The Oncology Institute, Inc.

Good afternoon, ladies and gentlemen, and welcome to the Oncology Institute's second quarter 2023 earnings conference call. Today's call is being recorded, and we have allocated one hour for prepared remarks and Q&A. At this time, I'd like to turn the conference over to Mark Hippel-Fisher, General Counsel at TOI. Please go ahead, sir.

The press release announcing the Oncology Institute's results for the second quarter of 2023 are available at the investor section of the company's website, oncologyinstitute.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. 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. 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 is our CEO, Dan Vernick, and our CFO, Mihir Shah. Following our prepared remarks, we'll open 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 second quarter call. I'm honored to have the opportunity to serve as the next CEO of the Oncology Institute. As noted in our June announcement, I took over as CEO on July 1st, and Brad Hively transitioned to the role of vice chairman, where he remains on our board and continues to provide strategic support for the organization. Since this is my first earnings call as CEO of the Oncology Institute, I want to start by expressing my gratitude to our exceptional group of physicians and care teams. Their dedication to clinical care has made a profound impact on the lives of the patients we serve each day. It is because of their commitment that we achieved outstanding results in Q2 of 2023. Starting with the top line, I am thrilled to share that in the second quarter, we achieved 32% revenue growth versus Q2 of 2022. Importantly, our organic growth rate was 24%, and our same-store sales growth was 18%. This strong revenue growth demonstrates the continued demand for our innovative care model among both our patients and our payer partners. Now moving to gross profits. On the first quarter call, we mentioned the pressures we were experiencing on our IV drug margins. I'm happy to report that through a heightened focus on our drug procurement efforts, we saw a return to expected levels in Q2, bolstering our gross margin performance by 40 basis points over Q1 of 2023. These strong results paved the way for our path to profitability as we head into the second half of 2023. As we previously mentioned, we anticipate reaching profitability in 2024. Now, I would like to highlight a few operational achievements from the second quarter. First, we are delighted to announce the acquisition of Southland Radiation Oncology, a multi-site radiation oncology practice. This strategic move strengthens our position in Southern California, expands our product offering, allows us to provide even better care to our patients, and will enhance our operating margins in this critical market. Second, we have successfully acquired a pharmacy in Southern California, a strategic move aimed at bolstering our drug dispensing capability. We are currently in the process of obtaining approval from the pharmacy board, which we anticipate will take approximately 60 days. Once approved, this pharmacy license will enable us to fulfill oral prescriptions for our Medi-Cal patients. a service we have been unable to provide since January of 2022. This development alone is expected to generate upwards of $7 million in additional annual revenue on patients that we already treat, representing a substantial growth opportunity for us. Additionally, I'm happy to announce that plans are underway to open three additional dispensaries this year, one in Fresno, California, and two in South Florida. Finally, we are proud to unveil a few important partnerships that have been finalized and will help drive our growth to margin expansion efforts moving forward. Our partnership with Massive Bio will enable us to leverage the power of artificial intelligence in optimizing clinical trial randomizations. We have also signed an agreement with HouseRx to optimize our pharmacy operations and growth strategy. These developments reflect our commitment healthcare provider. In terms of management team focus, we have four key goals that will enable us to enhance shareholder value and continue as a leader in value-based oncology. Goal number one, eliminate cash burn. We are committed to eliminate our cash burn by the end of 2024, ensuring a financially stable and sustainable future for our organization. Our restructuring efforts from the first half of 2023 are on track to deliver $1 to $3 million in in-year 2023 SG&A reductions. Full year, we expect $6 to $10 million in realized reductions. Goal number two, expanding patient lives under care. In our legacy markets of California, Nevada, and Arizona remains a priority. as we strive to enhance profitability and solidify our position as a leading healthcare provider in these regions. Goal number three, improving new markets. In our expansion markets of Florida and Texas, we are committed to growing our patient base and improving our value-based model that is both clinically excellent and financially viable. Goal number four, leading the value-based oncology market. We take pride in our position as leaders in the value-based oncology market. Guided by clinical innovation and a steadfast commitment to outstanding patient care, we aim to set new standards for excellence in this industry. By relentlessly pursuing these goals, we are confident in our ability to achieve sustainable growth and deliver even greater value to our patients, partners, and stakeholders. Now, I'll turn the call over to our CFO, Mahir Shah, to provide additional details on our second quarter financial results.

