Starling Oncology, Inc. (STLN) 2026 Q1 法說會逐字稿

The press release announcing The Oncology Institute's results for the first quarter of 2026 are available at the Investors 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.

宣布 The Oncology Institute 2026 年第一季業績的新聞稿可於公司網站 theoncologyinstitute.com 的「投資人」專區取得。本次電話會議結束後，公司網站亦將提供本次電話會議的重播。

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 risks 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.

在開始之前，我想提醒各位注意公司 2026 年第一季新聞稿中所載的「安全港」聲明。管理層可能會作出前瞻性陳述，包括指引及其所依據的假設。前瞻性陳述係基於預期，並涉及可能導致實際結果出現重大差異的風險與不確定性。如需進一步了解與我們業務相關的風險，請參閱我們向美國證券交易委員會（SEC）提交的文件。

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 Virnich; 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.

本次電話會議亦將討論非 GAAP 財務衡量指標，例如調整後 EBITDA 與自由現金流。這些非 GAAP 指標與最可比 GAAP 指標之調節表，已包含於提交給 SEC 的財報新聞稿中，並可於我們網站取得。今天與我一同參與電話會議的有我們的執行長 Dan Virnich，以及財務長 Rob Carter。在我們的準備發言之後，我們將開放提問。接下來我把電話交給 Dan。

Thank you, Minh. 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.

謝謝你，Minh。各位下午好，感謝各位參加我們 2026 年第一季財報電話會議。我很高興報告，2026 年在第一季有一個強勁的開局，主要受惠於我們在各市場的價值導向合約持續擴張與表現，以及輔助服務（Ancillary Services）的持續成長，尤其是我們的藥局業務；這些都讓我們有信心重申 2026 年營收與全年調整後 EBITDA 獲利的展望。

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 million to $15 million, reflecting our ongoing performance and improving economies of scale as we grow. None of this would be possible without continued commitment to high-quality oncology care by our physicians and staff across the five states we operate in every day.

如我們在財報新聞稿中所述，我們也很高興將今年的自由現金流預測大幅更新為正向區間 500 萬至 1,500 萬美元，反映我們持續的營運表現，以及隨著成長而改善的規模經濟。若沒有我們在每日營運的五個州中，醫師與員工對高品質腫瘤照護的持續投入，這一切都不可能達成。

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 capitated revenue growth and record performance from our Specialty Pharmacy business. Record Part D sales 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.

接下來我想回顧本季幾項重點亮點。首先，營收為 1.47 億美元，年增 41%，主要由強勁的人頭計酬（capitated）營收成長，以及我們專科藥局（Specialty Pharmacy）業務創紀錄的表現所帶動。Part D 銷售創新高，帶動本季藥局營收較 2025 年第一季成長 78%，反映病患就診次數整體增加，以及我們在處方配藥作業上的持續營運執行力。

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 that this ongoing recognition from CMS underscores the clinical and economic value of TOI's integrated approach to oncology care applied to all patient populations, not just capitated members.

為了證明我們臨床模式的耐久性與可複製性，在 CMS「強化腫瘤照護模式」（Enhancing Oncology Model）績效計畫的第三期中，我們為 Medicare 支出節省了近 200 萬美元，較前一期產生更多節省，同時仍維持我們在社區為服務對象提供的高品質照護。我們相信，CMS 持續的肯定凸顯 TOI 整合式腫瘤照護方法在臨床與經濟上的價值，且適用於所有病患族群，而不僅限於人頭計酬會員。

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.

接下來談營運面。我想說明第一季的一些關鍵更新。我們在佛羅里達州的工作，持續成為我們在較新市場中驗證模式的重要例證；我也很高興分享我們在多個面向取得的實質進展。我們目前在佛羅里達市場已開始獲利。這是一個重要里程碑，反映我們在該州的人頭計酬合作關係逐步成熟，也驗證了我們一直在打造的模式。

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.

在委託式人頭計酬（delegated capitation）合作夥伴關係下的首批會員，持續展現優異臨床結果的數據指標，醫療損失率（MLR）表現符合計畫，甚至略優於預期。提醒各位，我們對新的委託式人頭計酬合約，目標成熟期 MLR 約為 85%；而我們目前在南佛羅里達的 2025 年生效合約已達成該水準。

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 TOI clinic and MSO network to cover effectively the entire Florida market to serve delegated capitation agreements across multiple health plans.

就短期內進一步的人頭計酬成長而言，我們預期在第三季（Q3）將把既有保險計畫合作夥伴關係擴展至另外 11 個郡的 Medicare Advantage 會員，這將擴大我們的 TOI 診所與 MSO 網路，實質涵蓋整個佛羅里達市場，以便在多家健康保險計畫下承接委託式人頭計酬協議。

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 payor partners.

這一階段涵蓋 Q3 的擴張，將使我們在委託式人頭計酬安排下的 MA 會員總人數擴大至約 20 萬人，涵蓋共 25 個郡。除了這些新病患帶來的人頭計酬營收外，這次擴張也預期將對我們的 Part B 藥局業務形成顯著助力，因為我們將掌握處方量，為病患提供更快速、更便利的配藥服務，並為付款方合作夥伴帶來人頭計酬以外的價值。

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.

為了有效支持這些重要的病患族群，我們預期在今年剩餘期間再開設 7 家新的 TOI 診所，以確保提供病患應得的高品質協調照護；同時，我們也將在全州大幅擴增簽約醫療提供者的覆蓋規模。

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.

