The Oncology Institute, Inc. (TOI): Business Model Canvas [Dec-2025 Updated]

You're looking at The Oncology Institute, Inc. (TOI) and wondering how they are navigating the shift in cancer care, right? Well, after digging into their structure, the story is clear: this isn't just another clinic network; it's a calculated pivot to value-based contracts covering roughly 1.9 million lives by late 2025, all supercharged by their high-margin specialty pharmacy, which pulled in $75.9 million in Q3 2025 alone. Honestly, managing medical cost risk across their 100+ physical locations while using agentic AI for efficiency is the real play here, so you need to see how these nine building blocks fit together to understand their near-term upside and the risks tied to capitation.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Key Partnerships

You're looking at how The Oncology Institute, Inc. (TOI) builds its value by aligning with major payers and research entities. These relationships are critical, especially given the company's focus on value-based care models.

The Oncology Institute, Inc. is operating across five states with 80 locations as of late 2025, relying heavily on these external relationships to scale its specialized oncology services.

Major national and regional health plans (e.g., Elevance Health)

The delegated capitated partnership with Elevance Health in Florida is a cornerstone of TOI's value-based revenue. As of the Q2 2025 report, there was a planned expansion of this fully delegated capitated partnership into two new counties in Central Florida. If finalized, this expansion is projected to more double the number of lives currently covered under that specific relationship for The Oncology Institute, Inc. Capitated contracts, in general, were a significant driver, comprising 17% of revenue in the third quarter of 2025. New capitated contracts signed are expected to contribute $36 million in incremental revenue, with an annualized run-rate potential reaching almost $50 million.

SilverSummit Healthplan for 80,000+ Nevada Medicaid lives

A major recent win involves SilverSummit Healthplan in Nevada. Effective July 1, 2025, The Oncology Institute, Inc. became the exclusive oncology provider for over 80,000 Medicaid patients associated with SilverSummit Healthplan in Nevada. This arrangement provides enhanced access to care for this population across The Oncology Institute, Inc.'s three convenient Nevada locations in Las Vegas, Henderson, and Spring Valley. This deal strengthens The Oncology Institute, Inc.'s position in value-based oncology care, which is its core model.

Doctors HealthCare Plans for delegated utilization management

The strategic partnership with Doctors HealthCare Plans, a Medicare Advantage plan in South Florida, centers on providing delegated utilization management (UM) services and clinical advisory support. Under this agreement, The Oncology Institute, Inc. delivers UM functions using its clinical protocols and medical director oversight to ensure high-quality, cost-effective cancer care. This builds upon The Oncology Institute, Inc.'s existing national track record of managing medical cost risk across various delegated risk contracts.

Helios Clinical Research for enterprise-wide trial expansion

The Oncology Institute, Inc. announced an enterprise-wide expansion of its strategic partnership with Helios Clinical Research in April 2025. This initiative scales a successful collaboration that began in Florida to enhance clinical research capabilities across all of The Oncology Institute, Inc.'s markets. The goal is to integrate clinical research into community oncology settings by leveraging Helios Clinical Research's centralized operations for regulatory support, patient recruitment, and operational management.

Independent Physician Associations (IPAs) and Medical Groups

The Oncology Institute, Inc. continues to expand its network through affiliations with other providers. In the third quarter of 2025, the company signed several new in-network MSO (Management Services Organization) providers specifically in the Florida market. These relationships are key to extending The Oncology Institute, Inc.'s reach and service delivery model.

Here's a quick look at the scale of the payer relationships:

The operational footprint supporting these partnerships includes:

• The Oncology Institute, Inc. operates in five states.
• The company has over 100 clinics and affiliate locations of care.
• New capitated contracts are projected to add $36 million in incremental revenue.
• The Retail Pharmacy and Dispensary segment contributed $75.9 million in revenue in Q3 2025.

The enterprise-wide research expansion with Helios Clinical Research is designed to create a scalable infrastructure, allowing The Oncology Institute, Inc. to expand its research footprint without a proportional increase in administrative burden on clinical sites.

