, was appointed Chief Operations Officer of The Oncology Institute in September 2023. He is responsible for enterprise field and central operations, pharmacy, real estate, and practice integration. Mr. Castle has over 15 years of experience in the oncology industry, including previous senior leadership positions as Chief Operating Officer for United Urology Group and Executive Director for The US Oncology Network.

Jeffrey Langsam, Chief Clinical Officer

Dr. Jeffrey Langsam assumed the role of Chief Clinical Officer at The Oncology Institute in May 2025. In this position, he oversees therapeutics, pathway and procurement decisions, utilization management, and clinical engagement within the MSO practice. Prior to joining TOI, Dr. Langsam served as the National Director of Oncology at Cigna Healthcare and a Senior Medical Director in the Specialty Pharmacy Division. He also held the role of Regional Medical Director at Aetna and was a practicing oncologist and clinical faculty at the University of Connecticut for many years.

Rakesh Panda, Chief Information Officer

Rakesh Panda was promoted to Chief Information Officer of The Oncology Institute in January 2026. He possesses more than 25 years of experience in IT, digital transformation, cybersecurity, and enterprise software development. His previous experience includes leadership roles at Cisco and Infosys. Mr. Panda continues to guide TOI's technology strategy, including AI-enablement efforts and enterprise-level data privacy and security practices.

Key Risks to The Oncology Institute (TOI)

1. Persistent Net Losses and Financial Instability: The Oncology Institute has a history of reporting net losses and negative cash flow from operations, with a significant level of debt. The company's financial strength is rated as poor due to high debt levels and a negative equity position. Management anticipates continued losses as the company invests in expansion, which could impact its long-term viability and ability to fund operations.
2. Regulatory and Reimbursement Risks: The company operates within a highly regulated healthcare sector and faces ongoing threats from changes in healthcare regulations and reimbursement policies. Specifically, changes or reductions in Medicare reimbursement rates or rules, as well as Pharmacy Benefit Manager (PBM) fees such as Direct and Indirect Remuneration (DIR) fees, could materially impact TOI's financial performance, revenues, and profitability.
3. Execution Risk of Growth Strategy and Transition to Value-Based Care: The Oncology Institute is pursuing a rapid growth strategy, including expanding its clinic network and transitioning further into value-based care models, which involves managing clinical trials, palliative care programs, and stem cell transplants. This expansion, which includes building or acquiring new clinics and integrating new capitated lives, presents significant execution risks. Expansion costs may be higher than anticipated, and the company's ability to achieve profitability from newly onboarded delegated contracts is a progressive and critical factor.

Addressable Markets for The Oncology Institute's Services (U.S. Region)

• Medical Oncology Services: The overall U.S. oncology market size was valued at approximately USD 72.79 billion in 2024 and is projected to reach around USD 211.78 billion by 2034, demonstrating an 11.75% Compound Annual Growth Rate (CAGR) from 2025 to 2034. Another estimate places the U.S. oncology market at USD 85.64 billion in 2024, expected to grow to USD 189.55 billion by 2033, with a CAGR of 9.23% from 2025 to 2033.
• In-House Infusion and Dispensary Services (Outpatient Oncology Infusion): The U.S. outpatient oncology infusion market was valued at over USD 21.97 billion in 2024 and is anticipated to reach approximately USD 62.80 billion by 2034, growing at a CAGR of 11.07% from 2025 to 2034. Another report estimates the outpatient oncology infusion market to expand from USD 70.9 billion in 2024 to USD 198.6 billion by 2034, with a CAGR of roughly 13.1%. The Oncology Institute's dispensary business is a significant revenue contributor, with Q3 2025 dispensary operations generating $75.9 million, representing 55.6% of the company's total quarterly revenue.
• Clinical Trial Services: The U.S. oncology clinical trials market size was calculated at USD 7.919 billion in 2024 and is projected to reach about USD 12.416 billion by 2034, expanding at a CAGR of 4.6% from 2024 to 2034.
• Outpatient Stem Cell Transplants and Transfusions Programs: The U.S. stem cells market size, which includes applications like transplantation, was estimated at USD 5.13 billion in 2024 and is projected to reach approximately USD 15.79 billion by 2034, with a CAGR of 11.9% from 2024 to 2034. Specifically, the hematopoietic stem cell transplantation market in North America is expected to reach USD 2.2 billion by 2032, with the U.S. accounting for a significant share.
• Palliative Care Programs: The U.S. palliative care market generated a revenue of USD 35.414.9 million in 2023 and is expected to reach USD 68.512.2 million by 2030, growing at a CAGR of 9.9% from 2024 to 2030.