如我在上次電話會議中提到的，我們正準備於今年夏天推出自有的醫療提供者入口網站（provider portal），我也很高興分享這項重要計畫的更多細節。我們認為 TOI 入口網站有兩項主要效益。第一，它旨在進一步強化簽約醫療提供者的參與度，並推動持續遵循我們的臨床路徑與品質倡議。臨床路徑遵循度是影響 MLR 表現的重要槓桿，我們相信此工具將成為持續改善的重要驅動因素。

Second, over time, we intend to use the portal to provide access to ancillary services, including Part D dispensing, clinical trials and care navigation, 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.

第二，隨著時間推進，我們計畫透過該入口網站提供輔助服務的存取，包括 Part D 配藥、臨床試驗與照護導航；這些都是我們整合式照護策略的關鍵組成，也是我們成長過程中的關鍵獲利槓桿。此外，也可能有機會將我們輔助服務所帶來的節省回饋給 MSO 醫療提供者，進一步提升參與度。

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 up 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.

我們的專科藥局業務本季表現極為出色，並持續成為全公司最強勁的成長動能之一。第一季我們完成的處方量（scripts）創下新高，專科藥局營收年增 78%，本季達 8,750 萬美元，帶來 1,680 萬美元的毛利。此成長由多項因素共同推動，包括病患量增加、我們在整體網路中持續優化藥局工作流程，以及持續降低可避免的處方外流至外部藥局。

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.

我們專科藥局業務本季毛利率亦高於預期，達 19.2%，主要受惠於 TOI 採購職能在藥品定價策略上的管理努力，並透過藥局內的處方集（formulary）路徑，運用我們已建立的中央臨床基礎設施。這是我們持續看見規模與經銷商關係帶來效益的領域，而隨著我們成長，這些優勢只會進一步提升。

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 B and D 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 B dispensing strategy, not contemplated in our annual revenue guidance. We continue to make meaningful progress on our AI-enabled operational initiatives this quarter.

我們也正致力於在佛羅里達州將藥局服務的可近性擴展至我們的委託網路成員，我們相信這將擴大我們從委託族群中同時取得 Part B 與 Part D 處方的能力。我們預期此項服務將於今年下半年推出，並將其視為在我們核心 Part B 配藥策略之上的增量機會，未納入我們年度營收指引之中。本季我們在 AI 賦能的營運計畫上持續取得實質進展。

As a reminder, last year, we launched 3 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.

提醒一下，去年我們啟動了 3 項 AI 整合工作，聚焦於營收循環管理、事前授權服務以及病患客服中心。我很高興報告，我們仍按計畫在 2026 年達成先前提出的 200 萬美元營運費用節省目標。

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 Minh Merchant to the Executive team as TOI's new Chief Legal Officer. Minh will oversee all legal, compliance, regulatory and privacy matters as we continue to scale the platform.

這些計畫不僅帶來成本效率，也改善了我們的病患、醫療提供者與行政團隊的體驗；隨著我們持續擴張規模，我們預期將在此基礎上進一步深化。最後，我很高興歡迎 Minh Merchant 加入管理團隊，擔任 TOI 新任法務長。隨著我們持續擴展平台規模，Minh 將負責所有法律、合規、監管與隱私相關事務。

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. Minh is a great addition, and we look forward to the contribution she will make as we continue to grow and strengthen the Executive team. In summary, we are off to a strong start in 2026.

作為一家正在擴大管理式醫療版圖、委託安排與營運複雜度的公司，讓一位資深的法務與合規領導者參與決策至關重要。Minh 是非常重要的補強，我們期待她在我們持續成長並強化管理團隊的過程中所帶來的貢獻。總結而言，我們在 2026 年有一個強勁的開局。

Revenue growth of 41%, record pharmacy performance, profitability in Florida and a growing pipeline of capitated lives, gives us confidence that the momentum we built 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 payor partnerships and continuing to invest in the technology and operational capabilities that will drive sustainable profitability over the long term.

營收成長 41%、藥局業務創下紀錄、佛羅里達州實現獲利，以及按人頭付費（capitated）人數管線持續成長，讓我們有信心 2025 年累積的動能正延續到新的一年。展望未來，我們的重點仍是營運執行與高品質病患照護、擴大我們的委託按人頭付費模式、深化與付款方（payor）的合作關係，並持續投資於能在長期推動可持續獲利的科技與營運能力。

With that, I'll turn the call over to Rob to review the financials in more detail. Rob?

接下來，我把電話會議交給 Rob，請他更詳細地說明財務狀況。Rob？

Thanks, Dan, and good afternoon, everyone. I want to echo Dan's comments on the continued momentum we're building across the business as we progress through 2026. On the call today, I will review our first quarter financial results, provide an update on the balance sheet and liquidity and close with our updated guidance and outlook.

謝謝你，Dan，各位下午好。我也想呼應 Dan 的評論：在我們邁入 2026 年的過程中，整體業務持續累積動能。今天的電話會議上，我將回顧第一季財務結果，更新資產負債表與流動性狀況，並以更新後的指引與展望作結。

Turning to financial performance. Total revenue for the first quarter was $147.4 million compared to $104.4 million in the prior year period, representing 41.2% year-over-year growth, a continuation of the strong momentum we have been building.

接著看財務表現。第一季總營收為 1.474 億美元，較去年同期的 1.044 億美元增加，年增 41.2%，延續我們持續累積的強勁動能。

Patient services revenue, which includes both our capitated and fee-for-service arrangements, was $59.1 million, representing 40.1% of total revenue and an 11.3% year-over-year increase. Within patient services, capitated revenue grew 54% year over year to $26.9 million, driven by new market momentum and the continued ramp of our delegated arrangements in Florida.

