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Here are 1-2 brief analogies for The Oncology Institute (TOI):

• DaVita for cancer treatment clinics: Just as DaVita operates a large network of outpatient dialysis centers, TOI operates a growing network of outpatient cancer treatment clinics.
• Oak Street Health for cancer care: Similar to how Oak Street Health focused on value-based care models for seniors in primary care, TOI aims to provide comprehensive, value-based oncology services in an outpatient setting.

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• Medical Oncology and Hematology Services: Provides comprehensive cancer care, including chemotherapy, immunotherapy, targeted therapy, and management of blood disorders.
• Radiation Oncology: Offers advanced radiation therapy treatments to destroy cancer cells and shrink tumors.
• Diagnostic and Imaging Services: Includes various diagnostic tests and imaging crucial for cancer detection, staging, and monitoring.
• Supportive Care Services: Focuses on patient well-being beyond treatment, encompassing pain management, nutrition counseling, and social support.
• Clinical Research and Trials: Offers patients access to cutting-edge treatments through participation in clinical studies and drug trials.

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The Oncology Institute (symbol: TOI) primarily sells its services directly to individuals, i.e., patients. Therefore, it does not have major corporate customers in the traditional sense.

The up to three categories of customers (patients) that it serves include:

• Patients with various cancer diagnoses: This includes individuals seeking comprehensive cancer care services, such as medical oncology, radiation oncology, surgical oncology support, and advanced diagnostics, for different types and stages of cancer.
• Patients seeking hematological care: In addition to solid tumor oncology, TOI also provides care for patients with blood disorders, including blood cancers (e.g., leukemia, lymphoma, myeloma) and benign hematological conditions.
• Patients requiring supportive care, palliative care, and survivorship programs: These individuals may be undergoing active treatment, in remission, or facing advanced disease, and require services focused on managing symptoms, improving quality of life, and long-term wellness after cancer treatment.

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Key Risks to The Oncology Institute (TOI)

1. Financial Stability and Path to Profitability: The most significant risk for The Oncology Institute is its precarious financial stability and the ongoing challenge to achieve sustained profitability. The company has been rated as having poor financial strength due to high debt levels, with an Altman Z-Score of 0.7 as of November 2025, indicating a "danger zone for potential financial distress within the next two years." Additionally, a concerning debt-to-equity ratio of -11.48 highlights a substantial level of balance sheet leverage. The Oncology Institute continues to report ongoing operating losses (negative EBITDA) and is not yet profitable on a GAAP basis. The company also faces negative equity risk and has a high dependency on external funding, with a significant cash burn rate, making future debt or equity raises likely to sustain operations. Recent financial reports show missed earnings per share and revenue forecasts, further underscoring the financial challenges.
2. Competitive Landscape and Payer Contract Risk: The Oncology Institute operates in an intense and highly competitive environment. It competes with large hospital systems and other community oncology groups, making its ability to secure and maintain favorable payer contracts paramount. There is a continuous risk of potential reimbursement cuts from Medicare and private insurance providers, which could directly impact revenue. The company has already experienced significant declines in revenue contribution from key payers and negative impacts on gross margins due to contract losses in 2024, including the loss of a large contract in July 2024.
3. Regulatory and Compliance Environment: The highly regulated healthcare sector presents a constant threat to The Oncology Institute's operations. The core risks include navigating complex and evolving healthcare regulations and compliance, such as HIPAA, Medicare compliance audits, and electronic health record mandates, all of which incur significant costs. Any adverse outcomes from judicial or administrative proceedings could disrupt operations, result in penalties, and generate negative publicity. Furthermore, changes in the regulatory landscape, such as the elimination of Direct and Indirect Remuneration (DIR) fees, have already negatively impacted dispensary margins.

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The emergence and growth of decentralized, home-based oncology care models, enabled by advancements in technology and logistics. These models offer convenient and potentially lower-cost alternatives to traditional clinic-centric care for a range of oncology services, including infusions, supportive care, and remote monitoring, thereby threatening to divert patient volume and revenue from established clinic networks like TOI.

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The Oncology Institute (TOI) provides comprehensive cancer care services, including medical oncology, radiation oncology, hematology services, in-house dispensaries, lab testing, outpatient blood transfusions, financial and end-of-life counseling, and comprehensive clinical trials. These services are delivered through a network of clinics primarily across California, Arizona, Nevada, and New Mexico. The company operates under a value-based care model, aiming to provide patient-centered care and cost-effective treatment alternatives.

The addressable markets for TOI's main products and services, primarily comprehensive cancer care, are substantial and projected to grow significantly in both the United States and globally.

• U.S. Oncology Market: The U.S. oncology market size was valued at approximately USD 85.64 billion in 2024 and is projected to reach around USD 189.55 billion by 2033, growing at a compound annual growth rate (CAGR) of 9.23% from 2025 to 2033. Other estimates place the U.S. market at about USD 72.74 billion in 2024, expanding to roughly USD 220.21 billion by 2034 with an 11.71% CAGR. Another report indicates a U.S. oncology market size of USD 145.52 billion in 2024, expected to reach approximately USD 416.93 billion by 2034.
• Global Oncology Market: The global oncology market size was estimated at USD 225.05 billion in 2024, growing to USD 251.01 billion in 2025, and is projected to reach around USD 600.97 billion by 2034, expanding at a CAGR of 11.54% between 2025 and 2034. Another perspective values the global oncology market at USD 321.19 billion in 2024, anticipated to reach about USD 903.81 billion by 2034, with a CAGR of 10.9%. Global spending on cancer medicine alone increased to USD 223 billion in 2023 and is projected to reach USD 409 billion by 2028.

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1. Expansion of Value-Based Care and Capitated Contracts: The Oncology Institute is strategically focused on expanding its value-based care model, evidenced by the addition of new capitation contracts. These contracts, which provide predictable revenue streams and align with outcome-driven healthcare, are expected to significantly contribute to future revenue, with new capitated contracts anticipated to add substantial incremental revenue annually.
2. Growth in the Pharmacy and Dispensary Segment: The company's pharmacy and dispensary business has consistently demonstrated strong performance, with notable year-over-year revenue growth. This segment, particularly driven by its California-based pharmacy and the attachment of prescriptions to patient visits, is identified as a primary driver for overall revenue expansion.
3. Geographic Expansion and Clinic Network Growth: TOI is actively pursuing growth through strategic geographic expansion, including entering new markets like Florida and Oregon, and expanding its existing network across states such as California, Nevada, and Arizona. This broader footprint and increased clinic count aim to enhance patient access and serve a growing population.
4. Launch and Expansion of New Clinical Services: The introduction and expansion of new services, such as radiopharmaceutical therapy in California, are expected to be important growth drivers. These new offerings contribute to the company's service portfolio and revenue generation.

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Share Issuance

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

Inbound Investments

• The company's significant inbound investment was its business combination in November 2021, which took the company public.
• This transaction included a PIPE investment that resulted in the issuance of up to 17,500,000 shares of common stock.

Outbound Investments

• In the fourth quarter of 2021, The Oncology Institute completed four practice acquisitions, which contributed approximately $1 million in revenue.

Capital Expenditures

• In 2021, capital expenditures totaled $3 million, primarily directed towards relocating, expanding, or refreshing clinics.
• Over the most recent 12-month period, capital expenditures amounted to -$2.89 million.
• Projected capital expenditures are $6 million for 2025, increasing to $13 million by 2029, consistently representing 1% of revenue.