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Component 05 of the NEMT Scaling Framework

Relationships

The contracts and credentials the whole company sits on. Every one of them decides something about your margin, and most of them were agreed to before you had the numbers to judge them.

What this component covers

Relationships is knowing which of your contracts pay you properly, and keeping the paperwork from taking a vehicle off the road.

01Whose revenue is itBrokers, facilities and private pay differ in who sets the price.
02Your biggest brokerVolume hides margin, and the scorecard that shows it.
03Facilities you ownDirect agreements pay better, cancel less, and belong to you.
04Private payThe highest-margin trip, and the plumbing that makes it possible.
05Compliance on a calendarAn expired credential parks a vehicle. Lead times are per item.

Split your revenue three ways

Quarterly · Owner

Take last month and divide what you were paid into three piles: broker trips, facility contracts, and private pay. One month is enough to start, and the exercise takes an afternoon.

The three are not variations on the same business. They differ in who sets the price, who the rider deals with, and how long the money takes to arrive.

Where it comes fromWho sets the priceWho the rider deals withHow you get paid
Broker tripsThey set itThe brokerSlowest, and denials come back weeks later
Facility contractsYou negotiate itThe facilityBetter, and cancellations are rarer
Private payYou set itYouAt the time of service

Read your own split against that table and one thing usually stands out. A company whose revenue is almost entirely broker trips has handed the price of its work to someone else, and it finds out what next year pays when the rate sheet arrives.

Nothing here says to walk away from brokers. They are volume, and volume fills vans. The point is to know the proportion you are running, so that moving it is a decision rather than something that happens to you.

Your biggest broker is rarely your best

Quarterly · Owner

Brokers get judged on volume, because volume is the number you see without looking for it. The trips arrive, the vans are full, and the contract feels like the reason the company works.

Score them properly and the ranking often changes. Five columns, one row per broker, once a quarter.

ColumnWhat it tells you
Trips per weekThe volume you are trading everything else against
RevenueWhat the relationship looks like before costs, which is how it is usually judged
Profit per tripRevenue minus direct cost. This is the column that changes minds
Denial rateTrips you ran and were not paid for, which is margin leaving twice
Days to paymentHow much of your cash this contract is holding, and for how long

Profit per trip is the column that does the work, and you cannot fill it in without knowing what a mile costs you, which is the first thing Fleet and tools asks you to work out. Long-distance contracts are where the two rankings usually part company: good revenue per trip, poor profit per mile, and a denial rate that quietly takes some of it back.

Knowing it rarely means firing anyone. It means you can ask for a rate, cap the volume you accept, or tighten which of their trips you take, and you can do it with a number in front of you. A rate conversation without that number is one side negotiating and the other side agreeing.

Facilities are the relationships you own

One a quarter · Owner

A direct agreement with a dialysis center, a day program or a skilled nursing facility does three things a broker contract cannot. It pays better, because there is no middle. It cancels less, because the schedule is standing. And it belongs to you rather than to someone else’s platform.

The way in is easier than it looks, because you are already there. Pick a facility you serve several times a week on broker trips. Your drivers know the building, the staff know your vehicles, and you are solving their problem already without having the relationship.

The person to find is whoever owns transport: a discharge planner, a transport coordinator, a clinic manager. What they want is narrow and worth knowing. They want patients collected on time, and they want to stop spending their afternoon chasing rides. Bring your on-time performance from the scoreboard, because it is the only sales material that means anything to them.

One new agreement a quarter is a modest-sounding goal that compounds quickly, and every one of them moves a slice of your revenue out of the first column of that table and into the second.

Set up private pay

Quarterly · Owner and dispatch

A private pay trip is the best one on your board. You set the price. There is no authorization to check, no claim to submit, no denial to appeal, and the money arrives on the day of service instead of forty-five days later.

It stays small in most companies for a plain reason, and it is plumbing. There is no published rate, so nobody can quote one. There is no way to take a card, so the driver is handed cash or nothing. And the dispatcher who picks up the phone has no authority to answer, so the call becomes a message for the owner, who calls back after the ride was needed.

Three things fix it, and none of them are hard:

A published rate, so a price exists before the phone rings. A way to take payment that does not involve a driver holding cash. And permission for whoever answers the phone to quote the rate, which is the same move Vision asks you to make with the margin floor: put the decision where the conversation happens.

Compliance belongs on a calendar

Monthly · Whoever runs the office

Driver credentials, vehicle inspections, insurance renewals, broker re-credentialing. One list, every expiration date, and a lead time against each.

The reason this sits under Relationships rather than under paperwork is what a lapse actually costs. The fine is the small part. An expired driver credential takes that driver off the road, an expired inspection parks the vehicle, and lapsed re-credentialing can stop a broker sending you trips until it is resolved. A filing problem turns into a capacity problem, and capacity problems arrive on a morning when you are already short.

Give each item its own lead time rather than one rule for everything. A medical card might need a week. Broker re-credentialing can take months and involves people who do not work for you. A single thirty-day reminder is useless for the second kind, which is the kind that costs the most.

The vehicle-side items on that list also show up in Fleet and tools, alongside the maintenance calendar. Same list, two reasons to look at it, and it only works if one named person sweeps it.

The cadence

What happensHow oftenWho owns it
Revenue split three ways: brokers, facilities, private payQuarterlyOwner
Per-broker scorecard filled in and readQuarterlyOwner
One conversation with a facility you already serveMonthlyOwner
Compliance calendar swept for anything inside its lead timeMonthlyWhoever runs the office
Rate card checked, and who can quote it without calling youQuarterlyOwner and dispatch

Putting it in place

Relationships runs on a quarterly review and a monthly sweep. The facility conversation is the only part that needs you to leave the office, and it is the part that changes the mix.

The sheet, block by block

Revenue split1 · Step 1

Last month divided three ways: brokers, facilities, private pay, with the share each carries.

One month is enough to start. The split tells you how much of your margin is set by somebody else, which is the number that decides whether you are running a business or subcontracting for one.

Broker scorecard2 · Step 2

One row per broker: trips, revenue, profit per trip, denial rate, days to pay.

Profit per trip is the column that reorders the list. Expect the ranking by revenue and the ranking by profit to disagree, because the biggest broker is rarely the best one.

Facility target list3 · Step 4

Who you already serve, who owns transport there, and the next step with each.

It asks who you already serve because you are at their door several times a week, and that is the whole advantage over a cold approach.

Compliance calendar4 · Step 3

Every expiration, its own lead time, and a named owner.

Its own lead time, because a medical card takes a week and re-credentialing can take months. One shared reminder date treats those as the same problem.

Private pay readiness5 · Quarterly

The rate, the payment method, and who is allowed to quote it.

Who can quote it is the part that gets skipped, and it is the reason private pay calls turn into callbacks that never happen.

Act early when

If

One broker is more than half your revenue

That is a dependency rather than a customer. It does not mean leaving them, it means the facility work starts this quarter instead of next year.

If

You cannot state profit per trip on your largest contract

You are going into the next rate conversation blind, and the other side is not. Fill in the scorecard before the renewal, not after.

If

A broker or an auditor tells you a credential lapsed

The calendar is not being swept. It gets a named owner this week, because the next one could park a vehicle or freeze the contract.

Download the relationships sheet

PDF, two pages, no email required.

Next

06 · Scoreboard

Run the weekly review.

All six components

05 of 6 · Relationships