Finance: draft 13-week cash view by Friday.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Key Activities

You're looking at the core engine of The Oncology Institute, Inc. (TOI) operations as of late 2025. These are the specific actions they take to deliver value and capture revenue across their integrated model.

Delivering comprehensive, value-based oncology care

The Oncology Institute, Inc. (TOI) focuses on advancing oncology by delivering highly specialized, value-based cancer care in the community setting. This involves managing a large patient population and driving growth through both fee-for-service and value-based arrangements. The company operates over 100 clinics and affiliate locations of care across five states, serving a population of approximately 1.9 million patients as of mid-2025.

The shift to value-based care is a primary activity, evidenced by the financial results showing strong growth in patient services revenue, which reached $60.2 million in the third quarter of 2025, marking a 21% year-over-year increase. Fee-for-service revenue also showed positive momentum, growing 13% over the third quarter of 2024. The company is actively expanding its footprint and care delivery models.

Here's a snapshot of the financial scale of operations through the third quarter of 2025:

Management updated its full-year 2025 revenue guidance to a range of $495 to $505 million, up from the previous guidance of $460 to $480 million. The company also reported achieving its first month of profitability in September 2025.

Operating in-house specialty pharmacy and dispensary services

Operating the in-house specialty pharmacy and dispensary is a critical revenue and margin driver. This segment set fill records consistently through 2025. In the third quarter of 2025 alone, the Retail Pharmacy and Dispensary contributed $75.9 million in revenue, a substantial 57.4% increase compared to the third quarter of 2024. The gross profit from this segment for Q3 2025 was $12.8 million.

To give you context on the segment's growth trajectory:

• Q1 2025 Revenue: $49.3 million
• Q2 2025 Revenue: $62.6 million
• Q3 2025 Revenue: $75.9 million

This activity is directly tied to the value-based care model, as the CEO noted strong MLR performance and continued ramping of new delegated lives in Florida, which helps drive script attachment to in-network providers.

Managing capitated contracts and medical cost risk (MLR)

Managing capitated contracts is central to The Oncology Institute, Inc. (TOI)'s strategy to reduce revenue volatility and improve medical cost risk (MLR) performance. The company is actively expanding these arrangements, which guarantee fixed payments per patient.

Key contract expansion metrics as of mid-2025 include:

• New capitation contracts signed in 2025 are estimated to contribute $19 million of full-year revenue.
• This represents a 29% increase to capitated revenue versus full-year 2024.
• In Q1 2025, The Oncology Institute, Inc. (TOI) added over 100,000 lives across four agreements in Florida, California, and Nevada.
• A new Nevada deal added over 80,000 Medicaid lives in Clark County, effective July 1, 2025.
• Anticipated new capitation contracts in the first half of 2025 were projected to add approximately $50 million in new revenue on an annualized basis.

The first fully delegated capitation agreement, which includes delegation for Utilization Management and Claims and Network, began in Florida on March 1, 2025. Strong MLR performance on these new delegated lives is a key indicator of success in managing medical cost risk.

Conducting clinical trials and evidence-based research

Conducting clinical trials is a core component of The Oncology Institute, Inc. (TOI)'s value proposition, positioning it as a provider of cutting-edge, evidence-based cancer care. The company offers clinical trials to its patient population. A specific action in this area was the announcement of an expanded research partnership with Helios Clinical Research on April 22, 2025.

Deploying agentic AI for prior authorization and OpEx efficiency

The deployment of agentic AI is a focused operational activity aimed at efficiency gains. The Oncology Institute, Inc. (TOI) announced a co-development partnership with Ascertain to deploy a "near-touchless" prior authorization workflow using Ascertain's Unified Payer Portal (UPP), an AI-powered automation module. This system went live in an early-stage deployment in September 2025, after an implementation that took 8 weeks.

The initial results from this AI deployment are concrete:

• Pilot submission time for authorizations was reduced by >80%.
• The program freed hundreds of staff hours per week.
• The portal now processes prior authorizations across The Oncology Institute, Inc. (TOI)'s 100+ clinics and affiliates.
• The initiative is estimated to yield up to $2 million in operating expense savings in 2026 as it scales.