病患服務營收（包含按人頭付費與按次計費兩種安排）為 5,910 萬美元，占總營收 40.1%，年增 11.3%。在病患服務中，按人頭付費營收年增 54% 至 2,690 萬美元，主要受新市場動能帶動，以及我們在佛羅里達州委託安排持續爬坡所驅動。

Fee-for-service was $32.2 million, down approximately 10% year over year despite increasing visit volumes, reflecting the impact of mix driven by active drug formulary management, more conservative reserves against collections and modest pricing pressure in the IV drug channel. Capitation now represents approximately 45.6% of Patient Services revenue, up from roughly 33% a year ago, underscoring the ongoing shift in our revenue mix toward value-based care. Specialty Pharmacy revenue was $87.5 million, representing 59.4% of total revenue and growing 77.6% year over year.

按次計費（fee-for-service）為 3,220 萬美元，儘管就診量增加，仍較去年同期下降約 10%；這反映了組合變化的影響（源自積極的藥品處方集管理）、對應收款項採取更保守的備抵，以及靜脈注射（IV）藥品通路的溫和價格壓力。按人頭付費目前約占病患服務營收的 45.6%，高於一年前約 33%，凸顯我們營收組合正持續轉向以價值為基礎的照護。專科藥局營收為 8,750 萬美元，占總營收 59.4%，年增 77.6%。

This was driven by a 103% increase in the number of prescription fills, reflecting the continued strength in fill rates as we bring new capitated lives onto the platform, partly offset by approximately a 12% decrease in average revenue per fill as our mix continues to evolve. Gross profit for the first quarter was $23.3 million compared to $17.2 million in the first quarter of 2025, reflecting continued top-line expansion across both segments.

此成長主要由處方配藥筆數增加 103% 所帶動，反映在我們將新的按人頭付費人數導入平台時，配藥率持續強勁；但部分被每筆配藥平均營收約下降 12% 所抵銷，因為我們的組合仍在演變。第一季毛利為 2,330 萬美元，較 2025 年第一季的 1,720 萬美元增加，反映兩個業務分部的營收持續擴張。

Overall, gross margin was 15.8% compared to 16.5% in the prior year. The roughly 80 basis point decline is primarily the result of a nonrecurring rebate we recognized in the first quarter of last year as well as the natively lower margin profile of the delegated business as it increases as a proportion of TOI revenue. Patient services gross profit was $5.7 million compared to $6 million in the first quarter of 2025.

整體毛利率為 15.8%，較去年同期的 16.5% 下降。約 80 個基點的下滑，主要是因去年第一季認列了一筆一次性回扣，以及委託業務本身毛利率較低，且其占 TOI 營收比重提高所致。病患服務毛利為 570 萬美元，較 2025 年第一季的 600 萬美元略低。

Patient services gross margin was 9.7% compared to 11.3% a year ago, a decrease of approximately 163 basis points. The year-over-year decline is primarily the result of new ramping delegated contracts and our aforementioned conservative fee-for-service reserve approach. Specialty Pharmacy gross profit was $16.8 million, growing 78.1% year over year from $9.4 million in the prior year period.

病患服務毛利率為 9.7%，較一年前的 11.3% 下降約 163 個基點。年對年下滑主要是新簽委託合約仍在爬坡，以及前述我們對按次計費採取較保守的備抵策略所致。專科藥局毛利為 1,680 萬美元，較去年同期的 940 萬美元年增 78.1%。

Gross margin was essentially flat at 19.2% versus 19.1% a year ago, evidencing TOI's ability to maintain unit economics as the pharmacy scales its distribution and adapts to an evolving pricing environment, including the phase-in of the Inflation Reduction Act. Our expanded utilization management program, which we refer to as TOI Pathways, now covers our entire drug portfolio, including the pharmacy versus historically only our Part B drugs, which continues to support margin stability, and we see further opportunity in this area as we increase scale.

毛利率基本持平，為 19.2%，去年同期為 19.1%；這顯示 TOI 在藥局擴大配送規模並因應不斷變化的定價環境（包括《降低通膨法案》的逐步導入）時，仍能維持單位經濟效益。我們擴大的使用管理計畫（我們稱為 TOI Pathways）目前已涵蓋全部藥品組合；相較過去僅涵蓋 Part B 藥品，這持續支撐毛利率穩定，且隨著規模擴大，我們也看到此領域仍有進一步機會。

Turning to operating expenses. Total SG&A for the first quarter was $28.2 million or 19.1% of total revenue compared to $25.4 million or 24.3% of revenue in the same period a year ago. That represents approximately a 520 basis point improvement year-over-year, reflecting continued cost discipline and the operating leverage inherent in our model as we continue to scale. We see further leverage ahead as we scale and are planning to launch AI pilots around prior authorization optimization and a next-generation call center later this year. Adjusted EBITDA for the first quarter was a loss of $2.4 million, favorable to a loss of $5.1 million a year ago.

接著看營業費用。第一季銷售、一般及行政費用（SG&A）合計為 2,820 萬美元，占總營收 19.1%，去年同期為 2,540 萬美元，占營收 24.3%。這代表年對年改善約 520 個基點，反映我們持續的成本紀律，以及隨著規模擴張，我們模式所具備的營運槓桿。隨著我們擴大規模，我們預期仍有進一步槓桿空間，並計畫於今年稍晚啟動圍繞事前授權最佳化與下一代客服中心的 AI 試點。第一季調整後 EBITDA 為虧損 240 萬美元，較一年前虧損 510 萬美元有所改善。

As we noted on our call last quarter, Q1 is seasonally our most challenging period. Deductible resets and annual drug cost increases create natural headwinds that take time to work through. We are pleased with the year-over-year improvement and remain confident in delivering positive adjusted EBITDA for the full year, driven by the continued ramp of our Florida delegated arrangements, our growing Specialty Pharmacy platform and our continued cost discipline and push towards AI and automation in our central operations.

