The Oncology Institute, Inc.

Greetings and welcome to the Oncology Institute fourth quarter 2025 earnings call. At this time, all participants are in a listen-only mode. A brief question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Mark Heppelheiser, General Counsel. Thank you, sir. You may begin.

The press release announcing the Oncology Institute's results for the fourth quarter of 2025 are available at the investor section of the company's website, theoncologyinstitute.com. A replay of this call will also be available at the company's website after the conclusion of this call. Before we get started, I would like to remind you of the company's Safe Harbor language included within the company's press release for the fourth quarter of 2025. Management may make forward-looking statements, including guidance and underlying assumptions. Overlooking statements are based on expectations that involve risks and uncertainties that can cause actual results to differ materially. For a further discussion of risks related to our business, see our filings with the SEC. This call will also discuss non-GAAP financial measures, such as adjusted EBITDA and free cash flow. Reconciliation of these non-GAAP measures to the most comparable GAAP measures are included in the earnings release furnished to the SEC and available on our website. Joining me on the call today are our CEO, Dan Vernick, and our CFO, Rob Carter. Following our prepared remarks, we'll open up the call for your questions. With that, I'll turn the call over to Dan.

Thank you, Mark. Good afternoon, everyone, and thank you for joining our fourth quarter and full year 2025 earnings call. Before getting into the results, I want to start by thanking our physicians, clinicians, and employees across the Oncology Institute. Their continued focus on delivering high-quality oncology care in the community is what drives the progress we are seeing across the business. Most importantly, the fourth quarter marked an important milestone, being our first profitable quarter as a public company from an adjusted EBITDA perspective. Based on the momentum that we have built, we are reaffirming our expectation to achieve four-year positive adjusted EBITDA in 2026. The biggest driver of this progress continues to be the expansion of our capitated care model, particularly through our delegated arrangements, which enables us to manage the oncology benefit more comprehensively while aligning incentives with our payer partners across markets and delivering quality clinical outcomes to the patients that we serve. Stepping back, 2025 was a very productive year for TOI and one where we made progress across multiple areas of the organization. From a financial perspective, we delivered strong top-line growth with revenue increasing approximately 28% year over year and surpassing $500 million for the first time in our history. We continued expanding our capitated footprint, initiating nine new capitated contracts during 2025 in California, Florida, and Nevada, representing approximately 260,000 additional patient lives under management. Another key contributor to this growth was our Part D dispensing platform, which remains an important part of our integrated care model as we continue to increase prescription volumes and attachment rates within our network. This segment of our business reached almost $270 million in total revenue and contributed close to $50 million in gross profit for the full year. From an operating standpoint, we continue improving efficiency across the organization. SG&A declined 2% year-over-year, demonstrating the leverage in our model as we scale. During the year, we also outsourced our clinical trials operations, allowing our physicians and care teams to remain focused on delivering high-quality clinical care while still being able to direct our patients to the trials they need in our clinics and supporting more rapid growth and multi-market scalability. And finally, we strengthened our balance sheet during the year. We reduced debt on our convertible preferred note by $24 million and ended the year with $33.6 million in cash after experiencing positive free cash flow in Q4, giving us additional flexibility as we continue to grow the platform. Operationally, we also made meaningful progress expanding our care model. Our delegated capitation partnership with Elements in Florida continued to ramp during the fourth quarter and remains on track to continue expansion across the state in 2026, which would more than double the current partnership. Today, we have approximately 70,000 lives under capitated arrangements within this partnership. Given the economics of our delegated model, it's also worth highlighting that delegated members represented less than 5% of total capitated lives at the end of 2025, but account for approximately a third of our run rate capitated revenue, reflecting the higher PMPM structure associated with these arrangements and the high utilizing populations they serve us. In addition to Elevance, we also initiated capitation agreements with Humana and Care Plus in Florida during the fourth quarter, further expanding payer partnerships and representing approximately 22,000 additional MA lives in South Florida. Our Florida Oncology Network platform also continued to grow with the number of participating providers increasing to approximately 207 physicians and advanced practice providers across our network, supporting what we refer to as our hybrid model of patient care, which allows us to treat our managed populations at a combination of TOI-affiliated as well as independent clinics and our employed clinics under our fully delegated network umbrella. Finally, from an organizational standpoint, we strengthened the leadership team substantially in 2025 with the additions of Jeff Langsam as Chief Clinical Officer and Kristen England as Chief Administrative Officer. Both bring significant experience scaling healthcare organizations and will play an important role as we continue expanding our platform and executing on our growth strategy. As we move into 2026, our focus remains on continuing to scale and drive profitability in our value-based care platform so that we can serve more patients and payers across the country with high-quality oncology care while improving access to therapeutics and reducing the financial burden of that care. First, we expect continued strong growth in our delegated capitation model, having guided in January to over 80% growth in capitated revenue for the year. Second, we are preparing to launch a proprietary new network portal in Q2, which will further strengthen engagement with both our affiliated and independent providers. The platform will improve visibility in the utilization management pathways, support formulary adherence, and help drive continued improvement in our medical loss ratio. Importantly, it will also help enable ancillary services engagement, such as Part D dispensing adoption across our independent network providers, which remains a meaningful opportunity for incremental growth. Finally, we strengthen our board of directors in Q1 with the additions of Mark Stolper and Kim Zumakis. Mark brings significant financial leadership and public markets experience as a longtime CFO of RadNet, while Kim brings deep expertise in oncology and pharmacy services through her prior leadership roles as CEO of Vital One and 21st Century Oncology, respectively. We believe both will add valuable perspectives as we continue scaling the organization. In summary, 2025 was a foundational year for TOI. We showed our ability to grow and manage industry-leading MLR performance under our delegated capitation model in Florida, set records in Part D pharmacy growth, de-risked our balance sheet, and recorded our first positive adjusted EBITDA quarter as a public company in the fourth quarter. As we enter 2026, our focus is on execution, and we believe we are well-positioned to further expand payer partnerships and deliver sustainable profitability over the long term. With that, I'll turn the call over to Rob to review our financial results. Rob.