Caswell Samms III, Executive Vice President and CFO of Nemours Children’s Health

Summary

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Podcast Summary

Becker’s Healthcare Podcast

Episode: Caswell Sams III, Executive Vice President and CFO of Nemours Children’s Health
Date: January 9, 2026
Host: Madeline Ashley

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Episode Overview

This episode features an insightful discussion with Caswell Sams III, EVP and CFO of Nemours Children’s Health. Caswell shares Nemours’ strategic financial outlook for 2026, addresses industry uncertainties—especially those affecting pediatric health systems—and explains purposeful growth, leadership mindset, and technology investments underpinning Nemours' mission to build the healthiest generation of children.

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Key Discussion Points & Insights

1. Background on Nemours and Leadership (01:07–02:42)

• Caswell Sams’ Career Path:
  • Over 25 years in healthcare finance.
  • Transitioned from consulting to provider-side leadership; joined Nemours in March 2025.
• About Nemours Children’s Health:
  • Only multistate pediatric health system in the U.S.
  • Operates in Delaware, surrounding states, and Florida.
  • 10,000+ associates, 1,100 employed physicians, 80 locations, 2.2 million patient encounters annually.
  • Mission: “to create the generation of the healthiest children in the world through our whole child health strategy.” (02:34, Sams)

2. Financial Landscape & Key Trends for 2026 (03:03–04:27)

• Pediatric Focus & Market Dynamics:

  • High Medicaid exposure means reimbursement and inflation are critical factors.
  • Monitoring the ongoing litigation over the 340B rebate model and effects of ACA subsidies.
  • Concerned about legislative impacts of HR1 (“one big beautiful bill Act”), advocating and educating policymakers regarding Medicaid reimbursement.

  “Our focus is on things that can impact inflation as well as reimbursement growth for the organization, as well as how do we provide access.”
  — Caswell Sams (03:18)

• Purposeful Growth:

  • Emphasizes smart, strategic expansion, not growth for its own sake.
  • Organizational efficiency through tech adoption.

3. Resilience Amid Uncertainty: Strategic Steadiness (04:49–06:09)

• Stance on HR1 & Navigating Uncertainties:

  • Remains steady, not reactionary; focus on mission and long-term strategy.
  • Preparation, advocacy, and board education to withstand potential negative policy changes.

  “We’re going to still move full steam ahead as an organization… We’re not going to continue to rest on our laurels, but… prepare for potentially negative outcomes in the future.”
  — Caswell Sams (04:49, 05:05)

4. Purposeful Growth: Strategy in Action (06:24–09:35)

• Market and Service Expansion:

  • Uses data and community needs to guide expansion decisions.
  • Deepening payer partnerships, especially with value-based and risk-aligned arrangements.
  • Delaware market: Introduction of a global budget/risk-sharing for Medicaid/HMOs.

• Key Initiatives:

  • Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders:
    Expanding local access so families don’t need to leave the area for pediatric cancer care.
  • Advanced Delivery Unit:
    Enhancing maternal-fetal medicine and perinatology, allowing mothers and complex newborn cases to be cared for within the region.

  “It's not about chasing volume, it's about delivering high quality of care. We're not looking at this from a numbers perspective... more of a holistic service line perspective.”
  — Caswell Sams (09:26)

• Strategic maternity care investments described as crucial for stabilizing regional care gaps, especially for high-risk pregnancies.

5. Leadership Mindset for Modern Healthcare Finance (09:54–11:16)

• Transformation of Financial Leadership:

  • CFOs must go beyond traditional “scorekeeping” and be deeply strategic.
  • Importance of fluency in clinical operations, technology (notably AI), quality, and workforce trends.
  • Calls for “rigor and empathy,” adaptability, and decisiveness.

  “As a financial leader, a little bit of rigor and empathy is going to create a lot of longevity for your organization.”
  — Caswell Sams (10:19)

  “We know that the path is not perfectly clear moving forward. But we're going to continue to make informed decisions as a leadership team...”
  — Caswell Sams (11:02)

6. Notable Technology Investments (11:16–12:24)

• Advanced Care at Home:

  • Telemedicine program keeping patients out of the ER and enabling early discharge from intensive care units.
  • Successful in Florida and now expanded to Delaware.