Thanks, Dan, and good afternoon. As Dan shared, we are excited about our second quarter results as we are on track to deliver the upper end of revenue and adjusted EBITDA guidance. Before we get into the financials, I want to remind you of the share purchase program announced on June 15th. Pursuant to the announcement, TOI repurchased 1.59 million shares of its common stock in open market purchases. After our acquisition of Southland Radiation Oncology Clinics, our clinic count is 67, with the provider counts at 99. Consolidated revenue for Q2 2023 was $80 million, an increase of 32% compared to Q2 2022, and a 5% increase compared to Q1 2023. Gross profit in Q2 2023 was $15 million, an increase of 36% compared to Q2 2022. SG&A in Q2 2023 was $30 million, an increase of 2% compared to Q2 2022. On a percentage of revenue basis, Q2 2023 was 38%, down 900 basis points from Q2 2022. We took several strategic steps to reduce our overhead burden in Q2 and expect the full impact to be realized in the second half of this year. Loss from operations in Q2 2023 was $15 million, a decrease of $3.3 million compared to Q2 2022. Net loss for Q2 2023 was $17 million, a decrease of $11.4 million compared to Q2 2022, primarily due to a change in fair value of earn-out liabilities and increase in operating revenue, offset by goodwill impairment charge. Adjusted EBITDA for Q2 2023 was negative 7 million. Our adjusted EBITDA calculation does not add back the wider startup cost, nor the consulting and the legal fees associated with acquisition costs. Further details on how we define adjusted EBITDA can be found in our 10-K. Of note, starting Q4 2022, we have modified our adjusted EBITDA calculation to now include cash compensation paid to our board of directors. As of quarter end, our cash and cash equivalent balance was $29 million and we had $69 million in investment for the total of $98 million in cash and cash equivalents and investment. This represents $11 million of cash fund in second quarter. Importantly, only $3.3 million of this cash fund was related to operations while $5.2 million of the cash burn was related to acquisition and share buyback in June. Our cash burn in Q2 was helped by very strong collection activities. Our full year 2023 guidance remains unchanged. Our revenue guidance range is $290 million to $320 million. This represents 15% to 27% growth over 2022 revenue. Our gross profit guidance range from 60 million to 70 million, and our adjusted EBITDA guidance range from negative 25 million to negative 28 million. We continue to expect to end the year with 1.75 million to 2 million in lives under capitation. I will now turn it back over to Dan for some summary remarks.

Thanks, Mihir. While we encountered some pressure from lower-than-expected IV drug margins in Q1, I am proud of how our team responded to the challenge in Q2 to drive our financial performance. I'm excited about the momentum that our key strategic initiatives gained in the past quarter and expect these to continue accelerating in the upcoming quarters. As a result, we anticipate a favorable trend in adjusted EBITDA as the year progresses. Our efforts in reducing cash burn will lead us to a margin-positive position by the end of 2024. We do not anticipate any additional funding needs to execute our current growth plans. Being the leading provider of value-based oncology care in the U.S., we remain dedicated to expanding our patient base, forging new value-based partnerships, and ensuring high-quality outcomes for oncology patients. I am excited about the possibilities that lie ahead for us, and we'll keep you updated on our advancements during future calls. With that, we're now ready to take your questions. Operator?

Thank you very much, sir. Ladies and gentlemen, we will now be conducting a question and answer session. If you would like to ask a question, please press star then 1 on your telephone keypad. The confirmation turn will indicate that a line is in the question queue. You may press star 2. to leave the question queue. For participants making use of speaker equipment, it may be necessary to pick up your handset before pressing the start keys. We'll pause a moment while we wait for the question queue to assemble. Our first question comes from Brian Tangulet of the Jefferies. Please go ahead.

