The Oncology Institute, Inc.

Hello and welcome everyone joining the Oncology Institute first quarter 2026 earnings call. At this time, all participants are in a listen-only mode. Later, you will have the opportunity to ask questions during the question and answer session. To register to ask a question at any time, please press star 1 on your telephone keypad. Please note this call is being recorded and we are standing by should you need any assistance. It is now my pleasure to turn the meeting over to Min Merchant, Chief Legal Officer. Please go ahead.

The press release announcing the Oncology Institute's results for the first quarter of 2026 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'd like to remind you of the company's safe harbor language included within the company's press release for the first quarter of 2026. Management may make forward-looking statements, including guidance and underlying assumptions. Forward-looking statements are based on expectations that involve risk and uncertainties that could 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 Vernage, and our CFO, Rob Carter. Following our prepared remarks, we'll open the call for your questions. With that, I'll turn the call over to Dan.

Thank you, Min. Good afternoon, everyone, and thank you for joining our first quarter 2026 earnings call. I'm pleased to report a strong start to 2026 in the first quarter, driven by continued expansion and performance of our value-based contracts across markets and the ongoing growth of ancillary services, particularly our pharmacy business, which provides us with confidence to reaffirm our 2026 outlook for revenue and full-year adjusted EBITDA profitability. As noted in our earnings release, we are also pleased to meaningfully update our free cash flow projections for the year to a positive range of 5 to 15 million, reflecting our ongoing performance and improving economies of scale as we grow. None of this would be possible without the continued commitment to high-quality oncology care by our physicians and staff across the five states we operate in every day. There are a few key highlights from the quarter that I would like to now review. First, revenue of $147 million was up 41% year-over-year, driven by strong, calculated revenue growth and record performance from our specialty pharmacy business. Record Part B fills drove pharmacy revenue up 78% in the quarter compared to the first quarter of 2025, reflecting overall growth in patient encounters and continued operational execution on prescription fills. As a testament to the durability and replicability of our clinical model, we saved nearly $2 million in Medicare spending as part of the CMS Enhancing Oncology Model performance program in period three, increasing the savings generated from the previous period while maintaining the high-quality care we deliver to the members we serve in the community. We believe this ongoing recognition from CMS underscores the clinical and economic value of TOI's integrated approach to oncology care applies to all patient populations, not just capitated members. Turning now to operations, I would like to walk through some key updates from the first quarter. Our work in Florida continues to be a critical proof point for our model in one of our newer markets, and I'm pleased to share meaningful progress on several fronts. We are now generating a profit in the Florida market. This is an important milestone that reflects the maturation of our capitated relationships in the state and validates the model we have been building. Our initial members under delegated capitation partnerships continue to show data points demonstrating excellent clinical outcomes with MLR performing in line to slightly better than planned. As a reminder, we target a mature MLR of approximately 85% for new delegated capitation contracts, and we are now achieving that with our 2025 effective contracts in South Florida. In terms of further near-term capitation growth, we anticipate expansion of existing plan partnerships across 11 additional counties for Medicare Advantage members in Q3, which will expand our KOI clinic and MSO network to cover effectively the entire Florida market to serve delegated capitation agreements across multiple health plans. This next phase of expansion encompassing Q3 will expand our total MA lives under delegated capitation arrangements to approximately 200,000 total lives across 25 total counties. In addition to the capitated revenue associated with these new patients, this expansion is also expected to be a meaningful tailwind to our Part B pharmacy business as we capture the prescription volume, which will deliver faster, more convenient fills to our patients and value outside of capitation to our care partners. To effectively support these important patient populations, we anticipate opening seven new TOI clinics over the remainder of the year to ensure we are delivering the high-quality, coordinated care that our patients deserve, and we will also add meaningfully to our contracted provider footprint across the state. As I mentioned in our last call, we are preparing to launch our proprietary provider portal this summer, and I'm excited to share more detail on this important initiative. We see two primary benefits of the TOI portal. First, it is designed to further strengthen contracted provider engagement and drive continued adherence to our clinical pathways and quality initiatives. Pathway adherence is a meaningful lever for MLR performance, and we believe this tool will be an important driver of ongoing improvement. Second, over time, we intend to use the portal to provide access to ancillary services, including Part B dispensing, clinical trials, and care navigations. all key components of our integrated care strategy and key profitability levers as we grow. There may also be an opportunity to pass on savings from our ancillary services to MSO providers, which will further drive engagement. Our specialty pharmacy business delivered an exceptional quarter and continues to be one of the strongest growth drivers across the enterprise. We filled a record number of scripts in the first quarter with specialty pharmacy revenue of 78% year-over-year at $87.5 million for the quarter, delivering $16.8 million of gross profit. This growth is being driven by a combination of higher patient volumes, continued optimization of pharmacy workflows across our network, as well as ongoing efforts to reduce avoidable leakage to outside pharmacies. Gross margin in our specialty pharmacy business also came in higher than anticipated in the quarter at 19.2%, driven primarily by efforts in TOI's procurement function to manage drug pricing strategy and capitalize on our developed central clinical infrastructure via formulary pathways within the pharmacy. This is an area where we continue to see the benefit of our scale and distributor relationships, which will only be further enhanced as we grow. We are also working to expand pharmacy access in Florida to our delegated network members, which we believe broadens our ability to capture both Part D and B scripts from our delegated population. We expect this to be available in the second half of this year and view it as an incremental opportunity on top of our core Part D dispensing strategy not contemplated in our annual revenue guidance. We continue to make meaningful progress on our AI-enabled operational initiatives this quarter. As a reminder, last year we launched three AI integration efforts focused on revenue cycle management, prior authorization services, and our patient call center. I'm pleased to report that we remain on track to achieve the $2 million in operating expense savings we outlined for 2026. These initiatives are not just delivering cost efficiencies, they are also improving the experience for our patients, providers, and administrative teams, and we expect to build on them as we continue to scale. Finally, I'm pleased to welcome Min Merchant to the executive team as TOI's new chief legal officer. Min will oversee all legal, compliance, regulatory, and privacy matters as we continue to scale the platform. As a company that is expanding its managed care footprint, delegated arrangements, and operational complexity, having a seasoned legal and compliance leader at the table is critical. Min is a great addition, and we look forward to the contributions she will make as we continue to grow and strengthen the executive team. In summary, we are off to a strong start in 2026. Revenue growth of 41%, record pharmacy performance, profitability in Florida, and a growing pipeline of capitated lives gives us confidence that the momentum we build throughout 2025 is continuing into the new year. As we look ahead, our focus remains on operational execution and quality patient care. scaling our delegated capitation model, deepening payer partnerships, and continuing to invest in the technology and operational capabilities that will drive sustainable profitability over the long term. With that, I'll turn the call over to Rob to review the financials in more detail. Rob?