30% margin and more: how to profitably grow an NEMT service

James from Duet, an NEMT technology company, and audience had an interactive discussion on building a high-margin NEMT service with Rachel Scholler, owner of NEMT Growth Consultants, who is also the previous owner of Lakeshore Transportation, an ambi/WC service which she grew to 15 vehicles and more than 30% margin. We covered a range of topics:

• Pricing vs. volume – How strategic under-scheduling can boost rider satisfaction and profit
• Trip sources that pay – How to win facilities, MCOs, and unconventional channels
• Overhead levers – How to trim the biggest cost buckets
• People & culture – Why low turnover is a hidden profit driver, how to hire at the right moment, and how to keep top employees aboard

Whether you’re launching your first van or looking to push past plateaued profits, this session will give you concrete tactics you can apply the very next day.

By James O’Donnell, Cofounder & COO at Duet June 26, 2025