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Component 05 of the NEMT Scaling Framework

Relationships

The contracts 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 accounts pay you properly, and moving more of your revenue to the ones that do.

01Your biggest accountScore every account on profit, and check what each one actually paid.
02Facilities you ownDirect agreements, and noticing the week one goes quiet.
03Private payA price built from your own costs, and the setup to take it.

Your biggest account is rarely your best

Quarterly · Owner

The problem

“I can’t tell which broker is worth keeping.”

“I don’t know if brokers paid me right, or what I left unbilled.”

Accounts get judged on volume, because volume is the number you see without looking for it. Score them on profit instead and the ranking often changes. One row per account, whether a broker, a facility or your private-pay riders, 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 account is holding, and for how long
Paid against expectedWhat reached the bank against what the rate card and your trip records say you were owed. Underpayments and unbilled extras only show up here

Profit per trip does the work, and it needs your cost per mile from Fleet and tools. Long-distance contracts are where the two rankings usually split: good revenue per trip, poor profit per mile.

Paid against expected is the column almost nobody fills in. Price each account’s trips at its rate card plus the extras you are owed (waiting time, extra miles, no-show fees) and set that against what they deposited. Anything short is money to chase. Any extra they do pay is one you can bill on every trip.

None of this means dropping an account. It means the next rate conversation happens with a number in front of you.

Check itProfit per trip and paid against expected, for every account, every quarter.

Facilities are the relationships you own

One a quarter, counted weekly · Owner

The problem

“My private accounts quietly stop calling.”

Split last month’s revenue three ways. The three differ in who sets the price and how fast the money arrives:

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, or weekly from a card or account on file

If almost all of it is broker trips, someone else sets the price of your work. Brokers still fill vans. The goal is to move the proportion on purpose.

Start with a facility you already serve several times a week, whether on broker trips or your own: a dialysis center, a day program, a nursing facility. Your drivers know the building and the staff know your vans. Find whoever owns transport there and bring your on-time record from the Scoreboard. A direct agreement pays better, cancels less, and belongs to you. One a quarter moves a real slice of revenue out of the broker row within a year.

Then keep them. A facility rarely tells you it has moved its trips; the calls just get fewer. Count trips per account every week against its normal week, and call the week it drops, while the reason is still recent.

Check itTrips per account this week, against that account’s normal week.

Set up private pay

Quarterly · Owner and dispatch

The problem

“I don’t know what to charge private pay.”

A private trip is the best one on your board. You set the price, there is no claim to submit, and the money arrives on the day. It stays small in most companies because nothing is set up to take it.

Build the rate from two numbers you already have: cost per mile from Fleet and tools and the margin floor from Vision. Price every mile the trip takes, including the empty miles to reach the rider, and check the result clears the floor. Then publish it, so a price exists before the phone rings.

  1. 01

    Your cost per mile

    Worked out per van, from twelve months of costs.

    From Fleet and tools
  2. 02

    The cost of the trip

    Every mile it takes, including the empty miles to reach the rider.

  3. 03

    Check the floor

    The rate has to clear the margin you will not go below.

    From Vision
  4. 04

    Publish the rate

    So whoever answers the phone can quote it.

Give whoever answers the phone permission to quote that rate, and a way to take a card so drivers are not handling cash. Without both, the call becomes a message for you, and you call back after the ride was needed.

Facilities that book private trips for their residents will want an invoice, and invoices drift. Set terms when the account opens: a card or bank account on file, charged weekly. Same terms from the first trip, even on a trial. Ask for direct deposit rather than checks. At Ride Well we learned that a check still has to clear at the bank after it arrives, and that wait comes straight out of cash flow.

Check itPrivate pay’s share of last month’s revenue, quarter against quarter.

Putting it in place

Who does what, and when

Weekly

52 times a year

  • Trips per account checked against its normal weekWhoever runs the office

Monthly

12 times a year

  • Each account’s payments checked against the trips they coverWhoever runs the office
  • One conversation with a facility you already serveOwner

Quarterly

4 times a year

  • Revenue split three ways: brokers, facilities, private payOwner
  • Per-account scorecard filled in and readOwner
  • Rate card checked, and who can quote it without calling youOwner and dispatch

Act early when

If

One account 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 account

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 facility’s trips dropped and you found out from the bank

Nobody is counting trips per account. Give the weekly count a named owner, and call that facility this week.

Download the relationships sheet

PDF, two pages, no email required.

Next

06 · Scoreboard

Run the weekly review.

All six components

05 of 6 · Relationships