Step Out of the Day-to-Day: Phil Wilkins on Strategy, Structure and Relationships in NEMT

Phil Wilkins works with NEMT operators on strategy, partnerships and business development through BYA Everyday. His route into the industry was, in his words, a little zigzagged: healthcare, then 23 years as a McDonald’s franchisee, growing to eight locations, then back to healthcare in the middle of COVID as a senior vice president on ModivCare’s executive leadership team. In this episode he talks with Jeff from Naveera about what owners miss when they are buried in the daily work, and how to build a business that can grow.

From franchising to NEMT

Phil says he fell in love with the industry. His mother lived with debilitating rheumatoid arthritis, and every trip to a doctor disrupted his father’s work schedule. The providers he met are small business owners serving very vulnerable people, and at the same time an economic engine for their communities, a point he thinks is too often overlooked.

Too deep in the day-to-day

Owner-drivers know their operation intimately, but Phil argues that being that deep makes it hard to see what is going on around you, including opportunities, not just problems. His test for a new client is simple: can you step away for one hour a week? If you cannot, the question is whether the people and systems are in place to let you.

Thinking strategically under rising costs

Fuel, reimbursement and insurance are major headwinds, and Phil says that without a strategic plan they lead to a cash flow crunch. He looks for places to plug in strategic partners: a PEO that helps with driver recruiting, or moving an expensive in-house call center nearshore or offshore. He also points to tax credits and Section 125 plans as ways to improve profitability that are not tied to fuel or insurance.

Some operators still resist going digital, sometimes out of worry that a broker will be watching. Phil suggests the opposite may be true: a broker that can see where you are during a ride may be able to give you more of them.

Diversify beyond one broker

Phil explains it with a Big Mac. On its own, its food cost was high; add fries and a drink and the mix, and the margin, improved. Broker work is the Big Mac: steady, but low margin. Private pay improves the mix, and it improves your bankability too. If 90 percent of your business comes from one broker, a lost contract or a reorganization can disrupt everything. His suggestion: draw a five-mile circle around your base and look for the home care companies, doctors’ offices and long-term care facilities you could build relationships with.

Structure: KPIs and a standing meeting

With some clients Phil has stepped in almost as a chief operating officer. He asks the owner which KPIs matter, such as on-time performance, call-offs or customer complaints, then tours the facility and asks the team what the owner’s top three priorities are. He also asks when the team meets. He cares less about how often than about whether it happens on a set day and time, and he suggests a simple agenda: people, operations, profit and sales.

Sharing the numbers and delegating is how an owner grooms a team that can run things when they step away. Before adding another back-office hire, he says, think long and hard, and lean on technology wherever you can.

ROPES before you scale

Everyone wants to scale, Phil says, but not everyone is ready. He walks clients through five questions before they take on growth:

• Resources: the technology you need, and the financial means to withstand the growth.
• Operations: whether you are hitting the KPIs your clients and brokers benchmark you against today.
• People: who you will hire and train, and when. Going from three vehicles to six is an investment.
• Execution: whether the team is meeting standards now, and whether the people you have, family members included, can take you to the next level.
• Systems: what keeps the existing business running well while the new business ramps up.

Relationship capital

Phil describes relationship capital as trust, credibility and influence earned over time by consistently adding value. It is a long game: you may not win the business right away. He gives the example of a client in Chicago who drives seniors to the polls for free on election days. When you meet someone, he suggests asking three things: how can I add value to this person, who can I connect them to, and what door can I open for them. Do that and follow up, he says, and you become memorable and referable.

Brand standards

Finally, Phil returns to his McDonald’s roots. Uniforms, clean and well-groomed drivers, and clean, organized vehicles are all part of the brand you put out every day. You can have all the relationships in the world, he says, but if your standards are not there, you will struggle.