XVARY Composite Score
41
/ 100
Below Average
Combines growth, value, risk, and momentum factors into a single institutional-grade score.
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What it is
TOI runs cancer clinics and manages oncology practices, so patients get cancer care outside big hospital systems.
How it gets paid
Last year Oncology Institute made $503M in revenue.
Why it's growing
Revenue grew 27.8% last year. EDGAR shows revenue rose 164% vs. prior year in the latest quarter.
What just happened
Revenue hit $361M, but EPS fell to -$0.49 as profitability lagged the top-line jump.
At a Glance
C++ balance sheet — some cracks in the foundation
4.2% return on capital — nothing to write home about
-$0.71 fy2024 eps est
$2B fy2026 rev est
7.2% operating margin
XVARY composite: 41/100 — below average
What They Do
TOI runs cancer clinics and manages oncology practices, so patients get cancer care outside big hospital systems.
TOI has 86 clinic locations across 16 markets and 130 oncologists and advanced practice providers. It also managed about 1.9 million patients under value-based agreements as of December 31, 2024. Value-based agreements → contracts paid for total care cost, not each visit → so a bigger local network can win if your insurer wants hospital-level cancer care at lower cost.
How They Make Money
$503M
annual revenue · their business grew +27.8% last year
total revenue
$503M
+27.8%
The Products That Matter
Outpatient cancer treatment
Clinical Services
$452M · roughly 90% of revenue
it generated roughly $452M last year. when one segment accounts for about 90% of a $503M business, that is not a segment mix story — that is the business model.
90% of revenue
Research and support services
Clinical Trials & Other
$51M · +25% growth
this $51M segment grew 25% last year. useful, yes, but still far too small to offset weak clinic economics on its own.
$51M
Multi-state clinic footprint
Clinic Network
86 clinics · five states
the footprint is the operating bet. more clinics can spread overhead, but only if the cost base stops growing as fast as the network.
86 locations
Key Numbers
$503M
annual revenue
TOI's revenue is larger than its roughly $281M market cap. The market is pricing the losses harder than the sales base.
7.2%
operating margin
Operating margin → profit after running the business → so what: TOI still loses money on its core operations.
1.9M
managed lives
That is the population under value-based agreements, which is where scale can turn oncology care from a service business into a contract business.
$76M
long-term debt
Debt is money senior to your equity. If the turnaround fails, creditors care before shareholders do.
Financial Health
C++
Strength
- balance sheet grade C++ — below average — limited financial resources
- risk rank 3 — safer than 50% of stocks
- price stability 5 / 100
- long-term debt $76M (21% of capital)
C++ — below average. watch for debt servicing and cash burn.
Total Return vs. Market
source: institutional data · return history unavailable
What Just Happened
missed estimates
Revenue hit $361M, but EPS fell to -$0.49 as profitability lagged the top-line jump.
EDGAR shows revenue rose 164% vs. prior year in the latest quarter. That sounds great until you see EPS at -$0.49, down 250% vs. prior year. Sales are scaling faster than profits.
$361M
revenue
$0.49
eps
n/a
n/a
the number that mattered
The number that mattered was $361M of quarterly revenue, because it proves demand and deal activity are real, but the -$0.49 EPS shows the operating model still needs fixing.
source: company earnings report, 2026
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What Could Go Wrong
The #1 risk is persistent losses in a reimbursement-driven clinic model.
Med
Reimbursement pressure hits the core business
roughly $452M of TOI's $503M revenue comes from clinical services. if reimbursement rates tighten or patient volumes slip, the part of the business that matters most feels it immediately.
impact: this risk touches about 90% of revenue.
Med
Cash burn meets $76M of debt
TOI still is expected to lose -$0.71 per share and carries $76M in long-term debt. that combination reduces flexibility if growth stalls or financing gets more expensive.
impact: a thin balance sheet gives management less room for mistakes.
Med
The cost structure keeps pace with growth
q4 operating expenses were 104% of revenue. that is the opposite of the scale story investors want to see from an 86-clinic operator.
impact: if costs do not bend, revenue growth alone will not get you to profit.
Med
Healthcare compliance and oversight stay constant
a multi-state oncology platform carries normal provider and trial-related regulatory exposure. with 86 clinics across five states, even routine scrutiny can become operationally distracting.
impact: compliance issues would pressure clinic throughput, costs, or both.
$76M of long-term debt sits next to a business that lost $0.71 per share, and about 90% of revenue comes from clinic care. if reimbursement, utilization, or expenses move the wrong way, the core gets hit fast.
Source: institutional data · regulatory filings · risk analysis
Pay Attention To
Metric
Operating expenses need to fall below revenue
q4 operating expenses were 104% of revenue. until that drops under 100%, the scale story is still just a story.
Calendar
Next quarterly print
the next report needs to show more than revenue growth. you want to see whether the recent -$0.18 quarterly loss starts narrowing in a meaningful way.
Trend
Clinical services concentration
with roughly $452M of $503M revenue coming from clinical services, you are still underwriting one dominant engine. any mix shift away from that dependence would matter.
Risk
Debt versus market value
$76M of long-term debt against a roughly $281M market cap is manageable only if operating results improve. if they do not, capital flexibility becomes part of the thesis.
Analyst Rankings
coverage
thin
in human-speak, you do not have a giant consensus machine doing the work for you. this is a $281M stock, and the published analyst picture is sparse.
revenue view
$2B
fy2026 revenue estimates point to $2B versus the current $503M base. that is not a small revision story. that is a transformation story.
Source: institutional data
Institutional Activity
institutional ownership data for TOI is being compiled.
Source: institutional data
Price Targets
3-5 year target range
$3
Current price
Target midpoint · from current
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