The company also hired a new Chief Administrative Officer in Q3 2025 to oversee Enterprise Central Business Operations, Technology Strategy, and AI Enablement.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Key Resources

You're looking at the core assets The Oncology Institute, Inc. (TOI) is using to execute its value-based care strategy right now. These are the tangible and intangible things they own or control that make the business run.

The physical and human infrastructure is substantial, built across five states. This scale is key to managing population health across a wider area. Here's a quick look at the footprint as of late 2025.

• Network of over 100 community oncology clinics and affiliate locations of care.
• Over 180 employed and affiliate oncology clinicians providing care.

The vertical integration, especially around drug management, is a major resource. This includes their in-house specialty pharmacy and drug supply chain, which is clearly a significant revenue driver. For the third quarter ending September 30, 2025, the Retail Pharmacy and Dispensary segment showed impressive volume.

The proprietary technology platform is an intangible asset they rely on for value-based care management. While the specific technology name isn't detailed here, its enablement is evidenced by recent operational hires, such as the Chief Administrative Officer overseeing Technology Strategy and AI Enablement. This suggests a focus on using tech to drive efficiencies, defintely.

Finally, the balance sheet provides a snapshot of immediate liquidity. As of September 30, 2025, the cash position was reported.

• Cash and cash equivalents: $27.7 million.

Finance: draft 13-week cash view by Friday.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Value Propositions

You're looking at The Oncology Institute, Inc. (TOI)'s core promises to the market as of late 2025. These aren't just mission statement platitudes; they are tied directly to the financial performance we're seeing, especially with the shift to value-based contracts.

High-quality, integrated cancer care in a community setting

The value proposition here is delivering advanced care where patients live, not just in distant academic centers. This integrated approach is supported by significant scale across the network.

The Oncology Institute, Inc. (TOI) operates across five states with over 100 clinics and affiliate locations as of the third quarter of 2025. They support this infrastructure with over 180 employed and affiliate clinicians. This network serves a covered population of approximately 1.9 million patients. The financial scale is evident in the updated full fiscal year 2025 revenue guidance, which is now projected to be between $495 million to $505 million. For the third quarter of 2025 alone, consolidated revenue reached $136.6 million.

Improved patient outcomes via a value-based care model

The commitment to value-based care, or VBC, is central to their strategy, meaning payment is tied to keeping patients healthier. This focus is validated by specific clinical results shared in May 2025 regarding their High-Value Cancer Care (HVCC) model.

The demonstrated improvements in patient care are stark:

• 53% reduction in Emergency Department utilization.
• 68% decrease in hospitalization rates.
• 75% lower odds of acute care facility death.

Lower total cost of care for payers and health plans

The clinical improvements directly translate into financial savings for payers, which is the core incentive of the capitated contracts The Oncology Institute, Inc. (TOI) is aggressively pursuing. The financial benefit for the payer is clear from the same HVCC data set.

The model delivered an estimated $12,000 cost savings per enrolled patient. This incentive structure is driving contract expansion; in 2025, The Oncology Institute, Inc. (TOI) added roughly 80,000 lives under new capitation agreements. To be fair, they managed over 200,000 lives in Florida under value-based agreements by late 2025, showing deep penetration in key markets.

Enhanced access to cutting-edge clinical trials

Access to trials is a key differentiator, keeping patients on the latest treatment protocols without leaving the community setting. The operational data shows activity in this segment.

The segment dedicated to clinical trials and other services recorded an activity metric of 6,150 in the third quarter of 2025. This is part of the overall offering to the 1.9 million covered patient population.

Comprehensive services: infusion, lab, financial counseling

The integrated nature of the model is supported by high-margin ancillary services that keep the patient journey in-house, which also helps control costs and improve coordination. The dispensary business is a major financial engine for this integration.

Here's how the key service components performed financially in the third quarter of 2025:

The company also provides services including infusion centers, outpatient blood transfusion, outpatient stem cell transplant, comprehensive lab testing, and financial counseling, all supporting the holistic care delivery.