  “Imagine as a mother or a father, you don’t have to travel and you can just log into a telemedicine system… instead of having an unnecessary visit in the emergency room.”
  — Caswell Sams (11:53)

7. Key Leadership Lesson from 2025 (12:39–13:29)

• Operational Agility & Informed Decision-Making:

  • Necessity for faster, more informed decision-making amid rapid change.
  • Emphasis on fundamentals, trust in leadership, and financial durability.

  “We have to move faster. Faster making informed decisions… we're going to double down on our fundamentals… and have the appropriate financial durability…”
  — Caswell Sams (12:43)

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Memorable Quotes & Moments

• Mission-Driven Focus:
  "Our ultimate goal... is to create the generation of the healthiest children in the world through our whole child health strategy." (02:34, Caswell Sams)

• On Adapting to Uncertainty:
  "We’re going to continue to do what we believe is best for the organization... to make sure we create the healthiest generation of children moving forward." (05:05, Caswell Sams)

• Changing Nature of Financial Leadership:
  "I don't think we can continue to operate as financial scorekeepers. We're going to have to be more strategically engaged...” (09:54, Caswell Sams)

• On Technology as a Lifeline for Families:
  "Imagine as a mother or a father, you don't have to travel and you can just log into a telemedicine system and have a discussion with a nurse..." (11:53, Caswell Sams)

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Timestamps for Major Segments

• Nemours Introduction & Mission – 01:07–02:42
• 2026 Financial Trends & Legislative Uncertainties – 03:03–04:27
• Staying the Course: Resilience in Uncertain Policy Environments – 04:49–06:09
• Purposeful Organizational Growth & Market Strategy – 06:24–09:35
• Future of Financial Leadership in Healthcare – 09:54–11:16
• Technology and Telehealth Investments – 11:16–12:24
• Key Lessons and Fast-Paced Decision-Making – 12:39–13:29

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Conclusion

Caswell Sams shares a measured, mission-driven vision for Nemours Children’s Health in 2026, stressing purposeful growth, strategic resilience in the face of policy shifts, innovative care models, and the evolving role of financial leadership in pediatric healthcare. The conversation underscores the importance of adaptability, advocacy, and keeping patient-centered values at the fore as the landscape continues to evolve.

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Transcript

[Event Announcer]

This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right, click Looking forward to hosting you in Chicago.

[Madeline Ashley]

This is Madeline Ashley with the Becker CFO and Revenue Cycle Podcast and I'm excited to be joined today by Caswell Sams, Executive Vice President and CFO of Nemours Children's Health. Caswall, thanks so much for being on with me today.

[Caswell Sams]

Thank you for having me. Looking forward to the discussion today.

[Madeline Ashley]

Me too. And happy 2026 to you as well.

[Caswell Sams]

Yes, happy New Year to you as well.

[Madeline Ashley]

Wonderful. So I know we've had you on the podcast before, but for those who did not have the pleasure of listening to our first discussion, do you mind sharing just a little bit about yourself and Nemours with our with our listeners?

[Caswell Sams]

Sure, I'll be excited to Caswell Sams I'm the Executive Vice President and Chief Financial Officer for Nemours Children's Health. Been working in health care finance for over 25 years. Started my health care career consulting. Decided real quickly that I did not want to be in consulting. I actually wanted to work for a provider. So I joined the provider side shortly after that and just continued to grow my career. And now I'm excited as of March of 2025 to be a part of the Nemours Children's Health leadership team.

[Madeline Ashley]

And do you mind just sharing a little bit more about Nemours with us as well?

[Caswell Sams]

Sure.

Nemours is the only multistate pediatric health.

System in the United States.

We provide a multitude of different provider based services, primary care, prevention and health.

We have two hospitals and our main and primary markets that we operate in are in Delaware and the surrounding states as well as the state of Florida.

We have over 10,000 associates, 1100 employee physicians operating in 80 different locations, provide more than 2.2 million patient encounters on an annual basis. Our ultimate goal as we continue to.

Provide for all children is to create.

The generation of the healthiest children in.

The world through our whole child health strategy that we have here at Nemours.

