Starling Oncology STLN

The Oncology Institute, Inc. was formed in 2007 as a collection of community oncology practices in southern California and has grown into a national organization focused on lowering the cost of oncology care while maintaining high quality treatment. The company provides physician services, infusion therapy, radiation therapy, outpatient blood product transfusions and around the clock patient support through its affiliated physician practices. It also operates under value based agreements with payors, runs specialty and retail pharmacies that fill oral and injectable medications for oncology patients, and manages clinical trial and palliative care programs. As of December 31 2025 the firm operated sixty five clinics owned by affiliated physicians, eighty one independently owned clinics under contract and a network of one hundred ninety eight unaffiliated providers, serving a total of approximately two million patients under value based arrangements across seventeen markets in five states including California Arizona Nevada Florida and Oregon.

The company generates revenue from several sources. In its fee for service business it bills for physician and infusion services using CPT codes and for drugs on a cost plus basis, collecting a small patient co pay at the time of service and seeking reimbursement from commercial and government managed care programs. Under value based contracts it receives prospective payments such as fixed per member per month amounts or gain or loss sharing arrangements from payors including Medicare Advantage Medicaid and commercial insurers, and retains profit when the cost of care for the enrolled population is below the agreed payment. In 2025 more than forty six percent of total revenue came from value based contracts. The specialty pharmacy division fills medication orders that are not administered in the clinic and bills pharmacy benefit managers, usually collecting a patient co pay at pickup. Clinical trial services are billed to pharmaceutical companies or contract research organizations based on the procedures performed on enrolled patients. All revenue streams are supported by the company’s technology platform and its relationships with provider networks.

The Oncology Institute, Inc. positions itself as a leader in value based oncology care in the United States. It differentiates from traditional oncology practices that rely mainly on fee for service reimbursement by offering a hybrid model that combines owned clinics with a broad network of independent providers, allowing it to manage risk and coordinate care across multiple sites. The company competes with large oncology groups such as American Oncology Network, US Oncology Network and OneOncology, as well as with specialty benefit managers like Evolent Health, Thyme Care and OncoHealth. Its competitive advantages include long standing relationships with major payors such as Anthem, CareMore Health, Heritage Provider Network and Optum Care, a disciplined focus on evidence based pathways aligned with National Comprehensive Cancer Network guidelines, and a technology infrastructure that standardizes care delivery and supports risk adjustment. The firm notes that its largest customer by revenue in 2025 represented approximately fourteen percent of patient services revenue, indicating limited concentration risk. These strengths enable the firm to achieve lower total costs while maintaining or improving clinical outcomes and patient satisfaction.

The company serves adult and senior patients who require medical oncology hematology and related care. Its customers include individuals covered by Medicare Advantage plans, traditional Medicare, Medicaid and commercial insurance policies. The firm works closely with referring physicians and hospitals that send patients upon diagnosis. Specific payor partners named in the filing are Anthem, CareMore Health, Heritage Provider Network and Optum Care, and the company notes that more than half of its 2025 revenue came from value based contracts where these payors have designated it as their preferred or exclusive oncology provider. In addition to direct patient care, the specialty pharmacy and clinical trial divisions serve patients who need oral medications or access to investigational therapies, broadening the overall customer base beyond the clinic setting. As of the end of 2025 the firm managed approximately two million patients under value based agreements, reflecting the scale of its population health responsibilities.