如同我們在上一季電話會議中提到的，第一季在季節性上是我們最具挑戰的期間。自付額重置以及年度藥品成本上升會形成自然的逆風，需要時間消化。我們對年對年改善感到滿意，並仍有信心在全年交付正向的調整後 EBITDA，動能來自我們佛羅里達州委託安排的持續爬坡、我們不斷成長的專科藥局平台，以及我們在中央營運中持續的成本紀律與朝向 AI 與自動化的推進。

We ended the quarter with $30.3 million in cash and cash equivalents compared to $33.6 million at year-end 2025. Our senior secured convertible note principal outstanding was $85.9 million, unchanged from year-end with a maturity date of August 9, 2027.

本季末我們的現金及約當現金為 3,030 萬美元，較 2025 年底的 3,360 萬美元下降。我們的優先擔保可轉換票據未償還本金為 8,590 萬美元，與年末持平，到期日為 2027 年 8 月 9 日。

I want to note that we are in late-stage discussions regarding the refinance of the notes and expect to provide an update during the second quarter. Operating cash flow for the quarter was negative $2.3 million compared to negative $5 million in the first quarter of 2025, reflective of the operating losses during each of those respective periods.

我想補充說明，我們正就票據再融資進行後期階段的討論，並預期在第二季提供最新進展。本季營運現金流為負 230 萬美元，相較於 2025 年第一季的負 500 萬美元，反映各自期間的營運虧損。

Turning to guidance. We are reiterating our full year 2026 outlook for revenue, gross profit and adjusted EBITDA and are raising our free cash flow outlook to reflect favorable terms from vendor renegotiations as we continue to realize the benefits of our scale. For the full year, we expect revenue of $630 million to $650 million with approximately $150 million of capitated revenue, gross profit of $97 million to $107 million, adjusted EBITDA of $0 to positive $9 million and free cash flow is now in the range of positive $5 million to $15 million compared to our previous outlook of a loss of $15 million to positive $5 million.

接著談指引。我們重申 2026 全年在營收、毛利與調整後 EBITDA 的展望，並上調自由現金流展望，以反映供應商重新議價帶來的有利條款，因為我們持續享受規模效益。就全年而言，我們預期營收為 6.30 億至 6.50 億美元，其中約 1.50 億美元為按人頭計費（capitated）營收；毛利為 9,700 萬至 1.07 億美元；調整後 EBITDA 為 0 至正 900 萬美元；自由現金流目前預期為正 500 萬至 1,500 萬美元，較先前展望的虧損 1,500 萬至正 500 萬美元有所改善。

For the second quarter, we anticipate adjusted EBITDA in the range of a loss of $1 million to positive $1 million, reflecting seasonal improvement as deductibles are satisfied and the continued ramp of our Florida delegated lives. We expect momentum to build through the remainder of the year and remain confident in our commitment to full year positive adjusted EBITDA.

就第二季而言，我們預期調整後 EBITDA 介於虧損 100 萬美元至正 100 萬美元之間，反映隨著自付額逐步滿足所帶來的季節性改善，以及我們佛羅里達州委託承接人數（delegated lives）的持續爬坡。我們預期動能將在今年剩餘期間持續增強，並仍對全年調整後 EBITDA 轉正的承諾充滿信心。

With that, I'll turn the call over to Dan for his closing remarks. Dan?

接下來，我把電話交給 Dan 做結語。Dan？

Thank you, Rob, and thank you to everyone for your continued interest in the world-class community oncology solution we are building at TOI. I'm pleased to reaffirm our revenue and EBITDA guidance for the year as well as meaningful improvements in free cash flow.

謝謝你，Rob，也謝謝各位持續關注我們在 TOI 正打造的世界級社區腫瘤解決方案。我很高興再次確認我們今年的營收與 EBITDA 指引，以及自由現金流的顯著改善。

Our initiatives on creating a world-class provider portal and using technology to drive OpEx efficiencies will continue to drive our story as a leader in high-quality coordinated oncology care while delivering profitability for shareholders. Before opening the call to questions, I want to thank our patients for putting their trust in our ability to deliver high-quality care and to thank our physicians, clinicians and employees across The Oncology Institute. Their unwavering focus on delivering high-quality oncology care in the community is what continues to drive the progress we are seeing across the business.

我們打造世界級醫療提供者入口網站，以及運用科技推動營運費用（OpEx）效率的各項計畫，將持續支撐我們作為高品質、協調式腫瘤照護領導者的故事，同時為股東帶來獲利。在開放提問之前，我想感謝患者信任我們提供高品質照護的能力，也感謝 The Oncology Institute 全體醫師、臨床人員與員工。他們對於在社區提供高品質腫瘤照護的堅定專注，正是推動我們在整體業務上持續看到進展的關鍵。

With that, I'll turn the call back to the operator for questions. Operator?

接下來，我把電話交回給接線員進行提問。接線員？

(Operator Instructions) David Larsen, BTIG.

（接線員指示）David Larsen，BTIG。

Congratulations on another great quarter. Can you talk a little bit about your delegated risk arrangements in Florida? Did I hear you correctly when I -- I think I heard you say you now cover the entire state. And then just any color around risk, like the trend, the medical expense trend, how it's performing relative to expectations? And I think I heard you say that you're profitable in Florida?