[Madeline Ashley]

Incredible. Thank you for sharing that background. So let's dive in. I know we just said it's the new year entering a whole new cycle, so as we are now here in 2026, could you share maybe some financial trends or shifts that you're keeping a close eye on from your perspective and why you're watching these so closely?

[Caswell Sams]

Yeah, I think when you have an.

Organization like Nemours, especially a pediatric health system that has a large portion of Medicaid services and patient population that it provides, our focus is on things that.

Can impact inflation as well as reimbursement growth for the organization, as well as.

How do we provide access.

So I'm quite sure these are top of mind for every organization. Number one, what's going to happen with the 340 rebate model? Obviously, that continues to be litigated and hopefully providers come out on top, lesser to the case, the ACA subsidies. But we do believe as a pediatric health system, there may be a halo effect on the pediatric services that organizations. So we're continuing to monitor that as well.

And then how do we mitigate the.

Potential growing impacts of HR1? So we continue to see what we can do, either from an advocacy perspective or an education perspective to our government officials on providing those type of educations that they need on the implications that it has on pediatric health systems. One of the top things that we're focusing on for 2026 is purposeful growth. Not just growing to just grow, but purposeful growth.

And, you know, how do we implement.

New technologies and get more efficient as.

An organization.

[Madeline Ashley]

And to kind of follow up there. When we connected on the podcast, and I believe it was early July of 2025, you said Nemours wasn't in, quote, panic mode. You know, despite some of the uncertainties tied to HR1, or, you know, more commonly known as the one big beautiful bill Act. So how has that steady approach you and I discussed kind of held up and what have you maybe learned since then?

[Caswell Sams]

No, I would probably say we are still not going to take our eye off our strategy. We're going to still move full steam ahead as an organization. Again, we're going to monitor, we're going to advocate, we're going to continue to do what we believe is best for the organization, partnering with the different hospital.

Associations we have, so that from a.

Strategy perspective has not changed for us. We can continue to do the things that we believe we need to do as it represents our mission as an organization as well as our strategy to make sure we create the healthiest generation of children moving forward. And our focus around whole child health is going to help us do that. So we understand that, hey, things are going to change. We're preparing to do what we need to do internally to mitigate any potential negative impacts on the organization. So we're not going to continue to rest on our laurels, but we're going to continue to see what we can do to say, well, what type of impacts do we need to make or changes we need to make and provide that education to our board, our leadership team and prepare for potentially negative outcomes in the future. But we believe we have a very solid strategy to help address those issues, but can continue to monitor and advocate as we need to, to make sure that pediatric health systems get the, you know, most appropriate, fair reimbursement on the Medicaid population that they're servicing. Right.

[Madeline Ashley]

Essentially you're ready for anything that it has to throw at you. Well, you also just talked about purposeful growth this year. So could you dive a little deeper into what that looks like and maybe you see where you see some of the biggest opportunities for this type of smart growth?

[Caswell Sams]

Yeah, I think for us we're looking at our markets and saying, hey, what.

Do we need to grow? How do we leverage the clinical data we have? How do we understand the community needs? How do we deepen our payer partnerships.

Either through value based and risk aligned arrangements? Number one, in our Delaware market we have what's called a global budget where essentially we are going to cap our own dollars and take a little bit more risk in the near future with the state of Delaware on the Medicaid.

And Medicaid HMO population. So how do we create that value.

Based strategy and make sure we bring more value than just utilization and unnecessary utilization into our Delaware market on top of still focusing on those services that need to have a positive impact on the Delaware market as well.

So the expansion of our Lisa Dean.

Moseley Foundation Institute for Cancer and Blood Disorders, we're excited about the opportunity for more patients in this market not to have to leave the market for cancer services. So that is going to. That is a state of the art service that we're expanding in this market. The other expansion that we're doing is our advanced delivery unit in this market mostly related to maternal fetal medicine interventions that need to have for stable obstetric patients in the Delaware Valley market. I think it's a great opportunity for the patient population not to have seek services out of this immediate area and be able to come to nemours and not only for us to be able to take care of the neonate perspective of the child, but also provide those services that a mother may need, need, who may be in need of that perinatology services here at Nemours as well. So we're excited about that continuing to grow for us.

