Oncology Institute at Noble Capital: Strategic Growth and Profitability Goals

On Wednesday, 08 October 2025, The Oncology Institute (NASDAQ:TOI) presented at the Noble Capital Markets Emerging Growth Virtual Investor Conference. The company outlined its strategic focus on providing affordable oncology care to underserved populations, while addressing past financial challenges and setting a path toward profitability. Despite previous negative EBITDA due to expansion efforts, TOI is targeting a break-even adjusted EBITDA by the end of the year.

Key Takeaways

• TOI is focusing on value-based oncology care, operating in five states with 80 locations.
• The company aims for adjusted EBITDA break-even in Q4, driven by new partnerships and increased productivity.
• Revenue has grown at a compound annual growth rate of 41% over the past 18 years.
• TOI has reduced SG&A expenses by $11 million to improve profitability.
• The company plans to expand into new markets with a focus on near-term profitability.

Financial Results

• Revenue CAGR of 41% over 18 years highlights TOI’s growth trajectory.
• New capitated contracts are expected to add $36 million in incremental revenue, with annualization potentially reaching $50 million.
• The dispensary segment has grown 70% year-over-year, benefiting from a new pharmacy in California.
• SG&A expenses have been cut by $11 million, aiding the path to profitability.
• Capitated contracts, comprising 17% of revenue, are the largest contributor to gross profit.
• The Part D margin stands at 18%, with the medical loss ratio improving significantly.

Operational Updates

• TOI operates across California, Florida, Nevada, and Arizona, focusing on new markets with rising Medicare Advantage penetration.
• The company has restructured operations, removing $11 million in SG&A costs.
• Clinical trials are offered to diverse communities, including non-English speakers.
• Cost reductions are achieved through outpatient blood transfusions and adherence to NCCN guidelines.

Future Outlook

• TOI plans to expand into new markets, leveraging payer outreach in regions where it currently has no presence.
• The focus remains on filling market capacity to drive profitability.
• Future market expansions will be considered if they offer near-term profitability potential.

Q&A Highlights

• TOI’s model reduces out-of-pocket expenses for patients on Part B and D medications.
• The company has demonstrated cost savings in five states, benefiting payers and physicians.
• Growth opportunities are concentrated in existing markets, particularly Florida and Nevada, due to high utilization rates.
• New market entries will be evaluated based on size and profitability projections.

For a detailed discussion, please refer to the full transcript below.

Full transcript - Noble Capital Markets Emerging Growth Virtual Investor Conference:

Dan, CEO, The Oncology Institute: I’m the CEO here at The Oncology Institute. I’ve been with the organization about six years, three years as CEO. I’m a physician by background. I’ve spent the last 14 years in value-based care. Really excited to tell you our story today. Before we get started, I’d also like to introduce our CFO, Rob. Would you like to introduce yourself?

Rob Carter, CFO, The Oncology Institute: Yeah, happy to. Good morning, everyone. Pleasure to be here with you. I’m Rob Carter, CFO here at The Oncology Institute. I’ve been at the org about four years now, about a full year as CFO. My career has been spent either in managed care or in pharma finance. TOI is a great place for my background and skill set. Looking forward to walking through the company with you. Back to you, Dan.

Dan, CEO, The Oncology Institute: Great. I will start the presentation today with a high-level overview of The Oncology Institute, who we are, what we do, and why it’s so valuable to healthcare in general right now. We’ll spend a little bit more time talking through our financials and open it up to Q&A. If we go to the next slide, please, Rob. Great. Just to set the backdrop, oncology care is a significant portion of spend for the U.S. healthcare system. It’s an industry that spends over $200 billion a year. The really unfortunate thing is that it’s been growing at a kind of an unsustainable cost trend for the last 16 plus years. The major driver of that unsustainable growth trend is oncology drug costs.