恭喜又交出一個很棒的季度。能否談談你們在佛羅里達州的委託風險安排（delegated risk arrangements）？我是否聽對了——我想我聽到你說你們現在覆蓋整個州。另外也請分享一些關於風險的細節，例如趨勢、醫療費用趨勢，以及相較於預期的表現如何？我想我也聽到你說你們在佛羅里達州是獲利的？

Dave, thanks for the great questions. Regarding the first question, yes, we will be network adequate across 25 counties by the start of Q3 of this year, so July 1. That coincides with the expansion of multiple health plan agreements, which in total encompass about 200,000 MA lives across those counties in the delegated capitation model.

Dave，謝謝你的好問題。關於第一個問題，是的，我們將在今年第三季開始前，也就是 7 月 1 日，在 25 個郡達到網絡充足（network adequate）。這與多項健康保險計畫協議的擴張同步；合計在這些郡的委託按人頭計費（delegated capitation）模式下，涵蓋約 20 萬名 MA 參保人（lives）。

The MLR performance on the delegated capitation book of business, which we mentioned in the earnings call for the 2025 cohort, is performing slightly better than our target MLR of 85%, which is a great data point. And we'll continue to update that as these additional lives enter the risk cohort. And then yes, on a four-wall EBITDA basis, that Florida market is now profitable due to all this growth.

我們在委託按人頭計費業務組合上的 MLR 表現（我們在 2025 年同批次的財報電話會議中提過），略優於我們 85% 的目標 MLR，這是一個很好的數據點。隨著這些新增參保人納入風險同批（risk cohort），我們也會持續更新。另外，是的，以單點（four-wall）EBITDA 口徑來看，佛羅里達市場因為這些成長現在已經獲利。

Daniel, I didn't quite hear the MLR percent. Did you say it was 85%, slightly better than 85%?

Daniel，我沒有完全聽清楚 MLR 的百分比。你是說 85%，略優於 85% 嗎？

That's correct. Yes.

沒錯。是的。

Okay. And then like Evolent Health, for example, I think this morning reported an MLR of 93%. What, in your view, causes such a significant delta? So why are you performing so much better than them in your opinion, at a high level without obviously having access to their data?

好的。另外像 Evolent Health 例如今天早上公布的 MLR 是 93%。你認為造成這麼大差異的原因是什麼？也就是說，在你看來，為什麼你們的表現會比他們好這麼多？當然你不可能取得他們的數據，所以就高層次談談即可。

Yes. I mean I can't really speak to exactly why they would be at our level, but there is obviously differences in the care delivery model with us having a hybrid employed and network care delivery approach and kind of very tight control over care delivery and patient experience in our employed clinics. I think that would be definitely one aspect of it as well as the high engagement we're seeing on the network providers through our portal and pathway integration.

是的。我的意思是，我無法確切說明他們為何會在那個水準，但顯然照護交付模式存在差異；我們採用混合式的自聘（employed）與網絡（network）照護交付方式，並且在自聘診所中對照護交付與病患體驗有相當嚴密的控管。我認為這肯定是其中一個面向，另外也包括我們透過入口網站與臨床路徑整合，在網絡醫療提供者端看到的高度參與度。

And then in the delegated model, are you bearing risk for Part D? And can you push those delegated lives through your own specialty pharmacy? And if you don't bear risk, I would imagine that would be a benefit to your pharmacy?

那在委託模式下，你們是否承擔 Part D 的風險？以及你們能否把這些委託的參保人導入你們自己的專科藥局？如果你們不承擔風險，我想那會對你們的藥局有利？

Yes, that's exactly right. Yes, the only take risk on Part B, as in boy, Part D as in dog, is fee-for-service revenue at that a little bit over 19% margin that we called out, which flows through our pharmacies and dispensaries. And those bills apply to both capitated as well as noncapitated lives.

是的，完全正確。是的，我們只承擔 Part B（B 如 boy）的風險；Part D（D 如 dog）則是按服務計費（fee-for-service）營收，毛利率略高於我們提到的 19%，這部分會流經我們的藥局與配藥點。而這些帳單同時適用於按人頭計費（capitated）以及非按人頭計費的參保人。

So it's an additional economic benefit to the capitated members coming to us for care. There is the additional added benefit of us having a pharmacy in that 4 practices in the network that deliver Part B, as in boy, medications, which are part of our risk, we can deliver those at our pricing, which is beneficial given our scale.

因此，按人頭計費的會員到我們這裡接受照護，會帶來額外的經濟效益。另外還有一個附加好處：我們在網絡中的 4 家診所有藥局可提供 Part B（B 如 boy）藥物；這些藥物屬於我們承擔風險的範圍，我們可以用我們的採購價格來提供，考量到我們的規模，這是有利的。

Just one more. Sorry to keep asking questions, I'll hop back in the queue, but just one more. Did I hear you say you were talking to additional health plans in the Florida market beyond Elevance?

再一個問題就好。抱歉一直提問，我會回到排隊隊伍裡，但就再問一個。我是否聽到你說，除了 Elevance 之外，你們也在佛羅里達市場與其他健康保險計畫洽談？

Yes. We're talking to additional health plans in Florida as well as other markets as well for the delegated capitation model. So we'll have additional updates for that in the next earnings call, but we are seeing a lot of opportunity and momentum around that specific delegated capitation model kind of across markets.

是的。我們也正在佛羅里達以及其他市場，與更多健康保險計畫洽談委託式按人頭付費（delegated capitation）模式。因此我們會在下一次財報電話會議提供更多更新，但我們確實看到這個特定的委託式按人頭付費模式在各市場都有很多機會與動能。

Okay. Congrats on the great quarter.