[Madeline Ashley]

Yeah, and in 2025, I covered a good amount of just maternity care closures in general. But do know that Nemours has been, you know, making major investments in these areas just in terms of child and, you know, mother. So how important is that to your organization and just the continued growth there?

[Caswell Sams]

Yeah, for the Moores, I think this is critical. You know, we're not looking at just traditional obstetric expansion, but we believe that this is going to be a way for us to stabilize what's happening across the maternity market. You know, there's a lot of safety nets, a lot of, as you pointed out to have maybe some, some fragmented impacts on how they handle high risk pregnancy.

For us, you know, we're looking at the upstream impact, identifying risk earlier, serving.

As a regional anchor for high acuity maternal and neonate care and then taking an approach that, hey, we're going to.

Stabilize this pediatric service by creating a more predictable pipeline for a NICU addressing complex pediatric care by also creating that continuity for pregnancies through high risk opportunities.

It's not about chasing volume, it's about delivering high quality of care.

We're not looking at this from a numbers perspective perspective. We're looking at it from more of.

A holistic service line perspective.

[Madeline Ashley]

Yeah, no, that's great to hear. And you know, just amid, you know, plans to grow and as we just touched on a little bit earlier, some of the uncertainties that we are seeing in the industry. From your perspective, what leadership mindset will be most important for financial leaders navigating 2026?

[Caswell Sams]

Yeah, I think it's going to be critical for financial leaders to have a different perspective. I don't think we can continue to oper great as financial scorekeepers. We're going to have to be more strategically engaged, very fluent on clinical operations technology, artificial intelligence quality and just workforce dynamics.

I think that means as a financial.

Leader, a little bit of rigor and empathy is going to create a lot of longevity for your organization. Adding that with making sure you can make decisive decisions with adaptability as it's needed. You know, I think that's going to help CFOs who, you know, might need clarity in uncertain times because we never know what's going to be the next potential hill we have to climb as we move forward in 2026. I think that helps bring confidence to your, the rest of the executive team members as well as the board because.

You know, we're going to continue to.

Make informed, data driven decisions, but we.

Know that the path is not perfectly clear moving forward. But we're going to continue to make informed decisions as a leadership team and continue to make sure that whatever we do is just not to grow the grow, but it's for purposeful growth reasons.

[Madeline Ashley]

Yeah. And you touched on technology. Is there a piece of technology, a tool right now or just an area that you are personally keeping an eye on?

[Caswell Sams]

Yes, I mean, we are continuing to make strategic investments for us of our advanced care at home home program that we're having, which is kind of more of a telehealth medicine model. We believe we've had a number of early successes with it, especially in our Florida market, to kind of keep patients out of the emergency room, keep our patients discharged earlier from our PICU and our nicu.

And, you know, because of the reach.

We have and people seeking, you know, specialized services, we have, you know, families who may travel 70, 90 miles. Imagine as a mother or a father, you don't have to travel and you can kind of just log into a telemedicine system and have a discussion with a nurse and be able to alleviate any concerns you may have instead of having an unnecessary visit in the emergency room. So we're significantly invested in seeing that continue to grow. And we actually just implemented that in our Delaware market as well.

[Madeline Ashley]

Wow. I mean, the technologies we're seeing right now are so incredible. So definitely worth keeping an eye on. Final question for you here. Looking at 2020, what's one lesson that you learned that you're looking to carry into the new year?

[Caswell Sams]

I'd probably say we have to move faster.

Faster making informed decisions. You know, I think the volatility that we experience from a, you know, a governance or a government perspective is going to continue to create challenges for us. So, you know, we're looking at our capital allocation, we're making sure we're aligned as a leadership team, but we definitely have to move faster and continue to make informed but better decisions. So we're going to double down on our fundamentals. You know, we're going to be as agile as we possibly can. We trust our leadership team to make informed decisions. We're going to have the appropriate financial durability that we need, you know, which is no longer an option in health care. And, you know, I think that'll continue to help us make sure we serve our mission in a way that we.

Want to serve, which is all about our whole child health.

[Madeline Ashley]

Yeah, well, Caswell as always, it's been such a pleasure getting to chat with you and hear about all the exciting things going on at Nemours. Really looking forward to hopefully connecting again soon. So I appreciate you taking the time.

[Caswell Sams]

Thank you.