Finance: draft 13-week cash view by Friday.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Customer Relationships

You're looking at how The Oncology Institute, Inc. (TOI) manages its connections with the people and organizations that keep the lights on. It really boils down to deep partnerships and a focus on the patient experience, all underpinned by new tech.

Deep, collaborative relationships with payer partners

The relationship with payers is central, especially as The Oncology Institute, Inc. (TOI) pushes its value-based care model. You see this commitment in the contract expansions and the revenue mix. For the third quarter of 2025, total revenue hit $136.6 million, with patient services revenue at $60.2 million.

Within that patient services revenue for Q3 2025, the value-based capitation contracts accounted for 34%, while fee-for-service made up the remaining 66%. The fee-for-service segment itself grew 13% over Q3 2024. The momentum in these payer relationships is clear from recent contract activity.

Here's a snapshot of the payer-facing growth metrics:

The expansion of the fully delegated capitated partnership with Elevance Health in Florida, expected in Q4 2025, is a big deal; it will more than double the number of Medicare Advantage lives covered for that payor. Also, as of July 1, 2025, The Oncology Institute, Inc. (TOI) expanded its capitation relationship with Silver Summit Health Plan to cover all of their Medicaid patients in Clark County, Nevada.

Patient-first, physician-led care model

The model centers on delivering care through a broad network of clinicians and facilities. The Oncology Institute, Inc. (TOI) offers cancer care services to a population of approximately 1.9 million patients. This care is delivered through over 100 clinics and affiliate locations of care across five states.

The clinical leadership is substantial, with over 180 employed and affiliate clinicians driving the care delivery. You also see the physician-led structure in the hiring of Dr. Jeff Langsam as the new Chief Clinical Officer, who leads efforts around therapeutics and Utilization Management.

Technology-enabled workflows for streamlined patient experience

The Oncology Institute, Inc. (TOI) is actively integrating technology, particularly Artificial Intelligence (AI), to make processes smoother for patients and staff. They were planning to launch AI pilots around prior authorization and patient advocacy in the third quarter of 2025.

The goal for the agentic AI model rollout in Q4 2025 is aggressive:

• Submission time reduction from 18 minutes to approximately 5 seconds.
• Expected savings per authorization of over 80%.
• Estimated total operating expense efficiencies from these efficiencies could yield up to $2 million.

This focus on efficiency is key to supporting the value-based contracts.

Financial counseling to assist patients with costs

The Oncology Institute, Inc. (TOI) explicitly includes financial counseling as one of the services provided to patients. This service is part of the comprehensive care delivery model alongside infusion centers, in-house dispensary, and clinical trials.

Centralized call center for patient support

Support infrastructure includes planning for a modernized patient interface. The Oncology Institute, Inc. (TOI) was planning to launch AI pilots for a next-gen call center in the third quarter of 2025.

Finance: draft 13-week cash view by Friday.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Channels

You're looking at how The Oncology Institute, Inc. (TOI) gets its services to the patient base, which is a mix of physical presence and deep contractual relationships as of late 2025. The physical footprint is substantial, supporting the delivery of both in-person care and specialty pharmacy services.

The network of physical clinic and affiliate locations is a core channel for patient access. The Oncology Institute, Inc. (TOI) operates with over 100 clinics and affiliate locations of care across five states, and this network is growing. This physical presence is key to achieving network adequacy for their value-based contracts.

The in-house retail pharmacy and dispensary is a major revenue driver, capturing both oral and Part B drug dispensing. The performance of this channel has been consistently strong throughout 2025. Here's a quick look at the revenue generated by this segment across the first three quarters of the year:

Also, The Oncology Institute, Inc. (TOI) opened a new pharmacy location in Florida during the third quarter of 2025 to serve network providers requiring delivery of Part B drugs.

Direct contracts with major health plans and Medicare Advantage plans form the backbone of the value-based channel. These arrangements allow The Oncology Institute, Inc. (TOI) to manage the entire oncology benefit in some cases. The narrow network capitation contracts are projected to represent approximately $50 million of revenue for the full year 2025. These specific arrangements typically produce medical loss ratios in the mid-60% range.