好的。恭喜本季表現亮眼。

Matthew Shea, Needham.

Matthew Shea，Needham。

Nice start to the year guys. Maybe first on dispensary, really, really impressive growth there and it sounds like volume driven by a mix of membership and continued attachment rates. I guess any additional color there? Membership seems pretty self-explanatory, but maybe on the attachment rate side, are these coming in ahead of expectations? And if so, my understanding is this is mostly driven by provider education. So is there anything you would call out on the provider education side that's been notable in helping drive this growth?

各位今年開局不錯。先談藥局（dispensary）部分，那邊的成長真的、真的很令人印象深刻，聽起來量的成長是由會員數以及持續提升的附著率（attachment rates）共同帶動。我想問是否能再補充一些細節？會員數看起來相當直觀，但在附著率方面，是否有超出你們的預期？如果是，我的理解是這主要由醫療提供者（provider）教育所驅動。那在提供者教育方面，有沒有什麼特別值得一提、對推動這波成長有明顯幫助的作法？

Matt, it's Rob. Yes, attachment rate has exceeded our expectations in the year. The workflow changes that we implemented last year, I think they're continuing to pay dividends. And so that work progresses. I think as you look at the rest of the year, I think you can expect some improvement quarter over quarter as we continue to refine those workflows and as additional value-based lives come on the platform.

Matt，我是 Rob。是的，今年的附著率已超出我們的預期。我們去年導入的工作流程變更，我認為持續帶來成效。而這項工作也仍在推進。我想展望今年剩餘時間，隨著我們持續優化這些流程、以及更多價值型（value-based）受保人數（lives）上到平台，你可以預期附著率會逐季改善。

Okay. Got it. That's helpful. And then maybe on the proprietary network portal, good to hear that, that remains on track for the Q2 launch. But maybe as we think about the pacing of the rollout, I would assume that will be sort of a provider-by-provider, market-by-market.

好的。了解。這很有幫助。接著談自有網路入口網站（proprietary network portal），很高興聽到仍按計畫在第二季上線。但就推廣節奏來看，我猜應該會是按提供者、按市場逐步推出。

But maybe how should we think about the cadence of that? And where are you hoping to get to in terms of provider coverage by year-end? And then given it can strengthen the provider engagement and drive adherence to the clinical pathway, it seems like a nice lever to drive MLR. So curious if you've built in any financial benefits to the 2026 guide or if we should think about that as more of a 2027 event?

那麼我們應該如何看待推進的節奏？以及你們希望在年底前達到多少提供者覆蓋率？另外，鑑於它能強化提供者參與度並提升對臨床路徑的遵循，看起來是推動醫療損失率（MLR）的不錯槓桿。因此也想了解，你們是否已在 2026 年指引中納入任何財務效益，或是我們應把它視為較偏向 2027 年才會顯現的事件？

Yes, absolutely. So when we roll out the portal, which we're anticipating in Q3, that's going to be immediately accessible to 100% of the nonemployed providers across our delegated contract network. So basically, all of Florida will have access to it in the MSO side of our business. We already see good adherence to pathways or care pathways for Part B medications by those providers, but I think this will drive additional adherence because it will just create additional visibility and control over those providers to access our formulary and pathways.

是的，完全同意。因此當我們推出入口網站時（我們預期在第三季），它將立即對我們委託合約網路中 100% 的非雇用型（nonemployed）提供者開放使用。基本上，在我們業務的 MSO 端，佛羅里達全州都會有權限使用。目前這些提供者對於 B 部分（Part B）藥物的治療路徑／照護路徑已有不錯的遵循度，但我認為這會進一步提升遵循度，因為它會讓我們的處方集（formulary）與路徑對提供者更具可視性與可控性。

We -- As we called out in the earnings call, the additional, I guess, P&L upside related to that portal, which we anticipate will happen this year, but is not contemplated in our current guidance, would be related to Part D fills. Recall that our current Part D fills are all from our employed physician base. There are no Part D fills flowing through to our MSO providers through implementation of e-prescribing in the portal and Part D formulary visibility. We hope to catch some Part D growth as well through our MSO network in the second half of this year, but we haven't specifically guided to that or included in the forecast given timing as well as lack of visibility into attach rate on that.

我們——如同在財報電話會議中提到的，與該入口網站相關、我們預期今年會發生但目前指引尚未納入的額外損益表（P&L）上行，將來自 D 部分（Part D）處方調劑量（fills）。請記得，我們目前的 Part D fills 全部來自我們的雇用醫師（employed physician）體系。透過在入口網站中導入電子開立處方（e-prescribing）以及 Part D 處方集可視性，目前尚未有 Part D fills 流向我們 MSO 的提供者。我們希望在今年下半年也能透過 MSO 網路捕捉到一些 Part D 的成長，但由於時程以及對其附著率缺乏能見度，我們尚未就此提供具體指引或納入預測。

Okay. Got it. Okay. That's super helpful clarification that the patient portal can help with that Part D. Okay. And then maybe last one for me before I jump back in the queue. So the 200,000 lives target in Florida for July 1, I guess, thinking back to the last earnings call or sort of where I had you guys in Q1, I had 70,000 lives in the Elevance partnership and then 22,000 from Humana and CarePlus, so call it, 90,000 in change.

