The case for & against
Bull & Bear analysis
Bullish
Starling Oncology, Inc. (NASDAQ: STLN), formerly known as The Oncology Institute, Inc. (TOI), is a leading provider in the oncology market focusing on value-based cancer care. The company has positioned itself as a key player by leveraging a unique hybrid model that combines employed and non-employed healthcare providers, expanding its footprint in the oncology domain across key states such as Florida, California, and Nevada. With growing demand for integrated oncology services, Starling Oncology targets improving patient outcomes and operational efficiency while effectively managing costs in the evolving healthcare landscape.
Bull says
- ↑Q1 2026 revenue $147 M (+41% YoY); pharmacy segment $87.5 M (+77.6% YoY)
- ↑FY 2026 revenue guidance $630–650 M underscores sustained growth
- ↑Capitated care deals to cover 200 K Medicare Advantage lives, boosting margins
- ↑AI automation to save ~$2 M in SG&A and improve operational efficiency
- ↑Adjusted EBITDA loss narrowed to $2.4 M; projected FCF of $5–15 M in 2026
- ↑Strong liquidity position enables expansion and supports investor confidence
Bear says
- ↓Negative earnings yield and weak profitability factors question returns
- ↓Adjusted EBITDA loss of $2.4 M and ops cash flow -$2.3 M signal ongoing cash burn
- ↓Fee-for-service revenue down 10% YoY highlights reimbursement risks
- ↓Scaling delegated care model risks execution challenges and cost overruns
- ↓Dependence on CMS policy exposes revenue to regulatory shifts
- ↓High share volatility may deter conservative investors
Earnings Call · Q1 2025 · Mgmt. Guidance
Updated 06-03-2026bullish
Transcript signals
Bull points
- I'm happy to report that revenue for Q1 increased by 10% versus the prior year period, driven by our retail pharmacy and dispensary business which continues to grow rapidly and set fill records, contributing 49.3 million in revenue and over 9 million in gross profit in Q1 alone, with this business segment growing over 20% in the first quarter of 2025 versus the prior year.
- we had a very strong start to the year with new capitated contract wins, adding over 80,000 lives in the first quarter on four agreements across the Florida, California, and Nevada markets. Anticipated new capitation contracts in the first half of 2025 are projected to add approximately $50 million in new revenue on an annualized basis.
- Our fee-for-service business also returned to growth in the quarter, growing 9% quarter-over-quarter and 2% year-over-year, highlighting the impact of our investments in referral relationship management and call center expansion.
Bear points
- we are outsourcing our clinical trials business to Helios Clinical Trials. Under the terms of the new arrangement, TOI will recognize revenue solely for our share of the profit, which will reduce our expected revenue for the year by $5 million.
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