The expansion of these contracts in 2025 is significant for future revenue scaling. You should note the following contract achievements:

• New capitation contracts signed across markets in 2025 are estimated to contribute $19 million of full-year 2025 revenue, representing a 29% increase to capitated revenue versus the full year 2024.
• Three new capitation agreements secured in 2025 added roughly 80,000 lives across Florida, California, and Nevada markets.
• A new capitation contract in Nevada, effective July 1, added over 80,000 Medicaid lives in Clark County.
• The total number of lives The Oncology Institute, Inc. (TOI) has under risk as of the second quarter of 2025 was right around 1.9 million lives.
• Expansion in Florida with Elevance Health is set to add over 40,000 additional Medicare Advantage lives, which more than doubles the relationship with that payer as measured by Medicare Advantage lives under capitation.
• The projected total Medicare Advantage lives under capitation in the Florida market across all payers is over 100,000.

Referral networks from primary care physicians and specialists remain a critical source for Fee-For-Service revenue. The company has been making investments in referral relationship management and call center expansion, which contributed to a 9% fee-for-service growth in Q1 2025 over Q4 2024. The provider network itself is a combination of employed oncologists and clinics, and those affiliated through contracted or MSO (Management Services Organization) arrangements with health plan partners. This leveraging of the health plan partners network allows for quicker scaling.

For technology-enabled engagement, The Oncology Institute, Inc. (TOI) is actively piloting new systems. They are planning to launch AI pilots around prior authorization, patient advocacy, and a next-generation call center in the third quarter of 2025. This focus on technology efficiencies is helping reduce SG&A as a percentage of revenue; for instance, SG&A, excluding depreciation and amortization, was 18.5% of revenue in Q3 2025, a reduction of approximately 820 basis points versus a year ago. Defintely, this tech push supports the value-based model by enabling real-time views into utilization trends.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Customer Segments

You're looking at the core patient base that fuels The Oncology Institute, Inc. (TOI)'s entire value-based strategy as of late 2025. This isn't just about volume; it's about the type of financial arrangement underpinning the care delivery.

The total population under TOI's care umbrella is substantial, providing a wide base for both risk-bearing and traditional revenue streams. The company offers evidence-based cancer care to a population of approximately 1.9 million patients across its operating footprint, which includes clinical trials and other care delivery models. This figure represents the total reach across their employed and affiliate clinicians and clinic locations.

The most strategically important segment is those under value-based contracts, as this drives the shift toward lower-cost, outcome-focused care. The expansion in this area has been aggressive through 2025.

You can see the focus is clearly on migrating the patient base into risk-bearing arrangements. The addition of over 80,000 Medicaid lives via a new capitation deal in Nevada, effective July 1, 2025, is a prime example of capturing government-sponsored lives under a value-based structure.

The Fee-for-Service (FFS) segment remains a significant component, though it is being managed for efficiency while the value-based contracts scale up. For instance, FFS revenue grew 10% year-over-year in the second quarter of 2025, showing continued organic strength in markets like Florida and Oregon.

The relationships with payers are formalized through contracts with various entities:

• Health plans entering into fully-delegated capitation agreements, such as the one started in Florida on March 1, 2025, which included delegation for Utilization Management and Claims and Network.
• At-risk provider groups, including winning sole source designation for a major captive provider group within an existing region during the first half of 2025.

Finally, pharmaceutical companies represent a distinct customer segment, primarily through the Clinical Trials business unit. While this segment saw a non-cash write-off of net assets in Q2 2025, it remains a service line that supports the overall patient care ecosystem.

Finance: draft 13-week cash view by Friday.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Cost Structure

You're looking at the hard numbers driving The Oncology Institute, Inc. (TOI)'s operations as of late 2025, specifically focusing on what it costs to run their integrated model. Honestly, for a company balancing fee-for-service with capitation, the cost structure is a mix of high-volume drug costs and fixed clinical overhead.

The primary cost drivers are clearly visible in the direct costs associated with their revenue streams. For the third quarter ended September 30, 2025, the company reported significant direct costs across patient services and dispensary operations. The dispensary side, which handles specialty pharmacy drugs, is a major component, reflecting the cost of the high-value oncology medications they dispense.