好的。了解。好的。這個釐清非常有幫助：病患入口網站能協助 Part D。好的。最後一個問題，我問完就回到排隊隊伍裡。關於佛羅里達 7 月 1 日要達到 20 萬 lives 的目標，回想上一季財報電話會議、或我在第一季對你們的理解，我估計 Elevance 合作帶來 7 萬 lives，Humana 和 CarePlus 帶來 2.2 萬，所以合計大約 9 萬的變動。

Maybe help me bridge the difference from there to 200,000? Is that all Elevance? It sounded like maybe you alluded to some other payers in there as well? Just kind of trying to get a sense of ultimately what sort of wins drove that expansion?

能否幫我銜接一下，從那裡到 20 萬之間的差額是怎麼來的？那全部都是 Elevance 嗎？聽起來你們也暗示其中可能還有其他付款方（payer）？我只是想了解，最終是哪些勝出案（wins）推動了這次擴張？

Yes. So we've opted not to disclose the specific health plans as additional lives are coming through, but it's effectively an incremental 130,000 MA lives with major carriers in Florida.

是的。因此，隨著新增 lives 的導入，我們選擇不揭露具體的健康保險計畫名稱，但實質上是在佛羅里達與主要保險業者合作，額外增加約 13 萬名 Medicare Advantage（MA）受保人數（lives）。

Yuan Zhi, B. Riley.

Yuan Zhi，B. Riley。

Congrats on a strong quarter. Maybe a question to Rob first. Can you give me more color on the substantial $20 million free cash flow improvement since the adjusted EBITDA and the gross margin guidance didn't change? Maybe specifically comment on the timing of this cash flow improvement?

恭喜本季表現強勁。先問 Rob 一個問題。在調整後 EBITDA 與毛利率指引都沒有改變的情況下，自由現金流卻大幅改善 2,000 萬美元；能否提供更多細節？尤其能否談談這項現金流改善發生的時間點？

Yes. Thanks for the question. So this is the direct result of negotiations that have been underway now for several months with some key suppliers, in particular, on the drug side of things. This is an advantage that we have as we continue to grow and scale. We have opportunities for leverage, and we're able to take advantage of that in a very, very meaningful way. And so very excited about the outlook there.

是的。謝謝你的提問。這是我們與一些關鍵供應商（特別是藥品端）進行、且已持續數月的談判所直接帶來的結果。這是我們隨著持續成長與規模化所具備的優勢。我們有槓桿空間，並且能以非常、非常有意義的方式加以運用。因此我們對那方面的展望感到非常振奮。

And on the Florida expansion, do you right now have the -- have your fully owned clinics ready to enter all these 25 counties in Florida under the dedicated model?

另外關於佛羅里達的擴張，在這個專屬（dedicated）模式下，你們目前是否已讓全資擁有的診所準備好進入佛羅里達這 25 個郡？

Yes, it's Dan. That is underway right now. We need to see by the time we go live with those additional lives that we'll have our clinics in place to adhere to our sort of ratio of employed clinics, MSO providers in the additional counties where we will be taking risk.

是的，我是 Dan。這項工作目前正在進行中。在這些新增 lives 上線時，我們需要確保診所已就位，以符合我們在將承擔風險的新增郡內，雇用診所與 MSO 提供者的配置比例。

Got it. And one last question on the Specialty Pharmacy. Can you clarify, are you able to dispense drugs outside of oncology, considering this patient may have other comorbidity or disease that may need oral drug?

了解。關於專科藥局最後一個問題。能否請您釐清：考量到這位病患可能還有其他共病或疾病、可能需要口服藥物，你們是否能夠調劑腫瘤科以外的藥品？

Yes. So at this time, our Specialty Pharmacy really focuses on oncology-specific medications, both oncolytics as well as medications that support chemotherapy pathways or oncolytic pathways exclusively. We don't prescribe for non-oncology conditions or non-hematology conditions.

可以。目前我們的專科藥局確實聚焦於腫瘤專用藥物，包括腫瘤治療藥（oncolytics），以及專門支援化療流程或腫瘤治療流程的藥物。我們不會為非腫瘤或非血液相關的疾病開立處方。

(Operator Instructions) Robert LeBoyer, NOBLE Capital Markets.

(接線員指示) Robert LeBoyer，NOBLE Capital Markets。

Congratulations on another nice quarter. My question has to do with the CMS enhancing oncology model, and you mentioned saving $2 million in Medicare spending as part of the program during one of the periods. Could you just elaborate on what the model measures and put the $2 million in perspective in terms of spending per patient, spending on the total, maybe tie in the medical loss ratios and if there's any information on how that compares with other providers, that would be helpful, too?

恭喜再度繳出漂亮的一季。我的問題與 CMS 的「強化腫瘤模型」有關；你們提到在其中一個期間，作為該計畫的一部分，為 Medicare 支出節省了 200 萬美元。能否請你們進一步說明這個模型衡量哪些指標，並把這 200 萬美元放在脈絡中解讀，例如每位病患的支出、總體支出，也許也能連結到醫療損失率（MLR）；若有任何與其他提供者比較的資訊，也會很有幫助。

Robert, great question. So that -- the savings performance was in periods two and three of the enhancing oncology model, which, as I think most people know is the next iteration of the oncology care model that CMMI had for a number of years. It's an episodic total cost of care risk model.

Robert，問得很好。那個節省表現發生在「強化腫瘤模型」的第二與第三期；我想多數人都知道，這是 CMMI 多年推行的腫瘤照護模型（OCM）的下一個迭代版本。它是一個以「照護總成本」為基礎、按療程（episode）計算的風險模型。

So a little bit different than Part B capitation, although the principles are the same, adherence to value-based therapeutics and then implementation of our high-value cancer care program, which is specifically designed for Part A avoidance, which is part of the risk in the EOM model. We don't have numbers off the top of our head in terms of MLR performance or total risk pool for that cohort. We can certainly follow up on that. So we'll have a set absolute savings amount at this time.

