1) Strategic Progress and Leadership Changes - The Oncology Institute (TOI) achieved its first profitable quarter as a public company from an adjusted EBITDA perspective in Q4 2025. - The company is focused on expanding its capitated care model, particularly through delegated arrangements, which align incentives with payer partners and improve patient outcomes. - Leadership was strengthened with the addition of Jeffrey Langsam as Chief Clinical Officer and Kristin England as Chief Administrative Officer, enhancing the team’s capability to scale operations.

2) Financial and Segment Results - TOI reported a revenue increase of approximately 28% YoY, surpassing $500 million for the first time, with Q4 revenue at $142 million, up 41.6% YoY. - Key revenue drivers included: - Fee-for-Service Revenue: Grew 9% YoY to $148.5 million. - Capitation Revenue: Increased 17.2% YoY to $80.5 million, driven by new delegated contracts. - Pharmacy Revenue: Rose 49.6% YoY to $269.2 million, with Q4 pharmacy revenue at $81.4 million, up 71.1% YoY. - Gross profit for Q4 was $22.7 million, with a gross margin of 16%, compared to 14.6% in the prior year.

3) Operational Efficiency and Challenges - TOI improved operational efficiency, with SG&A expenses declining by 2% YoY, reflecting the scalability of its model. - The company outsourced clinical trial operations to allow care teams to focus on patient care while enhancing scalability. - The Inflation Reduction Act is expected to have a minor impact on pharmacy revenue, with TOI prepared to optimize its pharmacy mix to mitigate any adverse effects.

4) Guidance and Outlook for 2026 - For 2026, TOI expects revenue between $630 million to $650 million, with approximately $150 million from capitated revenue. - The company anticipates continued strong growth in its delegated capitation model, projecting over 80% growth in capitated revenue. - Adjusted EBITDA is guided to be between $0 million to $9 million, with free cash flow expected to improve by the end of 2026. - The first quarter of 2026 is expected to show an adjusted EBITDA loss due to seasonal factors and prior year benefits.

5) Investor Considerations and Missing Information - The call highlighted TOI's strategic positioning in a potentially lower rate environment, suggesting that demand for its services may increase as payers seek effective care solutions. - However, specific details on the expected impact of new contracts and the overall market dynamics were not fully elaborated. - The transcript lacks detailed metrics on patient volumes and specific operational challenges faced in the transition to a larger capitation model.

Bottom line: TOI's strong growth trajectory, marked by its first profitable quarter and strategic expansion in capitated care, positions the company favorably for 2026. With a focus on operational efficiency and a robust pipeline of payer partnerships, TOI aims to enhance profitability while navigating potential market challenges.