Those rise typically high single to low double digits each year in terms of the market basket cost increase, which is a huge problem for both patients who bear out-of-pocket costs that oftentimes they can’t pay, which delays care or doesn’t allow them to get appropriate care, and for payers, meaning health plans, who have an unsustainable trend in specialty costs related to oncology. What does that mean? It means that there’s a huge need in the U.S. for an entity that can provide clinically excellent care in the community to underserved populations and bend the cost curve to provide better access for patients and more affordability for payers. If we go to the next slide, please, Rob. Who is The Oncology Institute? We’ve been a public company now for almost four years, but we’ve been in business for the last 18 years.

We are the largest value-based oncology care provider in the country. When I say care provider, we are both an employed physician group. We employ physicians in medical and radiation oncology sites of care across 80 locations in five states. We have engaged MSO or contracted independent community medical and radiation oncologists that also help deliver care underneath our capitated contracts. We are the largest in the country as measured by patients that we take risk on for Part B, as in boy, that’s the oncology-related spend on physician services and Part B or infusible medications. We’ve got over 2 million patients at a population level that we take risk on Part B for. That’s across product types: Medicare Advantage, commercial HMO, and managed Medicaid. Really, our mission is pretty simple.

It’s to bring cutting-edge care into the community to underserved populations, shift out of high-cost centers of care, and really elevate the level of community-based oncology care. The great news in terms of doing that while also reducing spend is that there’s a tremendous amount of overutilization in oncology related to using medications off-label, off-pathway, overuse of supportive medications, all of which drives up spend. Just by doing 100% NCCN compliant appropriate care and delivering it in a lower cost setting, you can dramatically bend the cost curve. We’ve been showing that we can do that for the last 18 years in published results. As you can see, we partner with most of the major health plans and large-scale risk-bearing medical groups in the country. This is not an exhaustive list on the bottom of the slide, but we’ve been partnering with them for the last 18 years.

Many of our contracts go back over 15 years, and we’ve got very low turnover in our partnerships, which I think is a testament to the quality of care we provide and the savings that we can generate. Go to the next slide, please. It’s important to understand how The Oncology Institute is unique in this space and really how differentiated we are in terms of our competitive advantage. If you look at the sort of landscape of lookalikes in oncology that provide value-based services, you’ve got what we call benefits managers. The public company example of that would be Evolent Health, which has New Century Health. There are also some private companies like OncoHealth and OPN. What they do, they do not employ physicians. They take capitated risk like us, and they provide utilization management services over a network that’s 100% independent community-based practices and academic centers.

There is value in those services, but at the end of the day, they’re providing utilization management to practices, which oftentimes have misaligned financial incentives to the recommendations that they’re making. There’s kind of limited cost savings and cost curve bending that can occur in that type of setting. You’ve got some of the newer, larger total cost of care care navigation models like a TimeCare. We’ve seen similar platforms in the kidney care space for many years with Monogram and Panoramic. They’re more frictionless. They do a lot more care navigation. At least what we’ve seen in the kidney care space is that there are some savings generated there, but it’s relatively modest. We’re differentiated in the sense that we have employed assets in all of the markets where we provide care.

That’s our employed clinicians and clinics, both medical and radiation oncology, as well as WRAP, MSO, independent providers. What that means is that we’ve got a much higher degree of control over care delivery, meaning higher compliance to value-based prescribing, better ability to deliver ancillary services like clinical trials and transfusions in our employed centers, all while also having engaged independence, which is desirable from a health plan perspective. We’re able to contract at more competitive rates, and we generate a more predictable cost savings in terms of the MLR that we’re able to generate and track on our risk-bearing contracts. This slide pretty much covers what I just mentioned. We’re solidly unique in this space in terms of our differentiated ability to provide cost savings for payers and patients. On the left side are, again, Evolent, that’s New Century Health. That’s kind of the public comparable.

