The Oncology Institute Breaks New Ground in Q4 2025: Strong Revenue Growth, First Profitable Quarter, and Expansion Plans
The Oncology Institute (TOI) has announced its fourth-quarter results for 2025, marking a significant milestone for the company. In a conference call on March 12, 2026, TOI's leadership shared their insights into the quarter's performance, highlighting key achievements and future plans.
According to Daniel Virnich, CEO of TOI, the fourth quarter was an important milestone, being the company's first profitable quarter from an adjusted EBITDA perspective. This achievement is a testament to the company's successful capitated care model expansion, particularly through delegated arrangements. As a result, TOI has reaffirmed its expectation to achieve full-year positive adjusted EBITDA in 2026.
The biggest driver of this progress continues to be the expansion of TOI's capitated care model, which enables the company to manage the oncology benefit more comprehensively while aligning incentives with payer partners across markets. This approach has delivered quality clinical outcomes for patients and contributed significantly to revenue growth. In 2025, TOI initiated nine new capitated contracts in California, Florida, and Nevada, representing approximately 260,000 additional patient lives under management.
TOI's Part D dispensing platform also showed impressive results, reaching almost $270 million in total revenue and contributing close to $50 million in gross profit for the full year. The company continued improving efficiency across its organization, with SG&A declining 2% year-over-year. Additionally, TOI outsourced its clinical trials operations, allowing physicians and care teams to focus on delivering high-quality clinical care while supporting more rapid growth and multi-market scalability.
The balance sheet also received a boost in 2025, with debt on the convertible preferred note reduced by $24 million and cash reserves totaling $33.6 million after positive free cash flow in Q4. This additional flexibility will aid TOI as it continues to grow its platform.
TOI's delegated capitation partnership with Elevance Health in Florida continued to ramp during the fourth quarter, with approximately 70,000 lives under capitated arrangements within this partnership by year-end. The company expects further expansion across the state in 2026, which would more than double current partnership numbers.
While TOI has achieved many successes in Q4 2025, there are still challenges ahead. To overcome these, the company will need to continue leveraging its scalable model, further improving operational efficiency, and expanding its care model through strategic partnerships.