Here is a breakdown of the key direct costs for the three months ended September 30, 2025, in thousands of US dollars:

Cost of Goods Sold (COGS) for specialty pharmacy drugs is heavily represented by the Direct costs - dispensary line item. For Q3 2025, this was $63,072 thousand. This cost directly correlates with the $75.9 million in revenue generated by the Retail Pharmacy and Dispensary segment in that quarter. To be fair, the gross profit on that segment was $12.8 million, meaning the COGS is the bulk of the dispensary revenue.

Provider and clinical staff salaries are embedded within the Direct costs - patient services, which totaled $54,572 thousand for the quarter. This category covers oncologists, nurses, and other health professionals whose wages are expensed as incurred. Looking back at Q1 2025, the company noted a 2.6% decrease in clinical payroll costs due to compensation adjustments and increased use of advanced practice providers, showing an active management of this large cost center.

Operating expenses (OpEx) for clinics and corporate overhead are captured primarily in the SG&A figure. The Q3 2025 SG&A was $25.3 million. Management highlighted that this represented an operating leverage improvement, as SG&A as a percentage of revenue decreased to 18.5% from 26.7% a year ago. This efficiency gain suggests better absorption of corporate overhead across a growing revenue base, which was $136.6 million in Q3 2025.

Technology and AI implementation costs are being managed through specific projects. While the exact implementation cost for the AI rollout wasn't itemized as a single OpEx line, the expected benefit is clear. The company announced that its agentic AI model for prior authorizations is expected to reduce submission time from 18 minutes to about 5 seconds, delivering savings per authorization of over 80%, which management estimated could yield up to $2 million in operating expense efficiencies in the near term.

Costs associated with managing medical loss ratio (MLR) risk manifest as adjustments related to their value-based contracts. A concrete example of this risk management cost in Q3 2025 was the $1.8 million reserve taken against fee-for-service revenue. This reserve directly impacts gross profit and reflects the company's conservative accounting for potential revenue adjustments under their evolving contract structures, especially as they expand their delegated capitation model.

• Capitated Revenue growth in Q3 2025 was 38.9% year-over-year.
• The company achieved its first adjusted EBITDA positive month in September 2025.
• Full-year 2025 Adjusted EBITDA guidance improved to a loss range of $(11) million to $(13) million.
• The company raised full-year 2025 revenue guidance to $495 million to $505 million.

Finance: draft 13-week cash view by Friday.

The Oncology Institute, Inc. (TOI) - Canvas Business Model: Revenue Streams

Specialty Pharmacy/Dispensary revenue: $75.9 million in Q3 2025. This segment set fill records in the third quarter.

Capitation revenue from value-based contracts (recurring revenue): For the quarter ended September 30, 2025, Patient Services Revenue totaled $60.2 million, with capitation accounting for 34% of that total.

Fee-for-Service (FFS) revenue from patient services: The FFS portion of Patient Services Revenue was 66% of the $60.2 million in Q3 2025. This segment showed 13% year-over-year growth compared to Q3 2024.

Delegated utilization management and advisory services fees: These fees are embedded within the value-based contract structure, exemplified by the Florida delegated capitation partnership.

Clinical trial revenue from pharmaceutical sponsors: The Oncology Institute, Inc. offers care to a population including clinical trials.

Here's a quick look at the Q3 2025 revenue composition:

The Oncology Institute, Inc. (TOI) reported consolidated revenue of $136.6 million for the third quarter of 2025, representing a 36.7% increase year-over-year.

The updated full-year 2025 revenue guidance is between $495 million and $505 million.

The revenue streams contributing to the overall business include:

• Retail Pharmacy and Dispensary revenue of $75.9 million in Q3 2025.
• Patient Services Revenue of $60.2 million in Q3 2025.
• The company is reinforcing its expectation to achieve profitability in the fourth quarter of 2025.
• The company expects Adjusted EBITDA of approximately $0 to $2 million in the fourth quarter of 2025.