You also have OPN and TimeCare. On the right side, that’s really the other set of assets that exist in oncology. This is sort of the problem against which TOI fights, if you will. These are the fee-for-service aggregators. Think OneOncology, AON, US Oncology. They really aggregate density in a market through contractual interests with independent groups. They drive up rates in utilization and drive up drug spend. They’re generating the high benchmark spend and overutilization against which we’re able to cavitate. We really provide a full suite of services and are differentiated in our ability to deliver high-level care in the community to underserved populations. If you look at your average community-based oncology practice outside of the academic or tertiary setting, typically they’re relatively limited in terms of the services that they can provide. We are full spectrum in the sense that we bring clinical trials to the community.

That’s actually very important in the sense that we have a large percentage of our patients that are non-English speaking or from demographics that are economically underserved. Data shows that those populations typically have difficulty with access to clinical trials. That makes us very attractive to clinical trial sponsors because we do have access to those populations. It’s important for those populations in that they can actually get enrolled in clinical trials that they might not typically have access to. We provide outpatient blood transfusions at scale. That keeps patients out of the emergency room, out of the hospital. Again, another tool to bend the cost curve. We provide 100% NCCN compliant. That’s the gold standard in oncology, prescribing through our proprietary utilization management pathways, which are overseen by our clinical leaders and developed and updated kind of real-time as new drugs are approved for use.

We provide highly coordinated care in terms of partnering with hospice and palliative care providers that our health plans and medical group partners are aligned with, having appropriate advanced care planning discussions. We’re also an NCQA certified patient safety organization and track a number of KPIs at scale related to outcomes, patient experience, and quality of care. We’ve studied and published on our model multiple times. We actually presented this last year at ASCO. ASCO is the largest clinical oncology conference in the world. It occurs each year in June in Chicago. We presented again on outcomes of our model versus standard of care as it relates to clinical outcomes, patient satisfaction, utilization, and cost savings. We have shown again that we are differentially better at bending the cost curve and driving overall cost savings and reduction in spend while delivering higher patient satisfaction.

This just goes over our current scale. This is important for a couple of reasons. One, in terms of understanding our P&L, which Rob will go into in more detail. TOI currently exists in five states. As I mentioned, we’ve been around for 18 years. 15 out of those 18 years were exclusively in California until we went public. We made a base bet on new market expansion where we saw areas of heavy Medicare Advantage penetration and opportunity to capitate. That means expansion in Florida, Nevada, Arizona, and adding additional sites of care in California. In 2021 through 2022, that led to a lot of CapEx, a lot of spend, which dipped us for the first time to negative EBITDA territory.

When I became CEO two and a half years ago, we restructured our company, took about $11 million of SG&A out of the business, figured out product market fit outside of California. As we’ve talked about in our prior several earnings calls, we’ve had record success in terms of signing new capitated partnerships in our expansion markets. We already have the cost structure set up in those markets to deliver care, and we have capacity, meaning as we add new value-based partnerships, it’s highly accretive to our P&L. That’s why we’ve projected flipping to adjusted EBITDA, break even, and profitability in Q4. What this slide also shows is there’s a huge percentage of the map where TOI does not deliver care. There’s tremendous runway to continue to grow this company to a multi-billion dollar platform in upcoming years.

We get constant outreach from payers in markets across the country where we don’t exist to expand our model. While we’ve been laser focused on filling capacity in our existing five markets as we generate profitability as a public company, there’s many, many years of growth ahead of us in terms of white space for the company. Let’s go to the next slide, please. With that, I’m going to pivot over to Rob for just a high-level overview of our financials, and then we can open it up to Q&A. Rob?

Rob Carter, CFO, The Oncology Institute: Thanks, Dan. This is a view of the history. TOI is not new. We started as a physician-founded company back in 2007. You can see that the top line has grown quite nicely over the past 18 years, now at a 41% revenue CAGR. As Dan mentioned, we made a large bet in Florida. We added GNA to the business by going public, and what was a profitable business became unprofitable. A lot of the story this year is how TOI is going from an unprofitable place to profitable, and as Dan mentioned, guiding towards an adjusted EBITDA break even in Q4 of this year. There are three main drivers of that path to profitability. I’m going to walk you through these right now. These have to do with our segments and the way in which we disclose our financials, which we’ll get to on another slide.