因此它和 B 部分（Part B）的定額給付（capitation）有些不同，但原則相同：遵循以價值為導向的治療用藥，並落實我們的高價值癌症照護計畫；該計畫是專為避免 A 部分（Part A）支出而設計，而這也是 EOM 模型風險的一部分。我們目前沒有現成數字可提供，像是該族群的 MLR 表現或總風險池規模。我們當然可以後續補充。所以目前我們能提供的是一個絕對的節省金額。

Okay. Great. And in terms of the portal that you mentioned, are there any particular things that you could point to or discuss in terms of how that would change the providers' actions or whether that would save money, keep them on track, monitor what they're doing or just exactly how that would work?

好的。很好。另外，關於你提到的入口網站（portal），是否有任何具體事項可以指出或討論：它會如何改變提供者的行為、是否能省錢、讓他們維持在正軌、監控他們在做什麼，或它究竟會如何運作？

Yes, absolutely. The portal is meant to be a centralized hub for our utilization management efforts. So all network providers that are helping serve our capitated partnerships in terms of patient care will be submitting their prior authorizations for care into that portal to get a UM decision made by our medical directors.

是的，當然。這個入口網站旨在成為我們利用管理（UM）工作的集中樞紐。因此，所有協助我們定額給付合作夥伴（capitated partnerships）提供病患照護的網絡提供者，都會透過該入口網站提交其照護的事前授權（prior authorizations），由我們的醫療主任做出 UM 決策。

Once that decision is made, then that authorization is approved or there's a peer-to-peer or a change request. It also offers a centralized hub where we've got a high degree of visibility into all of our pathways to help drive additional formulary adherence. And then as mentioned, it's got the added benefit of being a path to get network providers to engage in ancillary services like pharmacy and clinical trials.

一旦做出決策，該授權就會被核准，或進入同儕對同儕（peer-to-peer）討論，或提出變更申請。它也提供一個集中樞紐，讓我們能高度可視化掌握所有治療路徑（pathways），以推動更高的處方集（formulary）遵循度。此外，如先前所述，它還有一個額外好處：作為一條途徑，促使網絡提供者參與藥局與臨床試驗等輔助服務。

Matthew Shea, Needham.

Matthew Shea，Needham。

Appreciate the follow-up. Maybe, Dan, thinking longer term on AI and beyond 2026, sort of last quarter, you noted you're just starting to scratch the surface on use cases and capabilities of Agentic AI and that there were a number of sort of integration opportunities out into the future.

感謝後續說明。Dan，也許從更長期、AI 以及 2026 年之後來看；在上一季你提到，你們才剛開始觸及 Agentic AI 的使用情境與能力的表面，未來也有不少整合機會。

So maybe as we think about you moving beyond those three initial buckets that you've highlighted for 2026, are there any other potential areas that are top of mind? And as we think about you maybe going after some of those and looking out to the 2028 targets, is there anything contemplated in those targets in terms of AI efficiencies beyond sort of the initial $2 million that you've outlined for 2026?

因此，當我們思考你們在 2026 年所強調的三個初始類別之外的推進時，是否還有其他目前最優先想到的潛在領域？另外，當我們思考你們可能會投入其中一些領域、並展望 2028 年目標時，那些目標中是否有納入任何 AI 效率提升（超出你們為 2026 年所概述的最初 200 萬美元）？

Yes. So to hit the second question first, no, our long-range kind of forecast that we issued in January did not contemplate additional AI efficiencies, so very conservative. The $2 million that we forecast into 2026 is really just scratching the surface on integration into those three core functions: call center; RCM; and prior auth. I mean it's moving quickly in terms of the capabilities of Agentic AI in all three of those functions.

是的。先回答第二個問題：沒有。我們在 1 月發布的長期預測並未納入額外的 AI 效率提升，因此非常保守。我們預估納入 2026 年的 200 萬美元，真的只是開始把 AI 整合到三個核心功能：客服中心（call center）、營收循環管理（RCM）以及事前授權（prior auth）。我的意思是，Agentic AI 在這三個功能上的能力正快速進展。

So I do believe there will be substantial opportunity to expand upon those savings and drive additional OpEx efficiencies over the next two to three years. Additional use cases at this point, we do believe there's a good use case in the care navigation side of what we do as well with our high-value cancer care program.

因此我確實相信，在未來兩到三年，將有相當大的機會擴大這些節省，並帶來更多營運費用（OpEx）效率。就其他使用情境而言，目前我們也認為，在我們的高價值癌症照護計畫中，「照護導航」（care navigation）這一側也有很好的應用情境。

It's kind of a -- because it's highly protocolized, it's perfectly set up for that use case, which would obviously drive efficiencies in terms of labor costs to implement and scale that program over patients that are appropriate. And I'm sure there's many others. But I'd say just even the three core use cases that we have going right now, we are far from maximizing the savings and sort of efficiency opportunity amongst those three.

這有點像是——因為它高度流程化（protocolized），非常適合該使用情境；這顯然能在勞動成本方面帶來效率，讓我們能在適合的病患族群上導入並擴大該計畫的規模。我相信還有很多其他可能。但我會說，即便是我們目前正在推進的三個核心使用情境，我們距離把其中的節省與效率機會最大化仍然很遠。

Thank you. At this time, there are no further questions in queue. This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.

謝謝。目前沒有其他問題排隊。今天的會議到此結束。感謝各位撥冗參與。您現在可以中斷連線。