1. Expansion of the Value-Based Capitated Care Model: TOI is significantly expanding its delegated capitation model and securing new partnerships with major health plans. In 2025, the company initiated 9 new capitated contracts in California, Florida, and Nevada, adding approximately 260,000 patient lives under management. The successful launch of its delegation model in Florida generated over $10 million in new capitated revenue in 2025, with an anticipated annualized run rate of about $50 million as of early 2026. For 2026, TOI projects over 80% growth in capitated revenue, expecting approximately $150 million from this segment. This shift towards risk-sharing agreements with payers like Elevance, Humana, and CarePlus is central to its growth strategy.
2. Continued Growth in Specialty Pharmacy Operations: The company's pharmacy segment, including its in-house dispensary, is a primary driver of revenue growth. In 2025, pharmacy revenue surged by 49.6% year-over-year to $269.2 million. This growth is attributed to improved attachment of prescriptions to provider visits and reduced leakage of prescriptions to outside specialty pharmacies. TOI's 2026 outlook includes sustained performance in line with the second half of 2025's revenue run rate, plus an additional 3%-5% incremental growth from new capitation lives. The company plans to enhance its pharmacy platform and expand its network portal in Q2 2026 to further improve drug procurement and utilization management.
3. Geographic Expansion and Increase in Clinical Sites: TOI is actively expanding its physical footprint and market presence. The company prioritized growth in Florida and Texas, adding 12 clinics across 2024–2025 to capture Medicare Advantage populations. By the end of 2025, TOI aimed for a 15% increase in its clinical sites and expanded into new states like Oregon. This strategic expansion helps increase patient access and capture a larger share of metropolitan capitated lives.
4. Increase in Patient Volumes and Services per Patient: Overall, TOI's revenue growth is driven by the continued expansion in both patient volumes and the delivery of more services per patient. This organic growth is supported by the company's integrated care model, which encompasses physician services, in-house infusion, clinical trials, and patient support.

Capital Allocation Decisions for The Oncology Institute (TOI)

Share Issuance

• The Oncology Institute became a public company in November 2021 through a business combination (SPAC merger), which included the issuance of up to 43,178,072 shares of common stock to former stockholders.
• In connection with its 2021 SPAC merger, the company issued up to 17,500,000 shares as part of a Private Investment in Public Equity (PIPE).
• In the second quarter of 2025, the company completed a private placement, raising approximately $16.5 million in gross proceeds.

Inbound Investments

• A significant inbound investment was the company's business combination in November 2021, which resulted in The Oncology Institute becoming a public entity.
• As part of the 2021 business combination, a Private Investment in Public Equity (PIPE) occurred, leading to the issuance of up to 17,500,000 shares of common stock.
• In the second quarter of 2025, the company secured a $16.5 million private placement from accredited investors, including existing investors, management team members, and Board Directors.

Outbound Investments

• In the fourth quarter of 2021, The Oncology Institute completed four practice acquisitions.
• The company continued to pursue practice acquisitions in 2023 and 2024 as part of its growth strategy, incurring associated consulting and legal fees.

Capital Expenditures

• Capital expenditures amounted to approximately -$3.90 million in the most recent 12-month period available in late 2025. [cite: 6 from previous search]
• Free Cash Flow, defined as net cash flow from operations less capital expenditures, was $(4.0) million in the first quarter of 2025, showing an improvement from $(15.4) million in the first quarter of 2024.
• The company aims to achieve positive free cash flow by year-end 2026.