These are the three main drivers. The first is our value-based contracts. This is our capitated segment. As you can see, we have a robust pipeline. The contracts mentioned here went live in the second half of 2024 and then have launched in the first half of 2025. You can see $36 million in incremental revenue from these deals, annualized almost $50 million. The difference between those two numbers is simply when the contracts launch, and there’s a ramp associated with these contracts, which we can get into a little bit later. Tremendous momentum with our value-based contracts. The second piece is our growth in the dispensary segment. This is Part D oral drugs. TOI has historically dispensed Part D drugs through dispensaries or medically integrated dispensaries. We launched a pharmacy in California in late 2023. That led to 70% year-over-year growth, and the pace hasn’t slowed.

We continue to see rapid expansion in our attachment of Part D drugs. Finally is our clinical productivity. Dan mentioned before that because we have established clinics and we have providers in our growing markets like Florida, as we add new contracts and as volume increases in those clinics, there’s no additional overhead. The impact on the P&L is quite significant. You can see both the clinical payroll as an absolute dollar has gone down, but the payroll per visit has gone down dramatically. This sits above the line, and it’s a huge lever for us in terms of our overall gross margin. These three things are what’s taking the business. You know, we lost almost $36 million last year to guiding towards, again, adjusted EBITDA break even in Q4. Let me go a little bit into detail on the segments.

We break it out into patient services, dispensary, and then other. Patient services for us include medical and radiation oncology, or Part B. There are two main segments here, fee-for-service and CAP. Fee-for-service, as the name implies, this segment is growing with the organic oncology market, so around 10% per year. It’s growing quicker than that in newer markets, for sure. In terms of how we see growth in the future, it’s around that 10% mark. The margin contribution is relatively low. This is reimbursed at a cost plus. The exact number is ASP plus six. The margin is around 6% on those drugs. Our CAP business, as mentioned, is where the significant growth is coming. Although only 17% of revenue mix, it’s the highest contributor to gross profit. The pipeline is incredibly robust, and the margin contribution is quite high. Drug dispensing, as I mentioned, this is Part D.

This is now 52% of the revenue mix. It continues to grow rapidly. It will continue to grow rapidly as we grow both CAP contracts as well as fee-for-service. The attachment, as I mentioned before, follows that growth. Margin on Part D is around 18% at this point, so a nice contributor to overall margin. Clinical trials and other for us combined is about 2% of revenue. Clinical trials is fantastic from the perspective of giving patients the option. It also takes a patient off of a capitated drug, right? The cost for that drug isn’t being incurred by TOI as we’re at risk for it. Our other revenue segment includes management fees and data monetization, as well as quality programs. There’s no COGS associated with this segment, so directly to the bottom line. That is the segment view.

This is a super important slide as it relates to how TOI is growing. Capitated contracts are paid via a PMPM, per member per month, which is a sort of a fixed fee for us taking risk on and taking care of oncology patients. That PMPM, if you look at the first quarter of 2024, averaged $3 at TOI for the contracts that launched in that period. That’s a very California-based PMPM. California is a heavily managed market. It’s been doing value-based care for decades. The cost of care is much lower in those markets. As we move to Florida and other markets that are new to value-based care, the benchmark spend or the benchmark cost to treat patients is much higher. That equates to a higher PMPM for us. As you can see in more recent quarters, the PMPM on deals we’re doing is significantly higher.

This is an important lever for us because we don’t need a quarter million lives at $6 PMPM to have the same impact as a much lower lives count at a much higher PMPM. Finally, a super important slide here. This is our actual ability to lower the cost trend. This is measured as MLR, medical loss ratio. You can see this is a number of six new contracts actually that launched. This is the real experience over the first year, starting above 70% and then after a year in our system, around 50%. That’s the real savings that’s being driven by our pathways, by our protocols. That’s the savings that really drives the growth with providers going forward.