Hi, good evening. You've got Taji on from Brian. Thank you for taking my question. So first I want to touch on guidance. You know, if I annualize the first half of 2023 in terms of revenue, it looks like you're tracking ahead of your expectations in terms of revenue guidance, or at least I mean, you know, I think you're, I'm getting around like, you know, 312-ish in terms of annualized revenues. And it just generally sounds like from your commentary there's a lot of positive momentum in the business with your drug procurement efforts and the pending approval from the pharmacy board. Just curious if there's anything else or any other factors that are driving the outlook or at least a guidance reaffirmation for the remainder of the year. Anything else we should be thinking about as it relates to the business? And then as I shift that to EBITDA, right, if I do the same thing, I'm tracking around, you know, negative 28 fill within your guidance range. You know, as we kind of think through all of the factors that you've outlined, you know, I guess, you know, Anything else that would kind of uplift that run rate, I guess, from first half to second half?

Yes, definitely. Thanks so much for the question. As we enter the back half of 2023, we see several tailwinds related to all of our key growth levers that impact revenue. So continuing to see strong fee-for-service growth, continuing to have several opportunities in the pipeline for our value-based partnerships in both established and new markets, We have tailwinds on our orals business related to our dispensary and pharmacy locations opening as well as the HouseRx partnership and continue to see great opportunities in our clinical trials program with several of the new partnerships with entities like Massive Bio, which we called out. So we'd expect the back half of the year to continue to accelerate.

Great, that's really helpful. Dr. Vernation then, kind of going back to this conversation around the results of your drug procurement efforts. I think you had called out 40 basis points of improvement. Just curious, how much more runway is left, I think, within that effort? And I guess if there's more, how much more do you think you can squeeze out of gross margin improvement for this year? And how does that inform normalized gross margins even beyond this year?

Yeah, we believe that there are several factors that are going to continue to allow us to grab margin on our Infeasible Looks business with procurement and orals as well. And it really centers around a couple different things. One is driving discipline around procurement decisions through heightened analytics capabilities in-house and working more closely with some of our key distributors. Two is really some of the enhancements we're making to our utilization process, utilization review process. And then three, as we scale, we get benefits of pricing as overall volume increases. So there's substantial runway there. It's hard to put an exact number on the second half, but it's going to continue to drive forward.

Great. That's really helpful. And then just for my last question, I know you had kind of touched upon you're seeing the pipeline of physician partnerships looking pretty strong as you lead into the back half. And generally how we've been hearing that, you know, utilization in the oncology space has been pretty strong. You know, I guess, can you maybe characterize the opportunities at looking more so around your capitation book, gain sharing, you know, any other details you can provide around, you know, what that's looking like for the business and for the remainder of the year?

Yeah, so it's really in a couple different buckets. So our traditional capitation arrangements in legacy markets are continuing to show, you know, robust pipeline of growth opportunities, which we expect to, you know, continue to realize in Q4 and into next year. In new markets, we really have pivoted from sort of the gainshare model to more of a capitation-like model, which is adjudicated through service funds. So that's better for medical groups, better for TOI, and frankly, better for patients, and effectively helps create many of the dynamics that we have in capitation models and legacy markets. And then we are expanding our efforts around our ability to control Part A spend through our high-value cancer care program, and using that to provide value to some of our health plan and medical group partners.

Thank you so much. You're welcome.

Thank you. Ladies and gentlemen, just a reminder, if you'd like to ask a question, you're welcome to press start and then 1 to place yourself in the question queue. Ladies and gentlemen, with no further questions coming from the lines, I will now hand it back to management for closing remarks.

Thanks so much. In summary, we believe we had a really strong second quarter. We're really excited about the second half of 2023 and see a whole lot of tailwinds to the business, which are going to continue to drive our path to profitability and enhance our growth going forward. I want to thank you all for joining the call today and the thoughtful questions. Thank you. Thank you.

Thank you. Ladies and gentlemen, this concludes today's conference. Thank you for attending. Anyone else, connect your line.