Oncology Institute, Inc. (NASDAQ: TOI)

Oncology Institute, Inc. operates as a national leader in value-based oncology care, focusing on reducing the rising cost of cancer treatment while maintaining clinical best practices and compassionate patient care. The company manages a network of clinics across 17 markets in five states, providing a range of oncology services, including medical oncology, hematology, specialty infusion, oral pharmacy needs, and clinical trials. Oncology Institute, Inc. generates revenue through a combination of fee-for-service models and value-based contracts, which include gain/loss sharing, capitation, and full delegation contracts. These contracts allow the company to manage the treatment of cancer patients in an outpatient setting, controlling both medical oncology and radiation oncology services. The company's primary customer base includes managed care providers, other risk-bearing entities, and patients undergoing oncology treatment.

• Patient Services: Oncology Institute, Inc. offers medical care on a fee-for-service basis for physician services, in-house infusion, radiation, and innovative programs like outpatient blood product transfusions. The company also provides 24/7 patient support. Services are generally covered under commercial and government managed care programs, billed retrospectively for care provided in clinics, following a small patient co-pay collected at the time of service. The company bills for physician and infusion services on a CPT-code basis and for drugs on a cost-plus basis. Revenue is generated through referrals from primary care providers, non-oncology specialist physicians, or hospitalists, who refer patients upon diagnosis to an oncology provider within Oncology Institute, Inc.

• Specialty Pharmacy: Oncology Institute, Inc. operates specialty and retail pharmacies in all five states, filling medication orders incidental or coincidental to patients' oncology care. The company services patients undergoing outpatient oncology treatment who are receiving a combination of IV-infused, oral, and injectable medications. Pharmacy claims are generally billed at the time medication is ordered, along with a customary patient co-pay. Reimbursement for the pharmacy is generally calculated using a wholesale acquisition cost, or WAC-minus basis, which is on average a higher rate than the company is able to procure the medication from its vendors.

• Clinical Trials and Other: Through TOI Clinical Research, LLC, the clinical research arm of the company's affiliated professional corporations, Oncology Institute, Inc. provides and manages clinical trial services and research for the benefit of cancer patients, as well as palliative care for patients in the last stages of disease. Revenue in this business is billed to pharmaceutical companies or the contract research organizations engaged by pharmaceutical companies to administer their trials, and paid in arrears based on which individual medical procedures were performed on enrolled patients during the course of the trial.

Oncology Institute, Inc. holds a strong position within the oncology care industry, competing with large and medium-sized local and national providers of cancer care services. Key competitors include American Oncology Network, Inc., U.S. Oncology Network, Inc., and OneOncology, Inc. The company distinguishes itself through its value-based care model, which aligns provider incentives with both quality and efficiency of care. This model allows Oncology Institute, Inc. to offer fixed payments to payors that represent a discount to the historical oncology cost and/or cost trend for these patient populations, while still generating positive profitability. The company's competitive advantages include its ability to manage oncology populations efficiently, intensive clinical interventions, and comprehensive knowledge of therapeutic options across both pharmaceuticals and radiation therapy.

Oncology Institute, Inc. serves a diverse customer base, including Medicare Advantage, Medicaid, and commercial insurance populations. The company has contractual relationships with payors serving a variety of patients, including affiliates of Anthem, CareMore Health, Heritage Provider Network, and Optum Care. More than half of the company's revenue in 2025 was generated from value-based contracts where payors have made Oncology Institute, Inc. their preferred or exclusive oncology group. The company's ability to consistently attract patients across multiple geographic markets depends on its ability to contract with payors in each market.