Dan, CEO, The Oncology Institute: OK. Great. Just to kind of wrap it up, again, major points of the presentation today are, one, you should be aware that oncology care is a significant portion of every U.S. healthcare spend. There is, like any specialty in medicine, a misalignment of incentives. Unfortunately, in oncology, that’s a misalignment that’s driving 90% of the spend, which is around drugs and creating an unsustainable trajectory for patients and payers. Two, there are solutions. There have been solutions to this for the last 10 years, although they’ve been relatively limited in terms of their efficacy. The Oncology Institute is differentiated in terms of its ability to deliver savings to both patients and payers and has a track record of showing that we can do this across markets.

We are really the best model available right now, again, for both patients and payers in terms of delivering high-quality care at lower cost. We’ve got a proprietary platform that allows us to do so at scale, and we’ve shown we can do it now in five states and growing. That positions us well as we transition to profitability as a public company in the upcoming quarters to continue to grow successfully, continue to drive margin and scale across the country. Happy to open it up now to Q&A, Robert.

Great. Thank you very much. That was a great overview and lots of financial information. In the presentation, you talked about some of the benefits for the insurance company clients and third-party payers, as well as the services you’re providing to the practices. There was just a brief mention of the benefits for the patient. Could you just expand a little bit on patient satisfaction and outcomes?

Yeah, absolutely. Broadly speaking, if you look at the data for oncology care across the U.S., and this is published on cancer.gov and a number of other sources, there’s tremendous data on the financial toxicity of cancer care to patients, specifically the out-of-pocket spend, which can be quite high if you have cancer and need to initiate therapy, oftentimes in the thousands. For the vast majority of our country, that is an amount that requires significant savings, oftentimes tapping into long-term savings, delaying start of care, which is very concerning when you’ve got cancer, and also oftentimes going into financial instability. It’s a real problem across the U.S. We track data internally in terms of our ability to lower the out-of-pocket spend for patients on both Part B and Part D medications, provide better financial assistance to patients.

We measure our savings on Part D in terms of out-of-pocket spend each year. That’s well over $1 million a year, and on a per-patient basis, it is very significant. In terms of patient satisfaction, we measure that with Press Ganey methodology. We do that across thousands and thousands of visits a year via text and email and have shown high levels of patient satisfaction in our model. As I mentioned, we are also an NCQA certified patient safety organization and track a number of KPIs that are specific to oncology on clinical outcomes, showing the safety of our model and our ability to deliver high-level care in the community.

It sounds like you have the payers, the doctors, and the patients all benefiting from your methodology and the way you’re running these practices.

That’s right.

OK. In the moment or two we have left, it looks as if you’re concentrated in several markets. You mentioned getting contacted about entering new markets. Could you just discuss a little bit about your plans for entering new territories?

Absolutely. As we’ve talked about on our last few earnings calls, the pipeline for growth in the markets where we currently operate is incredibly robust. In terms of return on equity for investors, the most accretive opportunities for us right now are where we actually have a footprint and we’ve got capacity. We’ve been heads down focused on signing deals in our five existing markets with a particular focus on Florida and Nevada in the last few quarters. That’s where we’re seeing incredibly high benchmark utilization. That’s the utilization that we measure and then capitate against. It provides, on a PMPM basis, significantly increased opportunity to drive value for the company and for investors in those markets where we have capacity and there’s high utilization. We’ll continue to do that in the upcoming quarters. We’ve been approached about opportunities in other markets.

If we’ve got something that’s sizable enough where we can project near-term elimination of cash burn and profitability within a year, which there are those opportunities out there, then we’ll take those seriously. We haven’t been super aggressive about just putting dots on the map in new markets until we fill capacity in our existing footprint.

Great. That sounds like a very well-thought-out plan for growth. OK. I’d like to thank you for this presentation and look forward to following your progress in the coming quarters.

Thank you so much. Appreciate the opportunity.

Thank you.

Rob Carter, CFO, The Oncology Institute: Take care.

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